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   2016| January-March  | Volume 2 | Issue 1  
    Online since September 16, 2016

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Hemoglobin and oxygen transport
Nagan Varadaraj Nagalakshmi, Ravi Madhusudhana, Nikhila Rajendra, Abhishek Kanakuppe Manjunath
January-March 2016, 2(1):1-6
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.
  4,383 606 -
Transient vision loss in transurethral resection of prostate syndrome
Kempachary , TR Raghavendra, DK Vinutha, Chaithra Gundulpet Vasanth, Kiran Prasannan
January-March 2016, 2(1):28-30
We had an unusual experience of patient developing transient loss of vision following transurethral resection of prostate. Various pathophysiological changes contributing the vision loss during transurethral resection of the prostate has been discussed. The patient recovered his vision fully after therapeutic interventions. This paper discusses the possible etiologies for the transient vision loss and treatment of same.
  1,889 169 1
Comparative study of granisetron versus pethidine for the prevention of perioperative shivering under spinal Anesthesia
Savitri D Kabade, Y Venkatesh, S Karthik, Vikas Kumar
January-March 2016, 2(1):14-18
Aims: Shivering, the "big little problem," has an incidence of 19-33% following spinal anesthesia. Recently, studies showed the involvement of serotonergic system in the control of postanesthetic shivering. Pharmacological management includes opioids (pethidine) and nonopioids like 5-HT3 receptor antagonists (ondansetron and granisetron). Pethidine which is considered as a time-tested drug for control of shivering can have adverse effects such as respiratory depression, nausea, and vomiting. This study was performed to compare the effect of prophylactic granisetron versus pethidine in prevention of perioperative shivering in patients under spinal anesthesia. Settings and Design: A prospective randomized, double blinded study was conducted on 60 patients of ASA I and II physical status aged between 20-50 years scheduled for elective lower abdominal surgeries under spinal anesthesia. Subjects and Methods: After obtaining ethical committee clearance and patient consent, sixty American Statistical Association Grade I and II patients, aged 20-50 years scheduled for elective lower abdominal surgeries under spinal anesthesia were recruited for a randomized double-blinded study divided into Group G and Group P and received intravenous (IV) granisetron 40 mcg/kg and pethidine 0.4 mg/kg, respectively. Perioperatively, vitals and core temperature were monitored and shivering was assessed using 5-item scale once in every 15 min up to 6 h. Statistical Analysis: The results were analysed using Statistical Package for Social Science software. Results: Of the sixty patients we studied, the demographic profile between the two groups was comparable. Six patients had shivering in each group. The mean temperature at which patient developed shivering was 36.31°C in Group G and 35.85°C in Group P. The mean time of onset for shivering to occur in Group G was 95 min and in Group P was 65 min. None of the patients received rescue drug. Patients in both the groups were hemodynamically stable. Conclusions: Prophylactic granisetron 40 μg/kg IV is as effective as pethidine 0.4 mg/kg IV in preventing perioperative shivering following spinal anesthesia and also reduces the need of antiemetics.
  1,600 216 1
A comparative study of palonosetron versus palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting in subjects undergoing laparoscopic surgeries: A randomized double-blind control study
Aastha Srivastava, K Pai Raghavendra, Leena Harshad Parate
January-March 2016, 2(1):19-24
Background: Palonosetron is an effective antiemetic that can be used for treating postoperative nausea vomiting which is a major problem in laparoscopic surgeries. Aims: The aim of this study was to find out whether addition of dexamethasone to palonosetron would be more effective than palonosetron alone in prevention of this problem in patients undergoing laparoscopic surgeries. Settings and Design: This study was conducted as a double blind study in MS Ramaiah hospital, Bangalore. Materials and Methods: Ninety patients with ASA grade 1 and 2 between 20-60 years of age undergoing elective laparoscopic surgery under general anaesthesia were randomised into two groups of 45 patients each. Group-P received 0.075 mg of palonosetron and Group-P+D received the same dose of palonosetron and 8 mg of dexamethasone before induction. The number of complete responders along with four point nausea and vomiting scores were recorded at 2, 6, 24, 48 hours post-operatively. Statistical Analysis Used: Difference in the number of complete responders in each of the groups were tested to be of statistical significance through Chi square test of significance. P value <0.05 was considered as statistically significant. t-test was used for categorical data assessment. Results: Complete responders recorded in group P+D were 34 (75.5%) and in group P were 35 (77.7%). Three patients in group P+D (6.7%) and 4 patients in group P (8.9%) required rescue anti-emetics. The P value obtained was 0.694 (>0.05) and hence not statistically significant. Conclusion: The addition of dexamethasone to palonosetron does not offer an added advantage over the usage of palonosetron alone as a single drug.
  1,460 174 -
A randomized comparative study between Airtraq and Mccoy for intubation in patients with cervical spine injury
Srilata Moningi, Dilip Kumar Kulkarni, Gopinath Ramachandran, Anandram Aluri, Sudheer Kumar Atluri, Anshul Yadav
January-March 2016, 2(1):7-13
Background: This study was done to compare Airtraq and McCoy for intubation characteristics and hemodynamic parameters following endotracheal intubation in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery. Materials and Methods: After Institutional Ethical Committee approval, a prospective randomized comparative study was designed on forty American Society of Anesthesiologists I and II patients involving single level ACDF surgery. Following standard anesthesia protocol and manual in-line stabilization applied along with a cervical collar or pin traction for immobilization, tracheal intubation was performed either with Airtraq or McCoy. The time taken for intubation, intubation difficulty score (IDS), comfort grading, and hemodynamic parameters were noted following intubation. The categorical data were compared using Chi-square test and the continuous variables were compared between the groups using paired sample t-test. Repeated ANOVA was tested for hemodynamic data at each measurement time point and Tukey post hoc was used for within the group comparisons at different timings following intubation. Results: The mean intubation time was 24.41 ± 14.8 s in Airtraq group (Group A) which was statistically significant compared to McCoy group (Group M) 38.96 ± 15.55 s (P = 0.001). The IDS and comfort grading was statistically significant in Group A compared to Group M. The changes in hemodynamic vitals following intubation were comparable in both the groups. Conclusion: Airtraq improves the grade of glottic visualization with minimal assistance. It also minimized the time taken for intubation had stable hemodynamics with increased comfort to the anesthetist.
  1,453 164 -
Carotid body paraganglioma excision: Anesthetic challenges
Narayansa Irkal Jewarlal, Muddaraddi Rajaseker, Velayudha Sidda Reddy, Vykuntaiya Devika, Arun Bhardwaj
January-March 2016, 2(1):34-36
Carotid body paraganglioma (CBP) is a rare tumour which arises from chemoreceptor cells of the carotid body situated at the bifurcation of common carotid artery. Most commonly these tumours are benign, however, 5-7% of tumours may turn out as malignant; hence, excision is the rule. Anesthesia for excision poses numerous challenges, as these tumours are highly vascular, sense pH, arterial oxygen tension; may secrete catecholamine or serotonin, generally adhere to the carotid artery and accompanied with a perioperative morbidity of 20-40%. Anesthesia managed successful for excision of a CBP Shamblin Group II tumour avoiding invasive monitoring hence reported.
  1,331 119 -
Segmental epidural Anesthesia in an obese patient undergoing percutaneous Nephrolithotomy in prone position
Tasneem Dhansura, Aizaz Mohammed
January-March 2016, 2(1):25-27
The increasing incidence of obesity is a crisis in health care where these patients are increasingly being anesthetized for nonbariatric surgery. Anesthetizing an obese patient is a challenge and more so if surgery is to be done in prone position. We would like to present a patient, a 59-year-old male with body mass index of 45 (weight: 145 kg; height: 178 cm; abdominal girth: 135 cm) with a history of diabetes mellitus, hypertension, and chronic obstructive pulmonary disease since 10 years posted for a left-sided percutaneous nephrolithotomy. Successfully managed under epidural anesthesia and operated in the prone position.
  1,168 100 -
Amniotic fluid embolism during emergency hysterotomy
Abhishek Bhuva, Akshaya N Shetti, Vinod Kharde, Das Divekar
January-March 2016, 2(1):31-33
The most common obstetric surgeries performed in India are cesarean section. Unwillingness to undergo normal delivery, unfavorable anatomy, previous cesarean section, and pregnancy-induced hypertension are common indications to name. Although pregnancy is a natural process, many physiological changes occur in maternal health. Pregnant lady is at risk to develop pregnancy-related complications. Amniotic fluid embolism is one of the life-threatening complications that is seen during delivery.
  1,022 90 -
Limb ischemia after central venous cannulation: Is the cannulation to blame?
R Ranjana
January-March 2016, 2(1):40-42
A 65-year-old woman underwent right subclavian venous cannulation in the Intensive Care unit. Within a few hours following the cannulation, ischemic changes were noted in the right upper limb. A misplaced central venous catheter was suspected as the cause of the ischemia. However, a color Doppler study revealed right axillary artery thrombosis. She was put on antiplatelet therapy. Upper limb vascular complications can occur after central venous catheterization due to various causes. Timely investigations and management can help at such critical times.
  1,010 81 -
Apnoea during Spinal Anesthesia: A Medication Error
Bharat Paliwal, Anamika Purohit, Priyanka Sethi
January-March 2016, 2(1):37-38
  885 78 -
Incidental detection of venous air embolism during modified radical neck dissection
Tejesh C Anandaswamy, Prathima P Thamanna, Geetha C Rajappa, Manjunath A Chikkapillappa
January-March 2016, 2(1):39-39
  893 70 -