Academia Anesthesiologica International https://aijournals.com/index.php/aan <p><strong class="pull-left">Academia Anesthesiologica International </strong>is a double-blinded peer-reviewed, open access, Bi-annual, online journal that publishes original research articles, review articles, case reports, brief communications and clinical studies in all areas/advances of anesthesia, pain and intensive care. <br> <strong>Online ISSN: 2456-7388 | Print ISSN:&nbsp;2617-5479</strong></p> en-US drrohit.editor@gmail.com (Dr. Rohit Varshney) Fri, 31 May 2019 17:48:19 +0000 OJS 3.1.2.1 http://blogs.law.harvard.edu/tech/rss 60 Evaluation of Various Factors Affecting Emergency Intubation https://aijournals.com/index.php/aan/article/view/684 <p><strong>Background: </strong>Inadequate airway management is a major contributor to pre-hospital morbidity and mortality. The present study was conducted to evaluate various factors affecting endotracheal intubation. <strong>Subjects and Methods: </strong>This study was conducted on 474 patients requiring ETI. Informed consent was obtained from family members of all patients. Emergency intubation was performed as a ‘rapid sequence induction’ (RSI), with preoxygenation and cricoid pressure followed by an induction agent and then suxamethonium. Factors affecting ETI was recorded. <strong>Results: </strong>Out of 476 patients, males were 280 and females were 196. Indication of RTI was low GCS seen in 64, injury in 320, respiratory insufficiency in 10 and cardiac arrest in 82. The difference was significant (P&lt; 0.05). Method of ETI was RSI in 290, without relaxant in 81 and without any medication in 105. The difference was significant (P-0.05). Common difficulties in ETI were blood seen in 30%, vomit in 14%, hypersalivation in 28%, anatomical difficulties in 7%, patient position in 10% and technical problems in 11%. The difference was significant (P&lt;0.05). <strong>Conclusion: </strong>The presence of blood, vomit, hypersalivation, anatomical difficulties, patient position and technical problems are among various factors affecting ETI.</p> Meenakshi K. Moorthy Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/684 Fri, 31 May 2019 00:00:00 +0000 A Comparative study of Agomelatine and Ramelteon for Attenuation of Haemodynamic response to Laryngoscopy and Endotracheal Intubation https://aijournals.com/index.php/aan/article/view/686 <p><strong>Background: </strong>Pressor response to laryngoscopy and endotracheal intubation is a well&nbsp; recognised clinical entity, and many medications have been used for its attenuation. Agomelatine and Ramelteon are analogues of Melatonin which have been recently used for preoperative anxiolysis and sedation with less known effects on pressor response. <strong>Subjects and Methods: </strong>60 ASA-I patients scheduled for elective surgeries under general anaesthesia were randomly allocated into 2 equal groups. Group-A (Tab.agomelatine 10 mg) and Group-R (Tab.ramelteon 8mg) were administered per oral 1 hour prior to induction of anaesthesia. Heart rate and blood pressure were assessed preoperatively and at 0,1,3,5,10,15 minutes. <strong>Results: </strong>Reduction heart rate and blood pressure were noted when compared to baseline in both the groups(p&lt;0.05). However there was no statistical difference between the two groups at various intervals of time and were comparable (p&gt;0.05). <strong>Conclusion: </strong>Oral agomelatine and ramelteon when administered 1 hour prior to induction of anaesthesia, resulted in comparable reduction of heart rate and blood pressure response to laryngoscopy and endotracheal intubation.</p> Pradeep Hosagoudar, Arunashree S, M. Venkateswara Pradeep Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/686 Fri, 31 May 2019 00:00:00 +0000 Comparative Study of Attenuation of effects of Intubation on Blood Pressure Using IV Xylocard and IV Beta Blocker (Esmolol) https://aijournals.com/index.php/aan/article/view/689 <p><strong>Background: </strong>The occurrence of cardio vascular reactions to laryngoscopy and tracheal intubation has attracted the attention of anaesthesiologists and methods to avoid these potentially harmful responses even though transitory have been sought, particularly in critically ill patients, hypertensive patients. Tracheal intubation under light general anaesthesia is consistently accompanied by a pressor response, tachycardia and in some instances by cardiac arrhythmias. This pressor response, which was recognised early as 1951 is due to sympathetic reflex provoked by stimulation of the epipharynx and laryngopharynx. <strong>Subjects and Methods: </strong>Seventy five (75) patients belonging to ASA grade 1 &amp; 2 scheduled for general surgical, orthopaedic surgical, ENT, gynocological surgical producers were studied. <strong>Results: </strong>The age of the patients varied from 10 to 60 years. The MAP in group A decreased after induction. There was a highly significant raise to 109+/-11 mm Hg during laryngoscopy and intubation. This decreased to 105+/-9mm Hg after five minutes which is not significant. <strong>Conclusion: </strong>These responses are transitory, variable and are much more marked in a hypertensive patient than in the normotensive patient. Once the laryngoscopy and endotracheal intubation is completed, the increase in pulse and blood pressure subside, but the dysrhythmia persists for more than 2-3 minutes.</p> Mirza Afzal Baig Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/689 Sun, 02 Jun 2019 00:00:00 +0000 Effects of Intubation on heart rate: Xylocard and Esmolol https://aijournals.com/index.php/aan/article/view/690 <p><strong>Background: </strong>Lignocaine is a local anaesthetic of moderate potency and duration with good penetrative power and rapid onset of action carbonated lignocaine has remarkable penetrative power, rapid onset of action a high incidence of motor block and a reduced incidence of missed segments (When used for epidural anaesthesia) when compared to hydrochloride of lignocaine. <strong>Subjects and Methods: </strong>Seventy five (75) patients belonging to ASA grade 1 &amp; 2 scheduled for general surgical, orthopaedic surgical, ENT, gynaecological surgical producers were studied. <strong>Results: </strong>The age of the patients varied from 10 to 60 years. In our study, the heart rate in controls (Group A) before induction was 86+/-10 rose to 93+/-12 and 107+/-13 after induction and after laryngoscopy + ETI respectively. The changes seen after endotracheal intubation alone was statistically very highly significant (&lt;0.001).&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; In Group B, the pre induction heart rate was 94+/-17, which increased to 99+/-13, after induction.This increase not significant (P&gt;0.05). There was an increases of 15 at laryngoscopy + ETI which was very highly significant (P&lt;0.001). <strong>Conclusion: </strong>In Group C, the pre induction heart rate of 96+/-15 increased to 97+/-11 at induction and to 108+/-15 following endotracheal intubation.</p> Mirza Afzal Baig Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/690 Sun, 02 Jun 2019 00:00:00 +0000 Small Dose-Clonidine Prolongs Postoperative Analgesia after Sciatic-Femoral Nerve Block With 0.75% Rovpivacaine for Foot Surgery https://aijournals.com/index.php/aan/article/view/741 <p><strong>Background: </strong>Foot surgery is associated with severe pain that can extend significantly up to 48 hours and often requires large amounts of parenteral opioids. . The benefit of adding clonidine to LAs for peripheral nerve blocks is less clear, although it is widely believed that clonidine improves quality and duration of a LA block. The aim of this study was to evaluate the effects of adding 1 mg/kg clonidine to 0.75% ropivacaine during combined sciatic-femoral nerve block for hallux valgus repair. <strong>Subjects and Methods: </strong>Thirty six ASA physical status I and II patients, scheduled for elective hallux&nbsp; valgus repair under combined sciatic-femoral nerve block, were enrolled in the study. By using a sealed envelope technique, patients were randomly allocated to receive sciatic-femoral nerve block with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n 5 15) or 0.75% ropivacaine plus 1 mg/kg clonidine (group Ropivacaine- Clonidine, n 5 15). Standard monitoring was used throughout the study, including noninvasive arterial blood pressure, heart rate, and pulse oximetry. The time from the end of anesthetic injection to resolution of motor block at the ankle of the operated foot and first request for postoperative analgesic was recorded. At discharge from the orthopedic ward and 3 wk after hospital discharge, patients were also evaluated regarding the occurrence of neurological complications. <strong>Results: </strong>No differences in the time required to achieve surgical anesthesia were observed between patients receiving only 0.75% ropivacaine (10 [5–20] min) and those receiving the ropivacaine-clonidine mixture (10 [5–30] min).&nbsp; The mean time from block placement to first request for pain medication was shorter in group Ropivacaine than in group Ropivacaine- Clonidine (P = 0.03,. No differences in postoperative consumption of ketoprofen were observed between patients. <strong>Conclusion: </strong>Adding 1mg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects.</p> Anil Ratnawat, Vijay Kumar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/741 Sun, 23 Jun 2019 00:00:00 +0000 Comparison of Classic Laryngeal Mask Airway and I Gel Regarding Ease of Insertion and Efficacy of Ventilation in Lateral Position https://aijournals.com/index.php/aan/article/view/742 <p><strong>Background: </strong>The laryngeal mask airway (LMA) is a supraglottic airway device designed to maintain a clear airway, which sits outside of and creates a seal around the larynx. Aim of our study is to compare the ease of insertion and adverse effects using the insertion of classic LMA ad I gel in lateral position and to note if there are any adverse effects between both. <strong>Subjects and Methods: </strong>Hundred patients of either gender aged between 15 and 70 years who belonged to ASA physical status I and II, who were posted for elective surgical procedures under general anaesthesia under supraglottic airway devices were recruited for study. They were randomly divided into four groups of 25 patients each by closed envelop method. First group is Group IRL: Patients in whom I gel was used in right lateral position Second group is Group ILL : Patients in whom I gel was used in left lateral position Third group is Group CRL : Patients in whom classic laryngeal mask airway was used in right lateral position Fourth group is Group CLL : Patients in whom classic laryngeal mask airway was used in left lateral position. <strong>Results: </strong>Group IRL had success rate of 88.5% in 1st attempt 11.5% in this group had 2nd attempt of LMA insertion. Group ILL had 1st attempt success rate of 76% with.&nbsp; 24% patients needed 2nd attempt for LMA placement Group, CRL had success rate of 86% at 1st attempt 14% patients had LMA insertion in 2nd attempt. Group CLL had 1st attempt success rate of 67% only. 33% of patients in this group needed 2nd attempt for successful LMA insertion. <strong>Conclusion: </strong>Supraglottic airway devices can be successfully used for securing airway in lateral position. Both classic LMA and I gel can be used to secure the airway. I gel is a supraglottic airway device with its own advantages which can be successfully used in patients who need lateral position for their surgery.</p> Viral Prakashkumar Patel, Rekha Bayer, Hippal Patel, Kuntal Patel Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/742 Sun, 23 Jun 2019 00:00:00 +0000 Prediction of Intraoperative Hypotension in Full Term Parturients Planned for Elective Caesarean Section with the Help of Supine Stress Test and to Find out Applicability of Supine Stress Test https://aijournals.com/index.php/aan/article/view/744 <p><strong>Background: </strong>The patients those have tendency to develop supine hypotension syndrome during advance pregnancy also lands in intraoperative hypotension after spinal anaesthesia and this can be predicted in advance with preoperative use of Supine Stress Test. <strong>Subjects and Methods: </strong>120 full term parturients with singleton pregnancy planned for elective caesarean section under spinal anaesthesia subjected to Supine Stress Test in preoperative period. <strong>Results: </strong>Parturients those were positive for Supine Stress Test in preoperative period, significantly land in hypotension during caesarean section. Intraoperative hypotension managed with Inj Ephedrine and fluid. <strong>Conclusion: </strong>Supine Stress Test is an important tool in predicting intraoperative hypotension in parturients under going elective caesarean section.</p> Vivek Tyagi, Asad Mohammad, Navab Singh Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/744 Mon, 24 Jun 2019 00:00:00 +0000 A Comparison Study of Spinal Anesthesia with General Anesthesia in Cesarean Section https://aijournals.com/index.php/aan/article/view/755 <p><strong>Background: </strong>The present study was conducted to compare spinal anesthesia with general anesthesia in cesarean section. <strong>Subjects and Methods: </strong>The present study was conducted in the department of Anesthesiology. It comprised of 78 pregnant women with American Society of Anaesthesiologists (ASA) physical status grade I or II who were scheduled to undergo elective CS under SA. Patients were divided into 2 groups. In both groups, side-effects after surgery such as nausea, vomiting, headache, pain and other clinical symptoms were noted. <strong>Results: </strong>The mean WBC count in group I was 12.74 109/L and 10.62 109/L in group II which was significant (P&lt; 0.05). Other parameters such as mean RBCs, mean hemoglobin and mean platelet count was non- significant (P&gt; 0.05). In group I most common complication was fever (6) and hypotension (6) while in group II, fever (8) and hypotension (7). However, the difference was non- significant (P&gt; 0.05). <strong>Conclusion: </strong>Both spinal anesthesia and general anesthesia showed variations in hematological parameters as well as complications.</p> Rajeev Kumar Das, Manu Seth Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/755 Thu, 27 Jun 2019 00:00:00 +0000 Hemodynamic Stability of the Patients Receiving Intravenous Dexmedetomidine versus Intravenous Propofol Based Sedation in Cervical Disc Surgeries https://aijournals.com/index.php/aan/article/view/760 <p><strong>Background: </strong>The sedative effect of dexmedetomidine is exercised subcortically and mimics natural sleep. The area of the brain with the highest concentration of alpha2-ARs is the locus coeruleus (LC) in the upper brainstem, which is responsible for arousal, sleep, anxiety, and withdrawal symptoms from drug addiction. It projects into two areas in the thalamus: the ventrolateral preoptic nucleus and the tuberomamillary nucleus. When the alpha2-AR is activated, it inhibits adenylyl cyclase. This results in the reduction of cAMP, with net efflux of K+ (through Ca2+-activated K+ channels) and inhibition of Ca2+ entry into nerve terminals. This hyperpolarises the neuron and suppresses the release of noradrenaline (NA) from the LC. <strong>Subjects and Methods: </strong>In this prospective study hundred ASA Grades I and II patients between the ages of 20 and 60 years undergoing elective cervical disc surgeries were enrolled after Ethical committee and Scientific committee approval meeting the below selection criteria. <strong>Results: </strong>The intergroup variation in the SBP during the intubation and till 5 mins after intubation showed a significant lower values in patients with the dexmedetomidine as compared with the propofol (P &lt; 0.001). <strong>Conclusion: </strong>Patients on dexmedetomidine had significantly better hemodynamic response to Fiberoptic bronchoscopy and intubation compared to propofol group. Heart rate, systolic, diastolic and mean arterial pressures were significantly lower in dexmedetomidine group as compared to propofol group during intubation and at various intervals post intubation.</p> Padma S, Bhaskar Babu BD Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/760 Thu, 27 Jun 2019 00:00:00 +0000 Clinical Profile of the Patients Undergoing Awake Fiberoptic Intubation Along with Airway Blocks in Cervical Discectomy Patients https://aijournals.com/index.php/aan/article/view/762 <p><strong>Background: </strong>The optical characteristics of fine glass strands are what make fiberoptic technology possible. When glass rods are heated and stretched to diameters of 8 to 25µ, a flexible fiber capable of transmitting light is formed. Light that enters the distal end of the fiber is reflected off the walls until it emerges at the proximal end. To keep a fraction of the light from being lost during transmission, the fiber is clad in a layer of glass that has a different optical density. This process results in total internal reflection of light entering the fiber. The light transmitted along a single fiber emerges uniformly distributed over the cross-sectional area at the end. The resolution of a fiberoptic image is inversely proportional to the diameter of the glass fiber. <strong>Subjects and Methods: </strong>After overnight fasting, all patients under the study were premedicated with tab ranitidine 150mg orally and tab diazepam 10mg with sips of water 90 mins before shifting to operating theatre. Premedication with glycopyrrolate 0.2mg IM, administered 30-45 minutes prior to application of the local anesthetic. <strong>Results: </strong>At baseline, SO2 in both the groups were comparable. There were no significant differences between the groups with respect to changes in SO2 after bolus infusion, during intubation and after intubation clinically. <strong>Conclusion: </strong>Patients with study (D) group had a consciousness score of 2 (eyes open on command) in 41 patients out of 50 (82%), where as in control (P) group 17 patients (34%) had score of 2 (eyes open on command). 20 patients (40%) had score of 1 (response to ear pinching),in control (P) group compared to 3 patients in study(D) group.</p> Bhaskar Babu BD, Padma S Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/762 Thu, 27 Jun 2019 00:00:00 +0000 A Comparative Study of Plain and Hyperbaric Solution of Ropivacaine for Spinal Anaesthesia in Minor Gynaecological and Urological Surgeries https://aijournals.com/index.php/aan/article/view/770 <p><strong>Background: </strong>To compare the clinical effects of 3ml of intrathecal hyperbaric ropivacaine 0.5% (2ml of 0.75% plain ropivacaine and 1ml of 25%dextrose)&nbsp; with 3ml of 0.5% plain ropivacaine (2ml of 0.75% plain ropivacaine and 1ml of 0.9% normal saline) for spinal anaesthesia in minor gynaecological and urological surgeries. <strong>Subjects and Methods: </strong>60 patients belonging to ASA physical status I &amp; II scheduled for minor gynaecological and urological surgeries under spinal anaesthesia were randomly selected for the study and are divided into two groups of 30 each. Group H patients received 3 ml of intrathecal hyperbaric&nbsp;&nbsp; ropivacaine 0.5% (2 ml of 0.75% plain ropivacaine and 1 ml of 25% dextrose). Group P patients received 3 ml of plain ropivacaine 0.5% (2 ml of 0.75% plain ropivacaine and 1 ml of 0.9% saline). <strong>Results: </strong>There was significant difference between the two groups in mean time to onset of sensory block at T10, 257.5 ± 23.03 sec with group H and 478.0 ± 16.48 sec with group P, (P&lt;0.0001). Total duration of sensory block was 201.7 ± 8.64 min in group H and 261.17 ± 8.27 min in group P, which is significant (P&lt;0.0001).Mean time of onset of motor block was 355.50 ± 16.83 sec in group H and 568.33 ± 2.76 sec in group P, which is significant (P&lt;0.0001). Duration of motor block was 127.33 ± 6.53 min in group H and 168.83 ±&nbsp; 8.27&nbsp; min in group P which is clinically and statistically significant (P&lt;0.0001). Hemodynamic parameters were comparable in both groups. <strong>Conclusion: </strong>Addition of glucose to plain ropivacaine&nbsp;&nbsp; increases the speed of onset of both sensory and motor block, and also increases the speed of recovery from sensory and motor block in minor gynaecological and urological surgeries. Plain solutions are less reliable for surgery above a dermatomal level of T10.</p> Irfan Waris, Imran Khan KD Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/770 Fri, 05 Jul 2019 00:00:00 +0000 A Study on Haemodynamic Changes in Plain and Hyperbaric Solution of Ropivacaine for Spinal Anaesthesia https://aijournals.com/index.php/aan/article/view/771 <p><strong>Background: </strong>Historically bupivacaine was used as it had a long duration of action, but subsequently it was found that “propyl derivatives” of pipecoloxylidides were less toxic than ‘butyl derivatives’ (bupivacaine). Thus ropivacaine was developed after bupivacaine was noted to be associated with significant number of cardiac arrests. <strong>Subjects and Methods: </strong>A comparative study of plain and hyperbaric solution of ropivacaine for spinal anaesthesia in minor gynaecological and urological procedures was undertaken in 60 patients. Patients were randomized in to two groups with 30 patients in Group H (2ml of 0.75% plain ropivacaine and 1ml of 25% dextrose) and 30 patients in Group P (2ml of 0.75% ropivacaine and 1ml of 0.9% normal saline). The onset and duration of sensory and motor blockade, sensory level achieved, and haemodynamic parameters were assessed. <strong>Results:</strong> The mean age of patients in group H was 45.83 ± 5.43 years compared to 45.76 ± 6.97 years in group P. In group H there were 11 males (37%) and 19 females (63%). In group P there were 10 males (33%) and 20 females (67%). The mean height of the patients in group H was 157.20 ± 5.06 cms and in group P was 159.70 ± 7.78 cms. The mean weight of the patients in group H was 56.63 ± 6.46 kgs and in group was 59.07 ± 7.53. There was no statistically significant difference between the two groups with regard to age, sex, height and weight (p&gt;0.05). Both the groups were comparable with respect to age, sex, height and weight distribution. <strong>Conclusion:</strong> There was no significant change in systolic blood pressure following subarachnoid block in both groups. The systolic blood pressure values were comparable in both groups without any clinical or statistical significance.</p> Irfan Waris, Imran Khan KD Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/771 Fri, 05 Jul 2019 00:00:00 +0000 Assessment of Efficacy of Dexmedetomidine and Propofol for Sedation during Gastrointestinal Endoscopy: A Comparative Study https://aijournals.com/index.php/aan/article/view/797 <p><strong>Background: </strong>Gastrointestinal Endoscopy is performed as diagnostic and therapeutic procedure. Hence; we compared the clinical profile of propofol and dexmedetomidine in patients undergoing gastrointestinal endoscopy. <strong>Subjects and Methods: </strong>A total of 20 subjects scheduled to undergo gastric endoscopy were included in the present study and were broadly divided into two study groups as follows: Group A: included subjects who were given propofol, Group B: included subjects who were given dexmedetomidine. All the baseline parameters were recorded. Gastric endoscopy was performed in all the patients according to their respective groups.&nbsp; Patient satisfaction score was recorded in all the patients. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. <strong>Results: </strong>Mean heart rate among the subjects of group B at baseline, intraoperative and postoperative time were found to be 72.1, 66.8 and 69.4 respectively. Non- significant results were obtained while comparing the mean heart rate in between the two study groups at different time intervals. Mean PSS (Patient Satisfaction Score) of subjects of propofol group and dexmedetomidine group was found to be 42 and 45 respectively. However; the difference was found to be statistically non-significant. <strong>Conclusion: </strong>Both the anaesthetic solutions can be used with equal effectiveness among patients undergoing gastric endoscopy.</p> Swati Trivedi, Aditya Kumar Tripathi, Rajeev Kumar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/797 Thu, 11 Jul 2019 00:00:00 +0000 The Study was Conducted Using Isobaric 0.75% Ropivacaine 3.5ml (26.25mg) Intrathecally for Lower Limb Surgeries to Evaluate Onset and Duration of Sensory Block & Onset and Duration of Motor Block https://aijournals.com/index.php/aan/article/view/819 <p><strong>Background: </strong>This study was conducted at Civil Hospital, BJ Medical College, Ahmedabad, after approval from the ethical committee. Fifty patients admitted in our hospital undergoing lower extremity surgeries under spinal anaesthesia were included in the study. <strong>Subjects and Methods: </strong>Patients in the age group 18 – 60 years were selected including 45 males and 5 females. 39 patients had a ASA grade I and 11 patients had ASA grade II. Various lower limb and orthopaedic surgeries like arthroscopic ligaments repair, tibial and flap surgeries were included. <strong>Result:</strong> The duration of surgeries ranged from 45 to 270 minutes. 2%&nbsp; (1 patient) attained a maximum level of T4, 22% (11 patients) had a maximum level of T6 , 26% (13 patients ) had a maximum level of T8. Maximum number of patients, 44% (20 patients) had a level of T10. 6% (3 patients) had attained a maximum level of T12. Three patients did not achieve complete motor level.By the end of 15 minutes, 86% ( 43) patients had achieved a <strong>complete</strong> motor block.By the end of 20 minutes 94% (47) patients had attained a complete motor block. The mean time for complete motor block was 10.59 minutes (S.D.±4.7).<strong>Conclusion: </strong>A study was conducted in 50 patients belonging to ASA grade I and II posted for lower limb surgeries. They received 3.5ml of 0.75% isobaric Ropivacaine in L2-3 interspace. All patients were preloaded with 1000 ml of ringer lactate. Following institution of subarachoid block sensory characteristics such as onset of sensory block, maximum level achieved, duration of sensory block and request for first dose of rescue analgesics were studied. Motor blockade characteristics such as onset of motor block, duration and quality of motor blockade were studied. Onset of sensory block till T10 level was found to be 8.5minutes with a complete regression in 229.28minutes.</p> Monika Saini, Nagesh Mudgal, Smita Engineer Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/819 Fri, 31 May 2019 00:00:00 +0000 To Compare Isobaric 0.5% Levobupivacaine with Isobaric 0.5% Ropivacaine in Brachial Plexus Block For Elective Upper Limb Surgery. https://aijournals.com/index.php/aan/article/view/820 <p><strong>Background: </strong>The study entitled "To compare the effects of 0.5% Levobupivacaine with 0.5% Ropivacaine for brachial plexus block in elective upper limb surgeries" was conducted at Bombay Hospital, Indore (M.P.). <strong>Subjects and Methods: </strong>The study entitled "To compare the effects of 0.5% Levobupivacainewith 0.5% Ropivacaine for brachial plexus block in elective upper limb surgeries" was conducted at Bombay Hospital, Indore (M.P.) Sixty patients aged between 18yrs and 60yr physical status ASA grade 1 and ASA grade 2 undergoing elective upper limb surgeries were included in the study. <strong>Results: </strong>Mean onset time of sensory block was rapid ingroup L (11.203±1.58) minutes as compared to group R (13.62±1.544) minutes which is statistically significant with p value &lt; 0.05.Mean duration of sensory block wassignificantly prolonged in group L (12.07±1.09) hours as compared to group R(10.840±1.713) hours which is statistically significant with p value &lt; 0.05.Mean duration of motor block was significantly prolonged in group L (11.137±1.513) hours as compared to group R(10.063±1.209) hours which is statistically significant with p value &lt;0.05. Mean onset time of motor block was rapid in group L (17.3701.618) minutes as compared to group R (18.9771.375) minutes which is statistically significant with p value &lt; 0.05. Mean duration of Analgesia motor block was significantly prolonged in group L (15.073.902) hours as compared to group R(12.6631.608) hours which is statistically significant with p value &lt;0.05. <strong>Conclusion: </strong>To conclude the study, we observed Levobupivacaine 0.5% having better profile in comparison to ropivacaine 0.5%in having Faster onset of sensory and motor blockade, Prolonged duration of sensory and motor blockade, Prolonged duration of analgesia, Levobupivacaine should be considered for peripheral nerve block when postoperative analgesia is a concern but not when an early return of motor function is desired in postoperative period for upper limb elective surgeries.</p> Nagesh Mudgal, Monika Saini Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/820 Fri, 31 May 2019 00:00:00 +0000 Association of Platelet Counts with Outcome of ICU Stay https://aijournals.com/index.php/aan/article/view/822 <p><strong>Background: </strong>Low platelet count is common in intensive care unit (ICU). Thrombocytopenia has also been associated with poor outcome in ICU.1-4 There is sketchy data regarding thrombocytopenia and its effect on outcome from ICUs in India.5 We aimed to study association of platelet counts with outcome of ICU stay. <strong>Subjects and Methods: </strong>This was a retrospective study. This study was carried out in patients admitted with a diagnosis of sepsis in the medical ICU, Sepsis was defined using the criteria laid down in the surviving sepsis guidelines 2012.6 Data regarding demography (age and sex), probable source of sepsis, platelet count at admission (Plat-adm), lowest platelet count during the ICU stay (Plat-nadir), platelet fall- defined as Plat-adm – Plat-nadir, APACHE-II score and SOFA score at admission were recorded. Outcome parameters were mortality, length of ICU stay and length of hospital stay. <strong>Results: </strong>During the study period, a total of 87 patients were admitted in the medical ICU. In 29 patients, criteria of sepsis or outcome of ICU stay were not met, and were excluded from the study. Out of the 48 patients included in the study, 35 patients died and 13 patients survived to transfer out from ICU. Age and sex were similar between them. Data was analyzed for associations. In univariate analysis, there was no association between the platelet counts and disease severity scores, except for Plat-nadir exhibiting a weak negative association with SOFA score at admission (Pearson’s R: - 0.303, p= 0.036). Mortality was associated with platelet fall, APACHE-II and SOFA scores at admission (Table 2). A unit increase in APACHE-II-adm and SOFA-adm, and an increment of 10,000 in Plat-fall, increased the odds ratio (OR) of mortality by 14%, 33% and 21% respectively. Multivariate analysis was carried using logistic regression methodology and none of the aforesaid were associated with mortality. It is notable that platelet fall narrowly missed independent association, p= 0.07. <strong>Conclusion: </strong>This study demonstrates that patients with larger fall in platelet counts may be at increased risk of dying. Larger, prospective studies are needed to further clarify the association of platelet count with outcome of ICU stay.</p> Maninder Patni, Uday Pratap, Ruchi Sarawgi, Ruchi Gupta Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/822 Fri, 31 May 2019 00:00:00 +0000 Evaluation of Recovery Profiles of Different Anesthetic Techniques for Ambulatory Anorectal Surgery: A Comparative Study https://aijournals.com/index.php/aan/article/view/826 <p><strong>Background: </strong>Ambulatory surgery encompasses those surgical interventions that are more complex than office-based procedures performed under local anaesthesia but fewer complexes than major procedures requiring at least an overnight stay. Hence; we planned the present study to assess the recovery profiles of different anesthetic techniques for ambulatory anorectal surgery. <strong>Subjects and Methods: </strong>A total of 90 subjects were included in the present study who were about to undergo anorectal surgery. Random division of all the patients was done into three study groups: Group 1- Patients undergoing ambulatory anorectal surgery under spinal anesthesia, Group 2- Patients undergoing ambulatory anorectal surgery under local anesthesia, and Group 3- Patients undergoing ambulatory anorectal surgery under general anesthesia.&nbsp; All the subjects were prepared for surgical procedure. According to their respective groups, all the surgeries were performed. A master chart was prepared, where recovery profile of all the subjects was recorded and compared. All the results were analyzed by SPSS software. <strong>Results: </strong>Mean duration of anesthesia among subjects of group 1, group 2 and group 3 was 74.5 minutes, 43.8 minutes and 79.1 minutes respectively. Mean duration of surgery among the subjects of group 1, group 2 and group 3 was 27.5 minutes, 26 minutes and 26.5 minutes respectively. Mean duration of hospital stay among subjects of group 1, group 2 and group 3 was 260.4 minutes, 131.8 minutes and 255.3 minutes respectively. In the present study, recovery profile of local anesthesia was significantly faster in comparison to the recovery profile of general and spinal anesthesia. <strong>Conclusion: </strong>Local anesthesia is the most effective technique in terms of recovery profile in patients undergoing ambulatory anorectal surgeries.</p> Atanu Mukherjee, Gagandeep Singh Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/826 Fri, 19 Jul 2019 00:00:00 +0000 Comparative Study of Safety and Efficacy between Propofol-Fentanyl Versus Propofol-Dexmeditomidine Combination For Sedation in Upper Gastro-Intestinal (GI) Endoscopic Procedures- A Prospective Randomised Study https://aijournals.com/index.php/aan/article/view/840 <p><strong>Background: </strong>Endoscopy in patients with gastrointestinal disorders (GI) is of immense benefit for diagnostic and therapeutic measures.&nbsp; Inspite of use of flexible fibreoptic equipments, endoscopy remains an unpleasant experience for most patients. The purpose of sedation in these patients is to relieve anxiety, discomfort or pain, and diminish memory of the event.<sup>[1] </sup>There has been a general consensus that moderate sedation provides adequate control of pain and anxiety during endoscopic procedures. Conscious sedation enables patients to maintain their response to verbal and tactile stimuli without losing cardiovascular and ventilatory function.<sup>[2]</sup> The aim of study is&nbsp; to compare the safety and efficacy between propofol-fentanyl and propofol-dexmeditomidine&nbsp; combination for sedation&nbsp; in upper gastro-intestinal (GI) endoscopic procedures. <strong>Subjects and Methods: </strong>A prospective study of 70 cases of both sexes belonging to ASA Grade I,II and III. Planed for elective upper GI endoscopies under sedation were included in this study were randomly selected. The study group was divided in two groups of 35 each, Group A Propofol-Fentanyl (PF) and Group (B) Propofol-Dexmeditomedine (PD). In the PF group, patient was administered fentanyl 2mcg/kg initially followed by Propofol loading dose of 1.5mg/kg over five minutes. Then propofol infusion was started at 50mcg/kg/min to achieve bis value 50-60. Then endoscopy was done. If the subject did not tolerate the endoscope or patient experienced pain during the entire procedure then additional propofol bolus of 0.3 mg/kg was given. Similarly in PD group, the subject was given 1mcg/kg dexmeditomidine instead of Fentanyl, rest the same. Meanwhile HR, BIS value, SPO2, MAP were noted. <strong>Results: </strong>It was found that there was significant difference in SpO2 Heart rate,,Mean, BIS Meanwhile 54.3% of patients required airway manoeuvre to maintain Saturation in PF group while only 2.9% patients of PD group required airway support. This difference in airway manoeuvre was statistically significant. <strong>Conclusion: </strong>we concluded that propofol dexmeditomidine group had better respiratory parameters, better hemodynamic stability, lesser need of total propofol. Propofol dexmeditomidine had better satisfaction levels among patients as compared to propofol fentanyl group butrecovery time of Propofol-fentanyl group was faster than propofol dexmeditomidine group.Except for time taken for recovery, PD group was both safer and more efficacious. Overall Propofol Dexmeditomidine group achieved better conditions for sedation in upper GI endoscopy than Propofol-Fentanyl.</p> Ajay Basarigidad, Sandeep Killedar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/840 Wed, 24 Jul 2019 00:00:00 +0000 Determination of Spinal Anesthesia Induced Hypotension in Cesarean Section https://aijournals.com/index.php/aan/article/view/852 <p><strong>Background: </strong>Spinal anesthesia is the global standard method of anesthesia for cesarean section. The present study was conducted to determine spinal anesthesia induced hypotension in cesarean section in study group. <strong>Subjects and Methods: </strong>The present study was conducted in the department of Anesthesia. It comprised of 68 pregnant women in age range 18-30 years. In all patients, ASA grade, gravidity, history of previous cesarean section and hypotension was recorded. <strong>Results: </strong>Age group 18-22 years had 32 patients, 23-27 years had 22 and 27-30 years had 14 patients. The difference was significant (P&lt; 0.05). ASA grade I was seen in 48 patients and II in 20 patients. Gravidity 1 was seen in 24, 2 in 16, 3 in 15 and 4 in 13. 46 had 1 previous cesarean section and 22 had 2. The difference was significant (P&lt; 0.05). Mild hypotension was present in 2, moderate in 3 and severe in 6. The difference was significant (P&lt; 0.05).<strong>Conclusion: </strong>Authors found that hypotension is frequently seen in cesarean section.&nbsp; In this study, 11 patients exhibited spinal anesthesia induced hypotension.</p> Sanjay Kumar Gupta, Saurabh Singhal Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/852 Mon, 29 Jul 2019 00:00:00 +0000 Dandy Walker Syndrome – Always A Challenge https://aijournals.com/index.php/aan/article/view/858 <p>Dandy-Walker syndrome is classically described as a neuropathological triad consisting of hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and hydrocephalus. Clinical manifestations of the syndrome usually appear in the first year of life, but can occur during the neonatal period. Obstructive hydrocephalus with dilatation of the third and lateral ventricles occurs frequently.’ The syndrome was first described in 1914 by Dandy and Blackfan who postulated the pathogenetic theory of atresia of the fourth ventricle’s foramina of Luschka and Magendie; but today most authors consider the cerebellar hypoplasia to be a malformation independent of this atresia. DWS is also associated with abnormalities in the skeletal, cardiac, and genitourinary systems. In this report, we aimed to present a case of a patient with DWS who was scheduled for VP shunt surgery and was managed successfully without any perioperative complications.</p> Aman Preet, Dr. Kulsaurabh, Dr. Anshul, Mohit Jain, Satyaveer Verma Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/858 Thu, 01 Aug 2019 00:00:00 +0000 Ultrasound a Savior for Lost Central Line https://aijournals.com/index.php/aan/article/view/860 <p>Central line insertion is often needed for perioperative care as well for patients admitted in intensive care units. It has well established advantages for drug and nutrition delivery. Ultrasound guidance has improved first prick success rate as well as reduced the peri-procedural complications. We encountered an unusual situation of dissection right IJV cental line catheter with buried end under the skin. Careful planning was done and interventional endovascular removal of lost catheter was planned. Ultrasound scanning of neck was done to evaluate and assess the position and direction of the catheter and its findings changed the initial plan. During this crises ultrasound came as a savior to help removal of catheter avoiding major interventional procedure.</p> Tarun Yadav, Mayuri Golhar, Dr Kulsaurabh, Prashant Kumar, Dr Anshul, Samsher Singh Lochab Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/860 Thu, 01 Aug 2019 00:00:00 +0000 A Study to Compare and Evaluate the Efficacy of Granisetron and Granisetron Dexamethasone Combination as Anti-Emetic https://aijournals.com/index.php/aan/article/view/874 <p><strong>Background: </strong>Dexamethasone,&nbsp; a&nbsp; glucocorticoid&nbsp; is shown to produce stronger antiemetic effect, probable&nbsp; mechanism is prostaglandin&nbsp; antagonism, serotonin inhibition, releasing endorphins and&nbsp; 5HT3 antagonism&nbsp; with biological&nbsp; half life&nbsp; 36 to 72 hrs, confers&nbsp; longer&nbsp; duration&nbsp; of&nbsp; prophylaxis.Since etiology of PONV is multifactorial , combination of different classes of antiemetic can increases clinical efficacy compared to single drug alone. <strong>Subjects and Methods: </strong>A detail preoperative assessment was performed on preoperative visit on the day before surgery. Where detail history, thorough general examination, airway assessment and systemic examination was performed. All routine investigations were done like haemogram, routine urine examination, random blood sugar, blood urea, serum creatinine and serum liver function test.X-ray chest and ECG were done when indicated. &nbsp;<strong>Results:</strong> In Group-GD, only 13.33% had PONV which was statistically significantly low as compared to Group-G which was 36.66% (P&lt;0.05). Complete response in Group-GD was 86.67% which was statistically significantly high as compared to Group-G which was only 63.34% (P&lt;0.05). <strong>Conclusion: </strong>Requirement of Rescue anti-emetic was less in Granisetron-Dexamethasone combination group than Granisetron group.</p> Asha Rani BN, Swati Bhatt Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/874 Sun, 11 Aug 2019 00:00:00 +0000 Haemodynamic Stability and Side Effects of Granisetron and Granisetron Dexamethasone Combination https://aijournals.com/index.php/aan/article/view/876 <p><strong>Background: </strong>Granisetron is a selective 5-hydroxy tryptamine -3(5HT3) receptor antagonist with little or no affinity for other serotonin receptors. Chemically, it is endo-N-(9-Methyl-9-Azabicyclo [3.3.1]non-3-yl)-1-methyl-1H-indazole-3-carboxamide hydrochloride. Serotonin receptors of the 5HT3 type are located peripherally on vagal nerve terminals and centrally in the CTZ of the area postrema. <strong>Subjects and Methods: </strong>The protocol was explained to patients and informed consent was taken. All the patients received tab. Diazepam (10mg) and tab. Ranitidine (150mg) on the previous night before surgery. Patients were kept nil by mouth for 8 hours before surgery. On the day of surgery, nil by mouth status of patient was confirmed and written and informed consent obtained. Intravenous line was secured with crystalloid infusion was started. <strong>Results:</strong> In Group-GD, 2 patients had Headache, 1 patient had dizziness and 2 patients had dry mouth, while in Group-G, 3 patients had Headache, 1 patient had dizziness and 2 patients had dry mouth which did not require any treatment. No other side effect was observed during study. No difference in incidence of side effects in between two groups. <strong>Conclusion: </strong>Patients were haemodynamically stable throughout the study in both the groups.</p> Asha Rani BN, Swati Bhatt Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/876 Sun, 11 Aug 2019 00:00:00 +0000 Effect of Esmolol, Labetalol and Metoprolol for Attenuating the Cardiovascular Stress Response to Laryngoscopy and Intubation: A Comparative Study https://aijournals.com/index.php/aan/article/view/925 <p><strong>Background: </strong>To compare esmolol, labetalol and metoprolol in attenuating the cardiovascular response of L&amp;I. <strong>Subjects and Methods: </strong>It was a randomized prospective study in 120 patients of 18-60 years, of ASA grade I and II, of either sex, posted for elective surgery under GA. After approval from ethical committee and informed written consent, the patients&nbsp;&nbsp; were randomly allocated in four groups of 30 each. Group C (control) received 10 ml 0.9% saline, group E esmolol 0.5 mg/kg (both 2min prior to induction), Group L labetalol 0.25 mg/kg and Group M metoprolol 0.1 mg/kg (both 5min prior to induction). All patients were pre-medicated with inj. ondansetron 0.1 mg/kg, inj. glycopyrrolate 0.004 mg/kg, inj. pen-tazocine 0.6 mg/kg and inj. midazolam 1 mg.All patients were induced with inj. thiopentone 5 mg/kg and succinylcholine 2 mg/kg. Anaesthesia was maintained on isoflurane, O2:N2O and Atracurium. Heart rate and BP were recorded: pre-operative, after pre-medication, after induction, after L&amp;I, after 1, 3, 5, 10, 15 minutes following L&amp;I. <strong>Results: </strong>All the study drugs significantly attenuated the HR, SBP, DBP, MBP and RPP following L&amp;I compared to control. Metoprolol attenuated the heart rate and RPP compared to esmolol and labetalol. Esmolol attenuated the heart rate immediately following L&amp;I better than labetalol and significantly attenuated the SBP at 5min and 10 min following L&amp;I. All readings of RPP were lower in esmolol in comparison to labetalol. Esmolol, was better than labetalol in attenuating the hemodynamic response. Sinus tachycardia and hypotension were the common side effects. Three patients in control and one in labetalol group developed ectopic beats following L&amp;I. One patient in esmolol had pain on i.v injection. <strong>Conclusion: </strong>Metoprolol attenuated the cardiovascular stress response to L&amp;I in comparison to esmolol and labetalol. Esmolol was comparably better than labetalol. Metoprolol can be used as alternative to esmolol and labetalol.</p> Deepak R, Jaya Lalwani, Prathibha Jain Shah, K P Dubey Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/925 Fri, 06 Sep 2019 00:00:00 +0000 Effect of Two Different Concentrations of Ropivacaine in Axillary Brachial Plexus Block in Terms of Block Characteristics – A Comparative Study https://aijournals.com/index.php/aan/article/view/926 <p><strong>Background: </strong>Peripheral nerve block holds an important place in regional anesthesia. Application of ultrasound guidance in nerve blocks had increased success rate and minimize chances of complications. Ropivacaine, newer local anesthetic with wider safety margin, is widely used now a days in peripheral nerve blocks. Aim of our study is to compare two different concentrations of ropivacaine (0.5% and 0.75%) in axillary brachial plexus block in terms of block characteristics. <strong>Subjects and Methods: </strong>A prospective randomized study was carried out in total of 60 patients, all of them given ultrasound guided axillary brachial plexus block. All patients were randomized into group A (0.5% ropivacaine,25 ml) and group B(0.75% ropivacaine, 25 ml). Succes rate, onset/ duration of sensory and motor block, duration of postoperative analgesia and complications if any were noted. <strong>Results: </strong>Both groups were comparable in terms of demographic characterics. There was no significant difference in onset and duration of sensory and motor block, duration of analgesia and patient satisfaction for both groups. <strong>Conclusion: </strong>0.5 % ropivacaine and 0.75% ropivacaine, both are safe and effective in axillary brachial plexus block with no added advantage of 0.75 % ropivacaine over 0.5% ropivacaine.</p> Saurin B Panchal, Pankti A Panchal, Karishma D Mehta Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/926 Fri, 06 Sep 2019 00:00:00 +0000 Comparative Study of Maintenance and Recovery Characteristics of Sevoflurane and Isoflurane in Neurosurgery https://aijournals.com/index.php/aan/article/view/927 <p><strong>Background: </strong>Rapid recovery is very important in neurosurgical patients for early neurological assessment. The purpose of this study was to compare the maintenance and recovery characteristics of two most commonly used volatile anaesthetic agents, Isoflurane and Sevoflurane in neurosurgery patients. <strong>Subjects and Methods: </strong>A hospital based, prospective, randomized, comparative study was undertaken in tertiary care centre for a period of two years after institutional ethical committee approval. The study included 60 patients undergoing neurosurgical surgeries in general anaesthesia. After intravenous induction, maintenance was achieved by inhalational anaesthetic agent according to randomly allocated group. Haemodynamic parameters like heart rate, systolic blood pressure, diastolic blood pressure along with recovery time and complications were studied and p&lt;0.05 was considered significant on statistical analysis. <strong>Results: </strong>The pulse rate was significantly less in sevoflurane group than isoflurane group from 20 min to 120 min (p&lt;0.05). The mean systolic and diastolic blood pressure were comparable in both the groups except the systolic and diastolic blood pressure were lower in Sevoflurane group than Isoflurane group at 5 min(p&lt;0.05). The mean emergence time and extubation time were significantly shorter in Sevoflurane group than Isoflurane group(p&lt;0.001).<strong>Conclusion: </strong>Sevoflurane provides stable haemodynamics during maintenance of anaesthesia and allows rapid recovery for faster postoperative basic neurological assessment.</p> Lulu Fatema Vali, Sonali M. Khobragade Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/927 Fri, 06 Sep 2019 00:00:00 +0000 Effect of Dexamethasone as an Adjuvant To 0.5% Bupivacaine in SupraclavicularBrachial Plexus Block- A Randomized Study. https://aijournals.com/index.php/aan/article/view/928 <p><strong>Background: </strong>Aims and Objectives: To study the effects of addition of Dexamethasone to Bupivacaine with respect to onset, duration of sensory and motor blockade, haemodynamic variables and rescue analgesics used in first 24 hours. <strong>Subjects and Methods:</strong>A prospective, randomized, study of 100 patients of ASA I &amp;II, aged between 20-60years were included. Patients were randomized to two groups, 50 of bupivacaine group (B) and 50 of bupivacine and dexamethasone(BD). Brachial plexus block was performed via supracalvicular route using ultrasound machine. The onset of anesthesia, loss of sensory perception and temperature was recorded. The patients were also monitored for any side effects or complications. The data obtained was analyzed using (SPSS vs 18). Quantitative data were analyzed by using student ‘t’ test, Qualitative by using Chi – Square test.&nbsp; p value of less than 0.05 was considered as statistically significant. <strong>Results: </strong>Demographics were comparable between the groups. The mean onset of sensory block [10.3 Vs 16.7] and motor block [5.6±0.7 Vs8.6±1.2] was earlier in BD group. Similarly the mean duration of sensory block in hours [5.9±0.67 Vs 4±6.3] and motor block was [4.3±0.9 Vs1.9±0.5]. The group BD received less rescue analgesics. There was a significant fluctuation in systolic blood pressure in group B. <strong>Conclusion: </strong>Use of dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block results in faster onset of action of sensory and motor blockade. It also results statistically significant longer duration of sensory and motor blockade.</p> Padmaja J, Jaganath A, Srinivasan K V Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/928 Fri, 06 Sep 2019 00:00:00 +0000 Comparative Evaluation of Different Needle Gauge of Needle for Spinal Anesthesia in Cesarean Section for Post-Operative Complication https://aijournals.com/index.php/aan/article/view/929 <p><strong>Background: </strong>Post&nbsp; duralPucture&nbsp; headache&nbsp; (PDPH)&nbsp; Particularly&nbsp; Following&nbsp; Caesarean&nbsp; Section&nbsp; is&nbsp; a&nbsp; well-known&nbsp; iatrogenic complication of spinal anaesthesia mostly occours due to loss of cerebrospinal fluid (CSF) during the procedure. Aims and Objectives: The study was planned to assess comparative superiority of 27 gauze spinal needle over 25 gauze spinal needle in caesarean section for reduction of PDPH. <strong>Subjects and Methods: </strong>The study was conducted on hundred full term primi-parous women aged within 18-36 years undergoing elective Caesarean Section were selected. They were divided into two groups, receive spinal anaesthesia with 25 gauze and 27 gauze spinal needle. <strong>Results: </strong>The overall incidence of PDPH of 100 CS patients was 17% and significantly higher incidence is noticed in-group A than group B (26% vs 10%, p &lt;0.05&gt;). Attempt required to attain CSF is higher in group B and finer needle takes significantly more time to collect CSF (P&lt;.001). Mean Duration for CSF Collection was 35.08±13.43 seconds (group A) and 81.12±16.71 seconds (groups B). <strong>Conclusion: </strong>Use of 27G spinal needle will be a good choice for reduction of PDPH.</p> Anirudh Prasad Mandal, P.K. Gyani, Sandeep Kumar, Rakesh Kumar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/929 Fri, 06 Sep 2019 00:00:00 +0000 Comparative Evaluation of Different Dose of Bupivacaine for Pain Control in Cesarean Section https://aijournals.com/index.php/aan/article/view/930 <p><strong>Background: </strong>Spinal&nbsp; anesthesia&nbsp; is&nbsp; the&nbsp; preferred&nbsp; choice&nbsp; of anesthesia&nbsp; for&nbsp; the&nbsp; conduct&nbsp; of&nbsp; emergency&nbsp; and elective cesarean&nbsp; section. Hypotension&nbsp; during&nbsp; spinal anesthesia for caesarean section continues to be a major problem. Aim: The present study investigated the safety and efficacy of 0.25% hyperbaric bupivacaine on the incidence of visceral pain during cesarean section performed under subarachnoid anesthesia. <strong>Subjects and Methods: </strong>Sixty patients who were scheduled for elective cesarean section, allocated randomly to one of three groups, according to patient`s height. Group 1, 2 and 3 received 3.2-3.6 mL (8-9 mg), 3.6-4.0 mL (9-10 mg) and 4.0-4.4 mL (10-11 mg) of 0.25% hyperbaric bupivacaine, respectively. <strong>Results: </strong>There was no difference in the incidence of visceral pain between three groups (p&gt;0.05), but the quality of intraoperative analgesia, as needs for general anesthesia was significantly lower in group 3 than groups 1 and 2 (p&lt;0.05). <strong>Conclusion: </strong>In conclusion, hyperbaric 0.25% bupivacaine in the dose of 10-11 mg is safe and effective in obtaining better quality of block in cesarean section, in order of reducing the severity of visceral pain.</p> Anirudh Prasad Mandal, P.K. Gyani, Sandeep Kumar, Rakesh Kumar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/930 Fri, 06 Sep 2019 00:00:00 +0000 Intravenous Dexamethasone as an Adjuvant in Reducing Post-Operative Pain, Nausea, Vomiting and Shivering https://aijournals.com/index.php/aan/article/view/931 <p><strong>Background: </strong>Outcome of any surgery depends on perioperative care of patients. Aim of our study was to hasten the recovery by reducing most common encountered complications like Pain, Nausea, Vomiting and Shivering seen in immediate postoperative period by using single dose of intravenous Dexamethasone. <strong>Subjects and Methods: </strong>This prospective randomized controlled study enrolled 120 patients scheduled for surgery under general anaesthesia. Patients were randomly divided in two groups. Group 1 was given intravenous Dexamethasone 8mg (2ml) preoperatively and Group 2 was given intravenous normal saline(2ml).Patients were observed for 24 hours post operatively to record postoperative pain, nausea , vomiting, shivering, haemodynamic and other complications .<strong>Results: </strong>Both the groups were similar in demographic data. Patients from study group had statistically significant lower postoperative VAS for pain at 0hrs, 6hrsand 24hrs (P value 0.048). Similarly patients of study group was also found to have statistically significant low incidence of Nausea (P value 0.022), Vomiting (P value 0.033) and shivering grade (P value 0.008) in first postoperative day. There was lesser requirement of rescue analgesia and rescue antiemetic in patients pre-treated with Dexamethasone (P value &lt;0.05). There were no significant variation in blood sugar levels or any other side effects noted in any patients. Patients from study group were more comfortable postoperatively as compared to control group. <strong>Conclusion: </strong>Intravenous 8mg Dexamethasone given preoperatively was found to reduce immediate postoperative pain, shivering, nausea and vomiting without any significant side effects.</p> Sangeeta Bansal Agrawal, Rohit Tiwari, Pranay Gupta Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/931 Fri, 06 Sep 2019 00:00:00 +0000 To Evaluate The Effect Of Addition Of Dexmedetomidine to Ropivacaine in TransversusAbdominis Plane Block on Post-Operative Analgesia After Caesarean Section- A Randomized Double Blind Study. https://aijournals.com/index.php/aan/article/view/933 <p><strong>Background: </strong>Studies have demonstrated the efficacy of Transverses abdomen plane (TAP) block as a component of multimodal postoperative analgesia after cesarean section. The aim of the present study was to compare the efficacy of combination of dexmedetomidine and ropivacaine to ropivacaine alone for Transversusabdominis plane (TAP) block as post-operative analgesic after lower segment cesarean section (LSCS). <strong>Subjects and Methods: </strong>A randomized double blind, prospective study was conducted on 100 ASA grade I and II pregnant patients undergoing LSCS under spinal anesthesia. They were randomly divided into two groups, group I (n=50) received 20 ml of ropivacaine 0.25% and 2 ml of normal saline while group II (n=50) received 0.5 mcg/kg dexmedetomidine dissolved in 2 ml of normal saline and 20 ml of ropivacaine 0.25% as bilateral TAP block at the end of surgery. The total duration of effective analgesia was recorded as primary outcome and secondary outcomes were pain score, total requirement of analgesics in the first 24hrs postoperatively and side effects. <strong>Results: </strong>The time for first analgesic dose was longer in group I than group II (282.58 vs 192.2 min, p&lt;0.05) and total dose of Tramadol used in the first 24 hrs was less among patients in group II when compared with those in group I (72 vs. 98 mg, p&lt;0.05). Pain was significantly reduced at all post-operative points for the first 6 hrs in group II compared with group I (p&lt;0.05). Changes in systolic, diastolic and mean arterial pressure and heart rate were statistically insignificant in both groups. There was no statistically significant difference in the incidence of side effects in both groups. <strong>Conclusion: </strong>In conclusion, this study shows that addition of dexmedetomidine to ropivacaine for TAP block after cesarean section, achieves better analgesia and provides longer duration of pain control post-operatively without any major side-effects.</p> Krishna Pratap Mall, Sujeet Rai, Richa Gangwar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/933 Fri, 06 Sep 2019 00:00:00 +0000 Compare the Clinical Profile of Pediatric Patients in either Deep or Awake State underSevoflurane Anaesthesia afterthe Removal of Proseal LMA https://aijournals.com/index.php/aan/article/view/934 <p><strong>Background: </strong>Infraumbilical surgeries in children are usually carried out under spontaneous inhalational technique. The advent of the LMA has ensured that such surgeries can be carried out at a lower concentration of the inhalational anaesthetic. In addition, a caudal block can be given intraoperative to decrease the anaesthetic requirement. <strong>Subjects and Methods: </strong>Two groups of 30 each by the computer. Group A (Awake Group): LMA was removed in the awake state.Group B (Deep Group): LMA was removed in the deep anaesthetized state. Anaesthesia technique: Patients were given the predetermined concentration of sevoflurane for 10 minutes depending on the group they belonged to. In the deep group patients were given sevoflurane at a concentration of 2-2.2% for 10 minutes prior to the anticipated end of surgery, while patients in the awake group were given sevoflurane at a concentration of 0.3-0.4% for 10 minutes prior to the anticipated end of surgery. <strong>Results: </strong>In the post operative period all 30 patients from the groups- deep and awake were observed during the first minute. In the second minute all 30 patients were still under observation in the deep group while in the awake group 15 patients were transferred to the recovery as they fulfilled the criteria for transfer. Hence after the third minute only patients from the deep group were left for observation in the operating room. <strong>Conclusion: &nbsp;</strong>LMA-ProSeal can be safely removed during awake and deep states of anaesthesia and neither is associated with an increase in the incidence of complications. Transfer time to the recovery room is however significantly less after awake removal.</p> Maninder Patni, Uday Pratap, Ruchi Sarawgi, Ruchi Gupta Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/934 Fri, 06 Sep 2019 00:00:00 +0000 A Randomised Control Study Comparing Hemodynamic Response to Laryngoscopy & Endotracheal Intubation with Macintosh Direct Laryngoscope & C-Mac Video Laryngoscope In Adult Patients https://aijournals.com/index.php/aan/article/view/935 <p><strong>Background: </strong>Aim: The aim of the present study is to assess and compare the efficacy of Macintosh laryngoscope with C-MAC video laryngoscope in attenuating the hemodynamic stress responses to laryngoscopy and endotracheal intubation. <strong>Subjects and Methods: </strong>A total of 60 patients of ASA grade I or II who were admitted in the hospital for general anaesthesia were included in the study. The total number of patients was randomly divided into two groups containing 30 patients each. In one of the group the endotracheal intubation was performed using the Macintosh laryngoscope while in the other group the endotracheal intubation was performed using the C-MAC video laryngoscope. After successful completion of the intubation process the various hemodynamic parameters were constantly recorded at regular time interval for any sign of hemodynamic response among the patients post intubation. <strong>Results: </strong>Hemodynamic parameters such as systolic, diastolic and mean arterial pressures and mean heart rate were found to be significantly higher among the Macintosh laryngoscope group in comparison to the C-MAC group. However, no significant difference was observed in the percentage of oxygen saturation among the two groups. The time taken for glottis view and total time taken for intubation was found to be significantly higher among the patients intubated with Macintosh laryngoscope in comparison to C-MAC laryngoscope. The increase in the total time taken for intubation was significantly found to increase the hemodynamic response among the patients signifying the increased risk of hemodynamic complications among patients intubated with Macintosh laryngoscope. Cormack-Lehane grading was found to be higher among the patients intubated with the Macintosh laryngoscope which might have resulted in the increased intubation time among the patients intubated with Macintosh laryngoscope. The percentage of successful intubation at the first attempt was also found to be higher in the C-MAC laryngoscope group in comparison to the Macintosh group.The percentage of glottis opening (POGO) was found to increase significantly with C-MAC video laryngoscope in comparison to the Macintosh laryngoscope. <strong>Conclusion: </strong>The study concluded that video guided C-MAC laryngoscope was a better alternative to conventional Macintosh laryngoscope with decreased hemodynamic response and increased successful intubation among the patients.</p> Valluri Anil Kumar, Busetty Prithvi Raj, V.S.P. Rajesh, A. Murali Chandradhar Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/935 Fri, 06 Sep 2019 00:00:00 +0000 A Randomized Prospective Study to Compare TruflexArticulating Stylet (TAS) versus Rapid Position Intubating Stylet (RPIS)by using D -Blade Video Laryngoscopy with Manual Inline Stabilization During Cervical Spine Surgeries https://aijournals.com/index.php/aan/article/view/938 <p><strong>Background: </strong>Intubation is an optimal method for opening the airway and effective ventilation to the patient. There are some problems during intubation. It is important to identify devices like videolaryngoscopes and guides for shorten the procedure. This study addresses the use of a Truflex Articulating Stylet (TAS) verses Rapid position intubating Stylet (RPIS) using D -blade video laryngoscopy with manual inline stabilization during cervical spine surgeries. <strong>Subjects and Methods: </strong>It was single blinded, prospective, randomized, interventional study. Sixty patients between 18 and 60 years of age belonging to either sex undergoing tracheal intubation under uniform general anesthetic technique will be randomly divided into Rapid position intubating Stylet (RPIS) group and Truflex articulating stylet group during cervical spine surgeries. For comparison of intubation times and the Intubation Difficulty Score, ANOVA will be used. Mallampatigrading (MPG), mouth opening (MO), thyromentaldistance (TMD), sternomentaldistance (SMD), CormackLehane's grading (CLG) were recorded. Student t test, Fisher’s exact test, Mann–Whitney U test and Chi square test were used where appropriate. A p value of less than 0.05 was considered statistically significant. <strong>Results: </strong>Intubation using a video laryngoscope with a Truflex articulating stylet was more effective than that using a standard intubation stylet with the same laryngoscope. There were no complications observed during the procedure with either of the stylets. There was no significant difference between the two groups with respect to total intubation time. <strong>Conclusion: </strong>The results suggest that the patients intubated using Truflex articulating stylet and RPIS stylet has no difference in terms of successful or failed intubation. The patients intubated using Truflex articulating stylet has lesser endotracheal tube negotiation time compared to the patients intubated with RPIS and without much significant difference in number of attempts, total intubation time, glotticoscopy time and any complications in any stylets.</p> Busetty Prithvi Raj, Kuraparthy Brinda, Anil Kumar Valluri, P Purohithi, Thomaala Madhavarao Mahadev Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/938 Sat, 07 Sep 2019 00:00:00 +0000 Effectiveness of Intra- Aortic Ballon Pump (IABP) Insertion as Rescue Mechanical Support for on Pump Coronary Artery Bypass Surgery Patients with Persistent Intraoperative Hemodynamic Instability. https://aijournals.com/index.php/aan/article/view/940 <p><strong>Background: </strong>Aim: Aim of this study was to evaluate the efficacy of IABP as a rescue mechanical support intra-operatively in persistent hemodynamic instability in a group of patients who have undergone elective CABG surgery. <strong>Subjects and Methods: </strong>It is a retrospective study conducted on patients who have undergone on pump CABG and received rescue IABP support intraoperatively. The IABP was inserted in the presence of hemodynamic instability as a rescue, inserted percutaneously via right&nbsp; or left femoral artery approach. <strong>Results: </strong>There is a marginal increase in the duration of mechanical ventilation 68.99±30.93 hours and duration of ICU stay 5.97±1.93 days. All patients had significant ST-T changes in more than 2 leads. No major complications related to IABP were recorded. An echocardiogram shown significant improvement in EF (p value=&lt;0.0001). No in-hospital and 30 days mortality was recorded. <strong>Conclusion: </strong>This study shows significant improvement in hemodynamics post IABP insertion; improvement in EF at discharge from hospital and no mortality at discharge from hospital and 30 days postoperatively. IABP also decreased the postoperative length of stay. Preoperative IABP suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB.</p> Harish R, Rajitha A, Kodandapani C Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/940 Sat, 07 Sep 2019 00:00:00 +0000 Upper Limb Surgeriesunder Brachial Plexus Block Using Infusion of Dexmedetomidine or Propofolfor Monitored Anaesthesia Care - A Comparative Study https://aijournals.com/index.php/aan/article/view/969 <p><strong>Background: </strong>Brachial plexus block is widely used for upper limb surgeries but intraoperatively,patients remain awake and anxious. This study has compared the intraoperative sedation of dexmedetomidine infusion versus propofol infusion during upper limb surgeriesby using monitored anesthesia care.<strong>Subjects and Methods:</strong>Sixty adult consenting patients of ASA physical status I to III of either&nbsp;&nbsp;&nbsp; genderwereenrolled and brachial plexus block was established with 20 mL of 0.5% bupivacaine using ultrasound. Patients were randomized into two equal groups of 30 patients each to receive either dexmedetomidine1µg/kgover 10 min, followed by maintenance fusion of 0.4 µg/kg/h (Group D) or propofol infusion of 75µg/kg/min over 10 min,followed by 50µg/kg/min (Group P). Intraoperative sedation and duration of postoperative analgesia were primary objectives. The hemodynamic changes, respiratory depression, recovery from sedationor any adverse events were noted as secondary outcomes.<strong>Results:</strong>Ultrasound helped to observe the spread of local anesthetic agent at brachial plexus. The patients of propofol group had faster onset with early recovery from sedationbut sedation in patients of dexmedetomidine was clinically better with statistically significant difference. Duration of postoperative analgesia was also significantly enhanced with dexmedetomidine infusion. In propofol group, the blood pressure and heart rate remained lower when compared to dexmedetomidine infusion. There was no episode of respiratory depression in any patient.<strong>Conclusion: </strong>Dexmedetomidine infusion was better due to its stable hemodynamic profile, better intraoperative sedation and enhanced duration of postoperative analgesia without respiratory depressionduring upper limb surgeries.</p> Kumkum Gupta, Salony Agarwal, Prashant K Gupta, Abhishake Kumar, Pavitra Kalra, Kopal Gupta Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/969 Tue, 01 Oct 2019 00:00:00 +0000 Clonidine versus Tramadol as Adjuvant to Epidural Anaesthesia With 0.5% Bupivacaine for Lower Limb Orthopaedic Procedures https://aijournals.com/index.php/aan/article/view/970 <p><strong>Background: </strong>Epidural anesthesia is safe to provide surgical anesthesia and postoperative analgesia. Its efficacy can be improved with diversity of adjuvants. The aim of the study was to compare the clonidine versus tramadol asepidural adjuvant to 0.5% bupivacaine for lower limb orthopaedic procedures.<strong>Subjects and Methods:</strong>Sixty adultpatientswere enrolled and divided intwo equal groups of 30 patients each to receive 14 mL of 0.5% bupivacaine with either1ml (50µg) clonidine (Group I) or 1ml (50mg) tramadol (Group II), through lumbar epidural catheter at L3-L4 intervertebral space.Theonsetanddurationofsensory andmotorblockadewithhighest cephalicspreadandduration ofpostoperative analgesiawereassessedasprimary objectives.Hemodynamic changes, respiration, sedationlevel or any adverse events were assessedassecondaryend points. <strong>Results:</strong>Mean onset timeand two dermatome sensory regression wascomparable. The meandurationofsensory analgesiawas 216.08±46.18mininpatientsof Group I and 251.33 ± 58.5 mininpatientsof Group II withstatistically highly significantdifferencebetween the groups (P=0.000). Mean onset time and duration ofmotorblockade wascomparable. The hemodynamic parameters remained stable, though 4 patients of Group I developedmanageable hypotension. No episode of respiratory depression, shivering, pruritus, nauseaandvomiting was observed.&nbsp; <strong>Conclusion: </strong>Tramadol (50mg)asepidural adjuvantto0.5%bupivacainewas better than clonidineforenhancingtheduration of postoperativeanalgesiainpatientsundergoing lower limb orthopedic procedures.</p> Kumkum Gupta, Pavitra Kalra, Prashant K Gupta, Salony Agarwal, Abhishake Kumar, Iqraa Khanum Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/970 Tue, 01 Oct 2019 00:00:00 +0000 Comparative Analysis of Different Doses of Intrathecal 1% Chloroprocaine in Patients Undergoing Short Duration Lower Limb Surgery https://aijournals.com/index.php/aan/article/view/972 <p><strong>Background: </strong>Preservative free Chloroprocaine seems like a promising alternative, being a short acting agent of increasing popularity in recent years. Chloroprocaine has many advantages like quick onset, dense sensory and motor block of short duration hence this drug is considered as a preferred choice for patient undergoing short duration lower limb surgery. Present study was performed with an aim to study and compare intra operative quality and duration of anaesthesia and level of sub arachnoid block. <strong>Subjects and Methods: </strong>This study was planned to evaluate the effect of 3ml, 4ml and 5ml of chlorprocaine in subarachnoid block in patient undergoing short duration lower limb surgery umder spinal anesthesia. After obtaining approval from the institutional ethics committee and informed consent, 50 patients between age group 16- 47 years of either sex belonging to ASA grade I and II for elective short duration lower limb surgeries were included in the study. A specially design performa was used to collect the data patient allocated to either group A(3ml),group B(4ml),group C(5ml) of intrathecalchloroprocaine. <strong>Results: </strong>There is no significant difference in patient age, gender &amp; ASA classification in three groups. There is no significant difference of systolic and diastolic blood pressure and heart rate between three groups. There is no significant difference in onset of sensory and motor block in these groups, but the duration of sensory block was shorter in group A (60.14±7.45) than group B (81.15±10.36) &amp; group C (102.79±7.64).<strong>Conclusion: </strong>Intrathecal 1% is safe short acting local anesthetics for short or ultra-short surgical procedures. Onset and duration of sensory and motor block &amp; time of recovery of ambulation were dose related.</p> Sanjay M Modi, Shobha Khandelwal Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/972 Tue, 01 Oct 2019 00:00:00 +0000 Utilization of Intrathecal Midazolam for the Prevention of Nausea and Vomiting In Caesarean Section under Spinal Anaesthesia- A Prospective Study https://aijournals.com/index.php/aan/article/view/973 <p><strong>Background: </strong>Antiemetic effect of midazolam could be explained by its action at the chemoreceptor trigger zone reducing synthesis, release and postsynaptic effect of dopamine. Administration of low dose of iv midazolam as premedication prior to caesarean section reduces anxiety of mother, without any adverse effect on newborn. Therefore present study was done with an aim to evaluate the effect of intratechal midazolam for reduction in incidence of intraoperative and immediate postoperative nausea and vomiting.<strong>Subjects and Methods:</strong>Present prospective study was performed in the department of Anesthesia, Pacific institute of Medical Science, Udaipur, Rajasthan for the period of one year. The patients received 10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 2 mg (0.4 ml) midazolam in Group A as a study group and 10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 0.4 ml normal saline in Group B as a control group. The patients were evaluated for possible adverse effects, including sedation, respiratory depression, nausea and vomiting, by a researcher who was blinded to the details of the study until 3 hours after the end of surgery.<strong>Results:</strong>28.8% of patients in control group had nausea as compared to 17.7% of patients in midazolam group. Similarly, 15.5% of the patients in control group had retching as compared to 2.2% in midazolam group. 2.2% of patients in midazolam group had frank vomiting where as in control group, 18.33% of the patients had vomiting. Difference between both groups regarding emetic symptoms was found to be significant statistically (p≤0.05).<strong>Conclusion: </strong>Intrathecal midazolam 2 mg with 0.5% hyperbaric bupivacaine in the subarachnoid block was effective significantly to prevent nausea and vomiting in parturient undergoing caesarean section under spinal anaesthesia.</p> Naitik B. Patel Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/973 Tue, 01 Oct 2019 00:00:00 +0000 Utilization of Intrathecal Midazolam for the Prevention of Nausea and Vomiting in Caesarean Section under Spinal Anaesthesia- A Prospective Study https://aijournals.com/index.php/aan/article/view/974 <p><strong>Background: </strong>Antiemetic effect of midazolam could be explained by its action at the chemoreceptor trigger zone reducing synthesis, release and postsynaptic effect of dopamine. Administration of low dose of IV midazolam as premedication prior to caesarean section reduces anxiety of mother, without any adverse effect on newborn. Therefore present study was done with an aim to evaluate the effect of intratechal midazolam for reduction in incidence of intraoperative and immediate postoperative nausea and vomiting.<strong>Subjects and Methods:</strong>Present prospective study was performed in the department of Anesthesia, Pacific institute of Medical Science, Udaipur, Rajasthan for the period of one year. The patients received 10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 2 mg (0.4 ml) midazolam in Group A as a study group and 10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 0.4 ml normal saline in Group B as a control group. The patients were evaluated for possible adverse effects, including sedation, respiratory depression, nausea and vomiting, by a researcher who was blinded to the details of the study until 3 hours after the end of surgery.<strong>Results:</strong>28.8% of patients in control group had nausea as compared to 17.7% of patients in midazolam group. Similarly, 15.5% of the patients in control group had retching as compared to 2.2% in midazolam group. 2.2% of patients in midazolam group had frank vomiting where as in control group, 18.33% of the patients had vomiting. Difference between both groups regarding emetic symptoms was found to be significant statistically (p≤0.05).<strong>Conclusion: </strong>Intrathecal midazolam 2 mg with 0.5% hyperbaric bupivacaine in the subarachnoid block was effective significantly to prevent nausea and vomiting in parturient undergoing caesarean section under spinal anaesthesia.</p> Naitik B. Patel Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/974 Tue, 01 Oct 2019 00:00:00 +0000 Efficacy of the LMA-ClassicTM and LMA ProsealTM in Children Undergoing Elective Surgery under General Anaesthesia https://aijournals.com/index.php/aan/article/view/975 <p><strong>Background: </strong>The LMA-Proseal<sup>TM</sup> is a second generation supraglottic airway device with modified cuff and a drainage tube, designed for better seal with both the respiratory and gastrointestinal tracts, notwithstanding the access to the alimentary tract. The present study is planned to compare efficacy of the LMA-Classic<sup>TM</sup> and LMA Proseal<sup>TM</sup> in children undergoing elective surgery under general anaesthesia. <strong>Subjects and Methods: </strong>120 children belonging to American Society of Anesthesiologists Physical Status 1 and 2, aged 3 to 15 years and weighing 5 to 45 kg undergoing elective surgery in the supine position were randomized for airway management with the LMA-Classic<sup>TM</sup> or LMA Proseal<sup>TM</sup> by computer-generated random assignments. <strong>Results: </strong>There was no difference between LMA Classic<sup>TM</sup> and LMA Proseal<sup>TM</sup> with regard to ease of insertion, number of attempts for insertion, device positional stability, airway trauma and hemodynamic changes. <strong>Conclusion: </strong>The LMA-ProsealTM has advantages over LMA-Classic<sup>TM</sup> like the placement of gastric tube, adequate ventilation and oxygenation without any gastric distension. The complications of usage of the LMA are minimal and similar in both the devices.</p> Pratik M Doshi, Ashish B Shah Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/975 Tue, 01 Oct 2019 00:00:00 +0000 Haemodynamic Comparison between Isobaric Bupivacaine Fentanyl and Isobaric Ropivacaine Fentanyl for Lower Abdomoinaland Lower Limb Surgery https://aijournals.com/index.php/aan/article/view/976 <p><strong>Background: </strong>Spinal anesthesia is the most commonly used method of anaesthesia and analgesia in lower limb surgeries.&nbsp; Spinal anaesthesia causes more sympatholysis and haemodynamic disturbances than general anesthesia. A low dose of local anaesthetic is preferred which may occasionally cause failure of spinal anaesthesia. Therefore, different adjuvants are added to local anesthetic to achieve desired level anesthesia. Aim: The aim of this study was to compare intraoperative haemodynamic changes associated with intra thecal use of isobaric 0.5% Bupivacaine 3ml(15mg)and isobaric 0.5% Ropivacaine 3ml(15mg)both with 20 mcg(0.4ml) Fentanyl in patient undergoing lower abdominal and lower limb surgery.<strong>Subjects and Methods:</strong>100 patients were divided into two groups of fifty each. First group (Group B) was given spinal anaesthesia with 0.5%&nbsp; bupivacaine 3ml(15mg) with 20mcg (0.4ml) Fentanyl and second group (Group R) was given spinal anaesthesia 0.5% ropivacaine 3ml(15mg) with 20mcg (0.4ml) Fentanyl. Baseline and intra operative haemodynamic parameters; onset and duration of sensory and motor blockade were evaluated. Unpaired Students t-test and analysis of variance were applied for quantitative data and Chi - square test for qualitative data.<strong>Results:</strong>Incidence of hypotension was greater in Bupivacaine group than Ropivacaine group (p=0.001). Duration of sensory and motor blockade was less in Ropivacaine group than Bupivacaine group (p&lt;.05).<strong>Conclusion: </strong>Ropivacaine Fentanyl provided better haemodynamic stability and shorter duration of motor block as compared to Bupivacaine Fentanyl so it is a better choice of anaesthesia in surgeries and early ambulation.</p> Sangeeta Varun, Tuhin Vashishth Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/976 Tue, 01 Oct 2019 00:00:00 +0000 Use of Bi-plane Mode of Transesophageal Echocardiography for Real Time Visualization and Cannulation of the Internal Jugular Vein: A Safe and effective Alternative https://aijournals.com/index.php/aan/article/view/977 <p><strong>Background: </strong>To check feasibility and efficacy of biplane mode of the transesophageal echocardiography (TEE) probe for use of visualization and cannulation of internal jugular vein (IJV).<strong>Subjects and Methods:</strong>This is Prospective, randomized, controlled pilot study done at tertiary care hospital. Fifty adult cardiac surgery patients in current study received right IJV catheterization using the TEE probe. Another fifty patient undergone same IJV cannulation with use of linear probe. The puncture time, success rate in first attempt, quality of the imaging with needle tip positioning and wire positioning were recorded. The occurrence of complication or any adverse event was also observed.<strong>Results:</strong>There was statistical difference in puncture time between two groups. Puncture time was less in TEE group. One failed puncture attempt with linear probe was there.&nbsp; There was no statistical difference in image quality with needle tip positioning and wire positioning between groups. No complications or adverse events were observed in either group.<strong>Conclusion: </strong>The Bi-plane mode of TEE probe can be used for visualization and cannulation of IJV to achieve higher success rate and decrease chance of complication with favorable feasibility and safety.</p> <p>&nbsp;</p> Harshil Joshi, Vijaya Kumara, Guruprasad Rai Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/977 Tue, 01 Oct 2019 00:00:00 +0000 Comparative Evaluation of Intrathecal Dexmedetomidine and Fentanyl with Hyperbaric Bupivacaine for Post-Operative Analgesia in Lower Abdominal Surgeries https://aijournals.com/index.php/aan/article/view/978 <p><strong>Background: </strong>Spinal anaesthesia is the fastest and most reliable form of regional anaesthesia. Additions of intrathecaly adjuvants are useful for prolonging the spinal anaesthesia effects.<strong>Subjects and Methods:</strong>The Patients were divided in three groups; Group C (control group) = received&nbsp;&nbsp; 15 mg (3 ml) of hyperbaric bupivacaine intrathecaly.&nbsp; Group D = received 15 mg (3 ml) of hyperbaric bupivacaine plus 4μgDexmedetomidine intrathecally. Group F = received Hyperbaric Bupivacaine 15mg (3ml) plus 25μg fentanylintrathecally.<strong>Results: </strong>For the total duration of sensory block p- value is 0.000003, which is less than 0.05 (α) and is highly significant. From the above p – value and scheffe post hoc test we conclude that the Bupivacaine + Dexmedetomidine has prolonged duration of sensory block as compared to bupivacaine alone and in combination with fentanyl. For the motor block p- value is 0.000000 and is less than 0.05 (α). It is highly significant. For the demand of Analgesic p-value is 0.0000001 and is less than 0.05 (α) i.e. there is highly significant difference between them. <strong>Conclusion: </strong>Intrathecal Dexmedetomidine&nbsp; used as an adjuvant to bupivacaine in spinal block seems to be a good alternative to intrathecal fentanyl as it produces&nbsp; early&nbsp; onset&nbsp; and prolonged&nbsp; duration&nbsp; of&nbsp; sensory and motor block&nbsp; without&nbsp; significant haemodynamic alteration and side effects.</p> Arun Kumar Saxena, Sapna Singh, B.L. Mathur, Neena Rungta Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/978 Tue, 01 Oct 2019 00:00:00 +0000 A Comparison of Caudal Epidural with Intravenous Ketamine Anaesthesia in Below Umbilicus Surgery in Paediatric Patients https://aijournals.com/index.php/aan/article/view/979 <p><strong>Background: </strong>Caudal epidural block has been found to be a safe and simple technique in paediatric surgery below umbilicus. This study was done to make a clinical comparison between effectiveness of caudal epidural and general anaesthesia with total intravenous Ketamine, in terms of intra-op and post- op analgesia. <strong>Subjects and Methods: </strong>Fifty patients in age group 1-12 years undergoing surgery below umbilicus were divided into 2 groups .Each group had 25 patients belonging to ASA groups 1 and 2. Group A was given general anaesthesia with total intravenous Ketamine. Group B received Caudal Epidural block under brief general anaesthesia with thiopentone. <strong>Results: </strong>Caudal block using injection 1% xylocaine was found to be a valuable technique of anaesthesia in paediatric surgery below umbilicus as it offered greater advantage of post op analgesia up to 6 hours. The recovery of consciousness was rapid on account of light general anaesthesia. <strong>Conclusion: </strong>Caudal blocks are effective in alleviating pain during intra op and post op period in sub-umbilical surgeries in paediatric patients. They offer perioperative hemodynamic stability along with the added advantage of minimal post-op sideeffects.</p> Geetanjali Singhal, Manish Kumar Modi, BL Mathur Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/979 Tue, 01 Oct 2019 00:00:00 +0000 Quadratus Lumborum Block for Post-Operative Analgesia Following Anterior Iliac Crest Bone Graft Harvesting. https://aijournals.com/index.php/aan/article/view/980 <p><strong>Background: </strong>The anterior iliac crest is the most common site used for harvesting autologous bone graft. This can lead to acute and chronic iliac crest donor site pain leading to significant morbidity. Quadratuslumborum block is a newer advanced block which may help to alleviate this pain. This study aims to evaluate the effect of quadratuslumborum block on post operative analgesia in iliac crest bone graft patients. <strong>Subjects and Methods: </strong>A total of 60 patients aged between 18 yrs to 65 yrs were randomised into two equal groups. Group A received wound infiltration with local anesthesia. Group B received ultrasound guided quadratuslumborum block. Pain scores and opioid consumption were recorded in both groups. <strong>Results: </strong>Demographic profile was comparable in both the groups. The VAS score was significantly less in group B when compared to group A at 4th, 8th and 12th hrs (p &lt;0.0001). The opioid consumption was 250.28±40.65 in group A and 100.57±25.48 group B. <strong>Conclusion: </strong>Ultrasound guided Quadratuslumborum block effectively reduces post operative pain in anterior iliac crest bone graft site when compared to local anesthetic wound infiltration.</p> Kumar Lokesh K S, Rajalakshmi J Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/980 Fri, 04 Oct 2019 00:00:00 +0000 Comparison of Plain Ropivacaine and Ropivacainewith Dexmedetomidine in Caudal Epidural Blockfor Paediatric Infra Umbilical Surgery. https://aijournals.com/index.php/aan/article/view/981 <p><strong>Background: </strong>Context: Caudal analgesia is reliable and safe method for perioperative analgesia in paediatric patients for infraumbilical surgeries. To prolong the duration of caudal block, many additives are added with local anesthetics. Aim: To compare the effects of ropivacaine and dexmedetomidine mixture with plain ropivacaine in caudal block in paediatric infra umbilical surgeries. <strong>Subjects and Methods: </strong>Sixty patients of ASA grade 1 and 2, aged 6 month to 10 year, undergoing below umbilicus surgery, were divided into two groups of 30 each. Group R received 0.25 % ropivacaine (1 ml / kg) with 0.5 ml normal saline and group RD received 0.25% ropivacaine (1 ml / kg) with dexmedetomidine (1 µg / kg) in 0.5 ml normal saline. <strong>Results: </strong>The duration of postoperative analgesia was significantly longer and the requirement of rescue analgesia was significantly lower in group RD as compared to group R. <strong>Conclusion: </strong>Caudal Ropivacaine (0.25%) with dexmedetomidine (1µg / kg) proved more effective than plain ropivacaine (0.25%) in providing analgesia in paediatricinfraumbilical surgeries.</p> Manish Kumar Modi, Geetanjali Singhal, BL Mathur, Neena Rungta, Sapna Singh, L.D. Agrawal Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/981 Fri, 04 Oct 2019 00:00:00 +0000 Comparison of Intermediate Vs Subcutaneous Superficial Cervical Plexus Block for Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Study. https://aijournals.com/index.php/aan/article/view/982 <p><strong>Background: </strong>Superficial cervical plexus has been used successfully for postoperative analgesia following anterior cervical discectomy and fusion (ACDF) surgery. It is not known if superficial and intermediate cervical blocks are equally effective, although anatomical evidence suggests that the latter might provide superior quality of analgesia. The aim of our study was to compare the effect of intermediate cervical plexus block (ICPB) vs superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing ACDF surgery. <strong>Subjects and Methods: </strong>Forty-nine patients were randomised to receive either bilateral ICPB or bilateral SCPB in patients undergoing elective single- or two-level ACDF surgery. The primary outcome measure was the quality of recovery at 24 hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for intra- and postoperative opioid consumption. Groups were compared using Student’s t test, Mann-Whitney U test or Chi-square test for different type of data. A p-value of &lt;0.05 was considered statistically significant. <strong>Results: </strong>The mean (SD) aggregated global QoR-40 scores at 24 hr were significantly greater in the ICPB group, indicating good quality of recovery compared with the SCPB (186 ± 9 vs 173 ± 12, respectively; P = 0.001). Intra- and postoperative opioid consumption was significantly higher in SCPB group. No major block related complications were noticed during the study. <strong>Conclusion: </strong>We showed that compared to SCPB, ICPB provides better analgesia in patients undergoing single- or two-level ACDF, thereby improving the early quality of recovery. We strongly believe the existence of investing layer of cervical fascia of neck.</p> Sarasa K Sahoo, Panigrahi Souvagya, Pradhan S Chandra Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/982 Fri, 04 Oct 2019 00:00:00 +0000 Anesthetic Management of Tracheobronchial Foreign Body Aspiration Cases in Children https://aijournals.com/index.php/aan/article/view/983 <p><strong>Background: </strong>Foreign body aspiration is one of the most common emergencies in paediatrics and is a leading cause of mortality and morbidity in otherwise normal and healthy children. Present study analyses the anaesthetic management and outcome of tracheobronchial foreign body cases in paediatric age group in a span of one year in a tertiary care paediatric hospital setting. <strong>Subjects and Methods: </strong>Present retrospective study was conducted in patients subjected to diagnostic and therapeutic bronchoscopy for suspected foreign body removal from March 2017 to April 2018. The subjected data was collected as per age, sex, suspected history of foreign body aspiration, clinical features and their duration, location and type of foreign body based on physical examination and radiological evaluation, anaesthetic management and outcome, Intraoperative and postoperative complications if any, postoperative mechanical ventilation if required. All children underwent bronchoscopy using Storz rigid bronchoscope. <strong>Results: </strong>Seventy two cases underwent bronchoscopy, in 08 cases esophagoscopy was done, 30 patients underwent laryngoscopy out of which one patient required esophagoscopy as well. In 84.1% cases we were able to retrieve foreign bodies, while 15.9% had negative bronchoscopy. 32% patients had vegetative foreign bodies and most common in these were peanuts. Coin was the most common non-vegetative foreign body retrieved during laryngoscopy. On bronchoscopy it was discovered that the most common site of lodgement of foreign bodies was in right main bronchus followed by left main bronchus. <strong>Conclusion: </strong>Tracheobronchial foreign bodies are frequently observed in young children with serious life threatening effects. There is need for preventive measures including parental education and awareness.</p> Jaldeep B Patel, Arun kumar Chauhan Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/983 Fri, 04 Oct 2019 00:00:00 +0000 Comparison of Clonidine and Dexamedetomidinein Reduction of Pressor Response during Endotracheal Intubation- A Prospective Study https://aijournals.com/index.php/aan/article/view/984 <p><strong>Background: </strong>Clonidine and dexmedetomidine have been used for attenuating sympathetic response to laryngoscopy and endotracheal intubation. Both these drugs have α-1 and α-2 receptors agonist activity but dexmedetomidine has selective α-2 receptor agonist activity which helps to blunt sympathetic response to laryngoscopy and tracheal intubation. Present study was performed to compare the effect of single dose clonidine and dexmedetomidine in attenuating pressor response to laryngoscopy and intubation. <strong>Subjects and Methods: </strong>This was a prospective, randomized, controlled study on 68 adult patients aged between 18 and 65 years in American Society of Anesthesiologists (ASA) physical status I and II undergoing elective surgeries under general anesthesia. The patients were allocated randomly into two groups of 34 patients each group received as Group A [Clonidine group]:1μg/kg iv in 20 ml normal saline over 10mins.&nbsp; Group B [Dexmedetomidine group]: 1μg/kgivin 20 ml normal saline over 10mins. Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP), heart rate and SpO2 was noted after 5mins of drug administration, and again at the completion of study drug infusion. <strong>Results: </strong>There was no difference in HR, SBP, DBP&amp; MAP between the two groups during the infusion of study drug. After laryngoscopy and intubation, the mean HR, SBP, DBP &amp; MAP at 1st and 3rd minute was increased in Group A than Group B and it was statistically significant. Also, there was no significant difference between the mean HR of the two groups at 7th and 10th minute after intubation but group D had lower mean SBP, DBP &amp; MAP compared to group C which was significant. <strong>Conclusion: </strong>Preremedication with dexmedetomidine in dose has significantly attenuated the hemodynamic pressor responses to laryngoscopy and intubation when compared to clonidine.</p> Hetal Sonavane, Parth Shah Copyright (c) 2019 Academia Anesthesiologica International https://aijournals.com/index.php/aan/article/view/984 Fri, 04 Oct 2019 00:00:00 +0000