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CASE REPORTS
Anesthetic management of a case of ventricular bigeminy posted for elective LSCS
Channabasavaraj Sanikop, Balraj Hariharasudhan, MG Dhorigol
July-September 2015, 1(3):153-156
DOI:10.4103/2394-6954.173539  
Ventricular bigeminy is a type of dysrhythmia which can complicate any pregnancy and labor. These dysrhythmias occur most commonly as sporadic occurrences in view of anxiety and can be treated by reassurance. Nevertheless, in certain cases where if they occur in an increased frequency even after adequate reassurance and primary supportive care can lead to dangerous morbidities and mortalities. We present the management of a case of 21-year-old female patient presenting with ventricular bigeminy posted for elective lower segment cesarean section in our institution. General anesthesia was considered the anesthetic modality of choice and injections loxicard and metaprolol IV were used introperatively to tackle the occurrence of ventricular ectopics. In conclusion, thorough history, clinical examination, and judicious use of antiarrhythmic agents recommended during pregnancy can prevent an asymptomatic ventricular ectopy transforming into a fatal arrhythmia in managing a case of ventricular bigeminy.
  10,871 407 -
REVIEW ARTICLES
Anesthetic concerns in patients with hyper-reactive airways
Gundappa Parameswara
January-March 2015, 1(1):8-16
DOI:10.4103/2394-6954.149714  
Hyperreactive airway disease occurs due to acute viral or bacterial infections in children, and due to chronic bronchitis, Asthma or Emphysema in adults. Smoking and exposure to allergens may worsen the disease. Anaesthesia in these patients is associated with higher incidence of perioperative bronchospasm, postoperative laryngospam, breath holding, and hypoxia due to maldistribution of Ventilation and Perfusion. Smoking and exposure to allergens may worsen the outcome. Severe bronchospasm is a life threatening emergency. Selective β2 agonists form the main drug of choice for bronchospasm. Corticosteroids should be given early to reduce inflammation and mucosal oedema. For anaesthesia, Propofol, Vecuronium or Rocuronium, Halothane or Sevoflurane and Fentanyl are drugs of choice. Histamine releasing drugs like morphine and atracurium should be avoided. If ventilator support is required, Non invasive Pressure Support ventilation should be used first. However, Intubation and mechanical ventilation may become necessary, which however, may be associated with difficult weaning.
  9,117 950 1
ORIGINAL ARTICLES
Validation of the Apfel scoring system for identification of High-risk patients for PONV
Lulu Sherif, Radhesh Hegde, Mallikajaya Mariswami, Anjali Ollapally
July-September 2015, 1(3):115-117
DOI:10.4103/2394-6954.173527  
Background and Aims: Postoperative nausea and vomiting (PONV) still present an important problem in anesthesia. In order to identify surgical patients who may benefit from prophylactic antiemetic medication, it is of interest to evaluate the risk factors for PONV using a simple scoring system. The simplified Apfel score includes four factors: female gender, nonsmoking status, postoperative use of opioids, and previous history of PONV or motion sickness. Each of these risk factors is supposed to elevate the incidence of PONV by about 20%. The aim of this study was to validate Apfel's clinical risk assessment score for identification of patients with high risk for PONV in our hospital. Materials and Methods: In a prospective study, 150 patients posted for various elective surgeries under general anesthesia with endotracheal intubation were analyzed and grouped into five groups, based on the Apfel risk scoring system. Each risk was given a score of 1, the total score being 4. PONV was monitored for 24 h and classified as grades 0, 1, and 2. Grades 1 and 2 were considered as PONV. The results obtained were analyzed for total incidence of PONV in each group of Apfel's scores and they were compared with the predicted incidence of PONV as per the documented Apfel's risk assessment. Collected data were analyzed by the Chi-square test, and the scoring system was assessed for sensitivity and specificity. Results: Of the 150 patients assessed, a total of 42% had PONV. Patients grouped under Apfel Score I had PONV incidence of 25.5%, the group with Score II had an incidence of 37.8%, the group with Score III had 64.6%, and the group with Score IV had 83.3%. This incidence of PONV corresponded to the predicted approximate values of 20% for Apfel Score I, 40% for Apfel II, 60% for Apfel III, and 80% for Apfel IV. Conclusions: The Apfel scoring system is simple and useful for identifying patients with high risk for PONV.
  7,953 588 2
CASE REPORTS
Anesthesia management of an elderly patient having permanent pacemaker for total hip replacement
Suresh Govindswamy, Sowmya Geetha
October-December 2015, 1(4):194-195
DOI:10.4103/2394-6954.180655  
Elderly patients with serious cardiac problems are presenting for major orthopedic surgeries. We present a case of an elderly male patient posted for total hip replacement having a permanent pacemaker in situ in ventricle paced, ventricle sensed, pacing inhibited (VVI) mode. The patient, on preoperative examination, was found to have a complete atrioventricular (AV) block on electrocardiogram (ECG) and electrophysiology study showed degenerative AV conduction disease and symptomatic complete AV block. The patient had seizure disorder and anemia, for which the patient was treated accordingly and optimized before surgery. The pacemaker mode changed to vesiculo-vacuolar organelle (VVO). Combined spinal-epidural was given. Arterial line was secured and the patient was monitored hemodynamically. The patient tolerated the procedure of total hip replacement well; vitals were maintained within 20% of the baseline. Phenylephrine infusion was given to maintain blood pressure. After operation was shifted to the intensive care unit (ICU), pacemaker was reprogrammed to VVI mode, and epidural infusion for pain and vigilant monitoring was done. The patient was shifted to the ward on the 3rd day and was discharged on the 5th day. To conclude, combined spinal-epidural along with invasive cardiac monitoring is a reasonable choice for elderly patients with permanent pacemakers coming for major orthopedic surgeries.
  5,957 414 -
Anesthetic management of a patient with ischemic heart disease posted for open reduction internal fixation of the upper limb
Nikhila Rajendra, Ravi Madhusudhana
April-June 2015, 1(2):69-71
DOI:10.4103/2394-6954.163083  
Patients undergoing noncardiac surgery may develop cardiac complications. Perioperative myocardial infarction (PMI) may be an important predictor of short- and long-term morbidity and mortality associated with noncardiac surgery. The etiology of PMI can be multifactorial; hence, it is indicated that one single intervention will not successfully improve cardiac outcome following noncardiac surgery and multifactorial stepwise approach. Perioperative management of ischemic heart disease (IHD) patients undergoing noncardiac surgery requires careful teamwork and communication between the patient, primary care physician, anesthesiologist, and surgeon.
  4,823 510 -
REVIEW ARTICLE
Hemoglobin and oxygen transport
Nagan Varadaraj Nagalakshmi, Ravi Madhusudhana, Nikhila Rajendra, Abhishek Kanakuppe Manjunath
January-March 2016, 2(1):1-6
DOI:10.4103/2394-6954.190767  
Once oxygen (O 2 ) that is present in atmosphere enters the respiratory tract, it reaches the alveoli and diffuses from the alveoli into the pulmonary blood. It is transported to the peripheral tissue capillaries almost entirely in combination with hemoglobin (Hb). The presence of Hb in red blood cells allows the blood to transport 30-100 times as much O 2 as could be transported in the form of dissolved O 2 in blood. This article is based on the published textbooks and articles that speak on the importance of O 2 and Hb; we have tried to put it into one place so that we can relate and apply the concepts.
  3,996 549 -
CASE REPORTS
Airway challenges in thyroid surgery
Safiya I Shaikh, Bheemas B Atlapure
January-March 2015, 1(1):28-30
DOI:10.4103/2394-6954.149717  
Huge goiters can lead to tracheal compression and, hence, difficulty in endotracheal intubation. This along with retro-sternal extension makes it an anticipated difficult airway scenario. In this report, we present a case of huge goiter (papillary carcinoma) compromising the airway, which presented with difficult airway for total thyroidectomy. CT scan of neck revealed retro-sternal extension with the pretracheal plane fixed to the trachea. Trachea was completely pushed to the right. We successfully performed an awake direct laryngoscopy and successful intubation by locally anesthetizing the airway. Plan B was ready with fiberoptic bronchoscopy and rigid bronchoscopy. Patient was successfully extubated in the intensive care unit (ICU).
  3,880 408 -
EDITORIAL
Anesthetic aphorisms II
Mohammed Meesam Rizvi
October-December 2015, 1(4):169-170
DOI:10.4103/2394-6954.180659  
  1,212 2,818 -
CASE REPORTS
Anesthetic management of a patient with gestational thrombocytopenia for elective cesarean section
Channabasavaraj S Sanikop, Saumitra Misra, Noor F Akram
January-March 2015, 1(1):33-34
DOI:10.4103/2394-6954.149719  
Thrombocytopenia is a common manifestation in pregnancy. It is mostly dilutional when no pathological causation is evident. There are no clear-cut guidelines to determine the platelet count at which anesthesiologists can safely administer regional anesthesia in obstetric patients. A safe approach in an asymptomatic mother is outlined here.
  3,581 289 -
ORIGINAL ARTICLES
Effectiveness of addition of intrathecal tramadol with hyperbaric bupivacaine in prevention of shivering in parturients undergoing cesarean section under spinal anesthesia: A randomized Placebo-controlled study
Rakshith B Prasad, Chakravarthy J Joel, Varghese K Zachariah
July-September 2015, 1(3):123-127
DOI:10.4103/2394-6954.173536  
Context: Intravenous (IV) tramadol has been in use for the treatment of postanesthetic shivering. Aims: To assess the efficacy of addition of tramadol to bupivacaine in subarachnoid block to reduce the incidence of shivering. Settings and Design: The study was conducted as a single-blind study in a 350-bedded teaching hospital. Materials and Methods: One hundred parturients undergoing cesarean section were randomly divided into two groups of 50 each. Group T received 0.2 mL (10 mg) of tramadol with 2 mL of 0.5% bupivacaine. The presence of shivering was noted intraoperatively and postoperatively. Statistical Analysis Used: Student's t-test (two-tailed, independent) was applied for continuous variables and Chi-square/Fisher's exact test was applied for categorical variables between the two groups. Results: Shivering was noted in 66% of the patients in Group NS as against the 16% noted in Group T with a majority of the cases (88%) noted in the intraoperative period. The mean duration to the two-segment regression was 135 ± 26 min in Group T versus 104 ± 22 min in Group NS and duration to 1-grade motor block regression was 128 ± 21 min in Group T versus 103 ± 18 min in Group NS. The analgesic effect of the block lasted for a mean duration of 232 min in Group T and 176 min in Group NS while nausea and vomiting were increased in group T versus NS. Conclusions: Tramadol (10 mg), along with bupivacaine given intrathecally plays a significant role in reducing the incidence of anesthesia-induced shivering in parturients while prolonging both the sensory and motor components of the subarachnoid block.
  3,335 341 -
REVIEW ARTICLE
Anaesthesia for VP Shunt Surgery
Summit Dev Bloria, Pallavi Bloria, Ketan Kataria
January-March 2017, 3(1):1-3
DOI:10.4103/kaj.kaj_17_17  
VP Shunt is one of the most commonly performed neurological surgeries.The patients undergoing this procedure may vary in age from neonates to elderly; they may be fully conscious or neurologically impaired. Knowledge of specific considerations of these patients will help the anesthesiologist to manage these patients in a better way.
  3,307 347 -
CASE REPORTS
Chemical lumbar sympathectomy for lower limb rest pain associated with thromboangiitis obliterans
Karthik Jain, Vasudeva Upadhyaya, Sheela Varghese
July-September 2015, 1(3):157-159
DOI:10.4103/2394-6954.173528  
Thromboangiitis obliterans (TAO) is often misdiagnosed and hence, there is enormous suffering by patients. Surgical options are limited in the management. Most of the drugs used for medical management do not alleviate pain or help in the healing of ischemic ulcer. Chemical lumbar sympathectomy (CLS) can help patients by relieving pain and improving blood flow to the affected area. It is a therapeutic option performed under local anesthesia with relatively less morbidity. Although the drugs used can cause neuritis, sympathectomy is a better option. Proper diagnosis and accurate neurolytic block helps in relieving patient suffering. A 30-year-old chronic smoker diagnosed to have TAO of the right lower limb underwent CLS with alcohol. The patient had good pain relief.
  3,232 260 -
ORIGINAL ARTICLES
A comparative study of intravenous dexmedetomidine-versus propofol-based sedation for awake fiberoptic intubation along with airway blocks in cervical discectomy patients
Kolli S Chalam
January-March 2015, 1(1):21-27
DOI:10.4103/2394-6954.149716  
Background: In unstable cervical spine, optimal intubation positioning of the patient may be unsafe. Awake intubation is indicated, which is rendered more comfortable by light sedation. Aims and Objectives: This study compared intravenous dexmedetomidine versus propofol-based sedation for awake fiberoptic intubation along with airway blocks. Materials and Methods: 100 ASA I and II patients with cervical PIVD are recruited for this study. Vital parameters such as heart rate, systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and SPO2 were monitored at regular intervals. Patient sedation score, endoscopy score, intubation score, post-intubation conditions, and discomfort score were also recorded. Results: There was no statistically significant difference between the two groups with respect to SBP, DBP, mean blood pressure (MBP), heart rate (HR), and SPO2. Conclusions: Dexmedetomidine appeared to offer better patient tolerance, better preservation of a patent airway, and spontaneous ventilation.
  3,043 382 -
REVIEW ARTICLE
Future of dexmedetomidine in gastrointestinal endoscopy
Hemlata Kapoor, Kirti Gujarkar
October-December 2015, 1(4):171-173
DOI:10.4103/2394-6954.180660  
In the scenario of gastroendoscopic setup, sedation is meant to enhance the comfort of the patient and to allay anxiety associated with the procedure. Most of the procedures under gastroendoscopic setup are performed on daycare basis; hence, the drugs with shorter half-life and which are easily metabolized are preferred. Dexmedetomidine is an attractive alternative to sedatives when the patient needs to be spontaneously breathing and easily arousable from sedation.
  2,234 1,190 -
ORIGINAL ARTICLES
Comparison of thiopentone sodium and propofol as anesthetic agents for modified electroconvulsive therapy
BP Manjula, PS Nagaraja
July-September 2015, 1(3):128-133
DOI:10.4103/2394-6954.173532  
Electroconvulsive therapy is a simple procedure, performed on highly diverse patient population with severe, drug resistant depression and other psychiatric disorders. Due to the occurrence of physical and psychological trauma caused to the conscious patient, has led to the concept of modified electroconvulsuve therapy. Ideal anaesthetic used for electroconvulsive therapy should have characteristics that include rapid induction, shorter duration of action, minimal side effects, rapid recovery and no interference with electroconvulsive therapy efficiency. The present study has compared propofol, which has been increasingly used recently with thiopentone, the drug most widely acceptable even today as anaesthetic agents for electroconvulsive therapy. This study was performed to assess the comparative effects of propofol and thiopentone sodium on recovery profile, hemodynamic stability and seizure duration during and after electroconvulsive therapy.
  2,992 253 -
REVIEW ARTICLE
Developing protocols for administering anesthesia
Murali Chakravarthy, Keshava Reddy, Jayaprakash Krishnamoorthy, Simha Rajathadri, Priya Motiani, Deepak Kavarganahalli, Ashokananda Devanahalli, Anitha Prashanth, Geetha Muniraju, Deepak Sheshadri, Mohan Gowda, Antony George
April-June 2016, 2(2):43-48
DOI:10.4103/2394-6954.194821  
The industrial sector especially the aviation industry has shown the world that by using check lists and protocols, disasters could be prevented. It is now a common practice in many fields to establish protocols to standardize the practices. Such standardization makes the processes similar despite various users practicing the procedure. Although in anesthesia, there are several guidelines suggested by bodies such as the American society of anesthesiologists and Indian society of anaesthetists, strict protocols are not available even for the commonly undertaken procedures. Anesthesia is akin in many respects to flying an aircraft. The induction of anesthesia compared to take off of an aircraft, maintenance to cruising and extubation to landing. It was therefore thought that anesthesia similar to aircraft flying could be made safer by using protocols and checklists. However it may take a while for the practice of anesthesia to get to the “6 Sigma” safety that the airline industry currently enjoys. It is our effort to standardize the commonly performed surgeries at our institution. “The protocols in Anesthesia” emerged as a result of the back breaking work of the consultants in the department of anesthesia. The intention of this effort was to standardize the practice of anesthesia in our institution and to showcase the benefits of such standardization. It is hoped that other institution interested in standardizing their practice could formulate their own protocols. It is also desirable that a “copy and paste” of other protocols in unlikely to benefit the end users. The authors wish to bring forth the point that customized protocols should emerge with the efforts of the users themselves. It becomes more pertinent to suit one's protocol to the prevailing infrastructure, availability of therapeutic agents and economic conditions. The authors sincerely hope this endeavour might stimulate others to put their systems in place, if not pre-existing
  1,970 1,249 -
CASE REPORTS
Management of submandibular abscess with limited resources
Jyoti Sharma, Amiya R Patnaik, Neerja Banerjee, Rajesh Sood
April-June 2017, 3(2):37-39
DOI:10.4103/kaj.kaj_20_17  
Though incidence of submandibular abscess is decreasing, from an anaesthesiologist point of view, it is invaluable to understand the disease process as the greatest impact is on the airway and failure of management can lead to catastrophic outcome. Successful management of submandibular abscess requires an accurate diagnosis, understanding the anatomy and spread of infection in the head and neck, airway control, appropriate antibiotic therapy and surgical drainage whenever needed. As an anaesthesiologist to be challenged with a submandibular abscess may not be infrequent particularly in a developing country like India, where dental and oropharyngeal hygiene can be of grave concern. The standardised approach of successful anaesthetic management of submandibular abscess usually involves an awake nasal intubation. But this may not be possible in some situations like an uncooperative patient, an acute emergency with limited resources where fibre optic bronchoscope is unavailable. We describe the successful management of one such case.
  2,644 202 -
ORIGINAL ARTICLES
Hemodynamic responses to endotracheal intubation: A comparison between Bonfils intubation fiberscope and direct laryngoscopy
Bharathi Hosdurg, Gollapalli Satyanarayanarao Nagaraj Prabhakar, Parameswara Gundappa, Jayashree Simha, Jalaja Koppa Ramegowda, Anita Pramod, Hanuman Srinivasa Murthy
January-March 2015, 1(1):17-20
DOI:10.4103/2394-6954.149715  
Background: Laryngoscopy and intubation are intensely stimulating procedures and can induce marked sympathetic responses. We hypothesized that by minimizing the oropharyngeal stimulus with Bonfils rigid fiberscope intubation, the hemodynamic responses to endotracheal intubation will be lesser. Therefore, we compared Bonfils intubation with conventional direct laryngoscopic intubation in adult patients with normal airway. Materials and Methods: Sixty adult patients of either sex, belonging to American Society of Anesthesiologists grade 1 or 2, were randomized into Bonfils group and laryngoscopy group, and studied over a 2-year period. Anesthet ic technique was standardized in both the groups. Hemodynamic variables were recorded at pre-induction, induction, post-induction at laryngoscopy and intubation, thereafter for every minute for 10 min, and half hourly till the end of surgery for both the groups. Intubation time, intubation attempts, and postoperative complications like hoarse voice and sore throat were compared between the two groups. Results: There was no statistically significant difference between the two groups with respect to systolic blood pressure, mean blood pressure, and heart rate changes throughout the study period. There was a statistically significant difference in the diastolic blood pressure (DBP) values between the groups (P < 0.05) for the first 10 min following intubation. The time required for intubation was significantly longer in the Bonfils group (36 ± 6 s) compared to the laryngoscopy group (28 ± 6 s) (P = 0.000). The incidence of postoperative sore throat (P = 0.009) and hoarseness of voice (P = 0.045) was significantly lesser in the Bonfils group compared to the laryngoscopy group. Conclusion: There was no clinically significant difference in the hemodynamic changes following intubation using either Bonfils fiberscope or conventional laryngoscope. Bonfils intubation required longer time, but was associated with lesser incidence of sore throat and hoarseness of voice when compared to laryngoscopic intubation.
  2,574 255 -
A comparative study of labetalol and fentanyl on the sympathomimetic response to laryngoscopy and intubation in vascular surgeries
Babita , Bhupendra Singh, Anjum Saiyed, Reema Meena, Indu Verma, Chand Kishan Vyas
April-June 2015, 1(2):64-68
DOI:10.4103/2394-6954.163081  
Background: Stress response to laryngoscopy and intubation causes autonomic or endocrine disturbance such as hypertension, tachycardia, and arrhythmias that may be potentially dangerous in cardiovascular disease patients. These changes are maximum at 1 min after intubation and last for 5-10 min. Labetalol is a selective α1- and nonselective β1- and β2-adrenergic antagonist. It lowers blood pressure (BP) by decreasing systemic vascular resistance by α1-blockade and reflex tachycardia attenuated by simultaneous β-blockade. Fentanyl is a potent synthetic opioid agonist with rapid onset and short duration of action. It blocks afferent nerve impulses resulting from stimulation of the pharynx and larynx during intubation. This is a prospective, randomized, control trial carried out to compare the effect of labetalol and fentanyl on sympathomimetic response to laryngoscopy and intubation in vascular surgeries. Materials and Methods: Eighty four patients [American Society of Anesthesiologists (ASA) grade I and II] scheduled for vascular surgeries were divided into three groups (28 each). Group A received fentanyl 2 μg/kg intravenous (IV), Group B received labetalol 0.25 mg/kg IV, and Group C received 10 mL saline IV. The groups were compared for heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and rate pressure product (RPP). Results: The groups were comparable as per their demographic data and preoperative vitals. All the vitals decreased significantly (P < 0.05) in Group A and Group B from just before intubation (5 min after the study drug) to 15 min after intubation compared to the control group. Labetalol decreased SBP, DBP, and MAP significantly at 1 min and 3 min after intubation and RPP at 1 min and 15 min after intubation. In HR, the difference was not significant (P > 0.05). The incidence of hypertension and tachycardia was higher in Group C. No hypotension, bradycardia, and abnormal electrocardiogram (ECG) were recorded in any group. Conclusion: In lower doses, labetalol is a better agent than fentanyl in attenuating the sympathomimetic response to laryngoscopy and intubation but the difference is not significant. However, both effectively blunt the pressure response.
  2,527 262 3
CASE REPORTS
Perioperative management of a case for elective surgery after high-voltage electrical injury
Rajender Kumar, Ritika Gandhi, Meenaxi Bose
October-December 2015, 1(4):191-193
DOI:10.4103/2394-6954.180653  
The spectrum of electrical injury ranges from minor skin lesions to severe multiorgan damage, at times associated with occult or delayed complications and even death. High-voltage electrical injury is characterized by skin lesions that are confined in comparison to the profound destruction of deeper tissues involved and masked by the good general condition of the patient. In light of the limited existing literature, we share our experience of managing a patient who survived a high-voltage electrical injury (6000 V) 5 days prior to scheduled laparoscopic interval appendicectomy, and discuss the factors that influence the degree of injury, probable complications, and our perioperative management.
  2,521 249 -
Perioperative pneumothorax: A rare complication
M Karthik Jain, Kshma Kilpadi
April-June 2015, 1(2):78-80
DOI:10.4103/2394-6954.163088  
We present a perioperative case of spontaneous pneumothorax in a 50-year-old female patient. The case report describes the presentation and outlines the management. The patient presented with difficulty in breathing, desaturation, and restlessness immediately after extubation. Decreased chest movements, hyperresonant percussion note, and absent air entry on auscultation on one side of her chest was noted. The patient was hemodynamically stable. Then, 100% O 2 with closed circuit was continued while a portable X-ray of her chest was taken to confirm the diagnosis of pneumothorax. Intercostal drainage was done on the affected side immediately and the symptoms were relieved. The case report discusses a very rare perioperative complication and highlights the importance of clinical diagnosis and swiftness of intervention.
  2,534 225 -
REVIEW ARTICLES
Comprehensive monitored anesthesia care during day care ophthalmic surgery
PM Chandrasekhara
January-March 2015, 1(1):3-7
DOI:10.4103/2394-6954.149641  
Today elderly patients with complex health-related issues undergoing successfully a day care ophthalmic procedure are a common scenario. How can these high risk patients safely undergo an eye surgery and be back at home on the same day? This is possible, only when a well-planned, scientifically drawn protocol is in place at an institution. This plan of action takes into consideration every possible detail about the patient and also his or her special requirements if not demands. The anesthesiologist commands these well-set actions and guides the other health care staff to streamline the day care program, thereby sparing the busy ophthalmologist to attend to his clinical and surgical workload.
  2,398 262 -
ORIGINAL ARTICLES
Identification of ideal preoperative predictors for difficult intubation
Ruchi Garg, CK Dua
October-December 2015, 1(4):174-180
DOI:10.4103/2394-6954.180649  
Background: Unexpected difficult intubation is probably the result of inadequate preoperative examination of airway and a lack of accurate predictive tests for difficult intubation. Preoperative evaluation forms basis to suspect and be prepared for a difficult airway situation. Aim: The aim of our study was to identify the ideal preoperative predictors of difficult intubation. Materials and Methods: It was a Prospective Observational study done on 350 patients in a community-based hospital. Preoperative airway assessment included: Mallampati Class (MC), Mouth opening (MO), Thyromental distance (TMD), Ability to prognath (AP) and Neck mobility and size (NM). Monitors were attached, anesthesia induced and laryngoscopy performed. Intubation Difficulty Scale (IDS) score was used to grade difficulty in intubation. Results: The overall incidence of Difficult Intubation was 24.6 %. A slight difficulty in 24% (IDS = 1-5) and moderate to major difficulty (IDS >5) in 0.6% cases was noted. Intubation was possible in all the patients. Mallampati class III & Mouth opening was less than 4 cm in about 6% cases and Thyromental distance less than 6 cm in 5.4%. 12.5% were unable to prognath and Neck mobility was restricted in 4.6% patients. Sensitivity and specificity of MC- 16.3 % and 97%, MO- 16.3% and 96.6%, TMD - 12.8% and 97%, AP - 33.3% and 93.9% , NM - 10.5% and 97.3%. Positive and Negative Predictive Values for MC, MO, TMD, AP and NM were 63.6% and 78%, 60.9% and 78%, 57.9 and 77.3 %, 62.8% and 81.9%, 56.3% and 76.9% respectively. Conclusion: We concluded that Mallampati grading and ability to prognath are the most important of the variables studied.
  2,171 448 -
A comparative study of intranasal midazolam spray and oral midazolam syrup as premedication in pediatric patients
R Abhishek, Anish NG Sharma, P Ganapathi, P Shankaranarayana, DS Aiyappa, M Nazim
October-December 2015, 1(4):186-190
DOI:10.4103/2394-6954.180661  
Background: Preoperative preparation of children to alleviate the stress and anxiety related to surgery is an important aspect of balanced anesthesia care, it can not only affect the smoothness of induction and emergence from anesthesia but also the emotional and psychological make-up of the child, considering the pharmacological profile, midazolam is widely considered to be the ideal premedicant. The purpose of our prospective randomized observer-blinded study is to compare the effect of midazolam through oral and intranasal routes and determine the safer, more effective, and acceptable route by children. Subjects and Methods: Sixty patients aged 2–8 years, belonging to the American Society of Anesthesiologist I and II undergoing various surgeries were randomized into two groups of 30 each. Group O received 0.5 mg/kg of oral midazolam syrup, and Group N received 0.2 mg/kg of midazolam intranasal spray. Hemodynamic variables, sedation scores, ease of parental separation, and mask acceptance at the time of induction were studied. Results: Onset of sedation was shorter and the sedation scores were higher in intranasal group, separation from parents and acceptance to mask were satisfactory but statistically insignificant in both the groups. There was no statistical difference in hemodynamic parameters, and no major adverse effects were seen in either group. Conclusion: Both oral and intranasal midazolam are safe and effective as sedative premedication in children.
  2,097 318 -
CASE REPORTS
Hysterical paraplegia
Joginder Pal Attri, Ranjana Khetarpal, Rajinder Pal Singh, Lipsy Bansal
October-December 2015, 1(4):208-209
DOI:10.4103/2394-6954.180657  
Hysterical paralysis is an uncommon, psychogenic, nonorganic loss of motor function precipitated by some type of traumatic event. Typically, it is a diagnosis of exclusion after all the organic causes have been ruled out. The purpose of this case report is to highlight the phenomenon of hysterical paralysis.
  2,247 103 -