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2013| January-March | Volume 7 | Issue 1
Online since
March 30, 2013
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ORIGINAL ARTICLES
Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries
Bhavani S Vijay, Vikram Bedi, Subhro Mitra, Bikramjit Das
January-March 2013, 7(1):29-32
DOI
:10.4103/1658-354X.109803
PMID
:23717228
Context:
Pharmacological agents are used to reduce postoperative blood loss.
Aims:
To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries.
Settings and Design:
A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital.
Methods:
Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid (TA) given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding (volume of blood in the drain), percentage fall of hemoglobin, transfusions and complications were recorded.
Results:
Mean volume of blood in the drain was 39.33±10.09 ml (mean±SD) as compared to 91.11±17.61 ml in placebo group showing a
P
>0.001. Mean percentage fall in Hb at day 0 was 2.99±3.45 in the study group as compared to 7.70±6.05 in the placebo group (
P
>0.001), and fall at day 2 in the study group was 0.35±0.74, compared to 2.72±2.70 in the placebo group (
P<
0.001). The number of patients required blood transfusions were lower in the study group than in the placebo group (
P
=0.01).
Conclusions:
We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries.
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The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: A randomized controlled study
Beena K Parikh, Vishal T Waghmare, Veena R Shah, Tanu Mehta, Beena P Butala, Geeta P Parikh, Kalpana S Vora
January-March 2013, 7(1):43-47
DOI
:10.4103/1658-354X.109808
PMID
:23717232
Background:
Transversus abdominis plane (TAP) block is suitable for lower abdominal surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound (USG)-guided TAP block for retroperitoneoscopic donor nephrectomy (RDN).
Methods:
In a prospective randomized double-blind study, 60 patients undergoing laparoscopic donor nephrectomy were randomly divided into two groups by closed envelope method. At the end of surgery, USG-guided TAP block was given to the patients of both the groups. Study group (group S) received inj. Bupivacaine (0.375%), whereas control group (group C) received normal saline. Inj. Tramadol (1 mg/kg) was given as rescue analgesic at visual analog scale (VAS) more than 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS both at rest and on movement, time to first dose of rescue analgesic, cumulative dose of tramadol, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively. Total tramadol consumption at 24 h was also assessed.
Results:
Patients in group S had significantly lower VAS score, longer time to first dose of rescue analgesic (547.13±266.96 min vs. 49.17±24.95 min) and lower tramadol consumption (103.8±32.18 mg vs. 235.8±47.5 mg) in 24 h.
Conclusion:
The USG-guided TAP block is easy to perform and effective as a postoperative analgesic regimen in RDN, with opioids-sparing effect and without any complications.
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323
Clinical vs. bispectral index-guided propofol induction of anesthesia: A comparative study
Snehdeep Arya, Veena Asthana, Jagdish P Sharma
January-March 2013, 7(1):75-79
DOI
:10.4103/1658-354X.109819
PMID
:23717237
Background:
Clinically optimized focusing of drug administration to specific need of patient with bispectral index (BIS) monitoring results in reduced dose and faster recovery of consciousness. This study was planned with an aim to study and compare the conventional clinical end point or BIS on the requirement of dosage of propofol, hemodynamic effects, and BIS alterations following propofol induction.
Methods:
70 patients, ASA I and II, 20-60 years undergoing elective surgical procedure under general anesthesia with endotracheal intubation were selected and divided into two groups. Group A received (inj.) fentanyl (2 μg/kg), followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion till the loss of response to verbal command while group B received inj. fentanyl (2 μg/kg), followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion. The end point of hypnosis was when the BIS value was sustained for 1 min at 48±2. The patients were intubated. Total induction dose of propofol was noted in each group. The value of BIS and hemodynamic parameters (heart rate, systolic/diastolic blood pressure) were noted at the time of loss of consciousness, at the time of intubation, and 1 min after intubation, thereafter every minute for first 10 min and thereafter every 10 min till end of surgery. Any involuntary muscle activity such as jerky movements, dystonic posturing, and opisthotonos were also recorded.
Results:
The mean dose of propofol used in groups A and B were 1.85±0.48 mg/kg and 1.79±0.41 mg/kg, respectively. The dosage used in group B were less but not clinically significant (
P
=0.575). On comparing the dosage of propofol in males among the groups there was a significantly lower dosage of propofol required in group B (2.06±0.45 mg/kg and 1.83±0.32 mg/kg, respectively,
P
=0.016). This decrease however was not seen in female patients dosage being 1.65±0.44 mg/kg and 1.75±0.49 mg/kg, respectively (
P
=0.372). The hemodynamic variables including heart rate, systolic/diastolic blood pressure and BIS were comparable within the group at induction, post-induction, and intubation. However, there was a significant increase in all the parameters at postintubation readings (
P
<0.001).
Conclusion:
No significant difference in the induction dose of propofol was observed when assessed clinically (loss of verbal response) or by BIS monitoring. Traditional teaching to titrate the dose of propofol and depth of anesthesia during intubation by loss of verbal response is as good as BIS value monitoring.
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Single-dose paravertebral blockade versus epidural blockade for pain relief after open renal surgery: A prospective randomized study
Hazem Ebrahem Moawad, Sherif Abdo Mousa, Ahmed S El-Hefnawy
January-March 2013, 7(1):61-67
DOI
:10.4103/1658-354X.109814
PMID
:23717235
Background:
Paravertebral block (PVB) has been an established technique for providing analgesia to the chest and abdomen. We conducted the current study to compare single-dose PVB versus single-dose epidural blockade (EP) for pain relief after renal surgery.
Methods:
Eighty patients scheduled for renal surgery were randomly assigned into two groups according to the analgesic technique, PVB group or EP group. General anesthesia was induced for all patients. Postoperative pain was assessed over 24 h using 10-cm visual analog scale (VAS). Postoperative total pethidine consumption was recorded. Any postoperative events, such as nausea, vomiting, shivering, or respiratory complications, were recorded. Hemodynamics and blood gasometry were also recorded.
Results:
EP group showed significant decrease of both heart rate and mean blood pressure at most of the operative periods when compared with PVB group. There was no difference in total rescue analgesic consumption. Postoperative VAS showed no significant difference between the studied groups. Postoperative events were comparable in both the groups.
Conclusion:
Single injection PVB resulted in similar analgesia but greater hemodynamic stability than epidural analgesia in patients undergoing renal surgery, therefore this technique may be recommended for patients with coexisting circulatory disease.
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Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy
Amene S Sarvestani, Shahram Amini, Mohsen Kalhor, Reza Roshanravan, Mehdi Mohammadi, Amir Hussein Lebaschi
January-March 2013, 7(1):14-17
DOI
:10.4103/1658-354X.109799
PMID
:23717225
Background:
Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy.
Methods:
Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline (
n
=31) or 100 mg hydrocortisone in 250 ml normal saline (
n
=31) before insufflation of CO
2
into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function.
Results:
Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores (10.95 vs 12.95;
P
<0.01). The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group (151.66 (±49.9) mg vs 61.66 (±38.69) mg;
P
=0.00). The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group.
Conclusion:
Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects.
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Equal ratio ventilation (1:1) improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study
Wesam Farid Mousa
January-March 2013, 7(1):9-13
DOI
:10.4103/1658-354X.109559
PMID
:23717224
Background:
Hypoxaemia and high peak airway pressure (Ppeak) are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory) ratio ventilation (1:1) improves arterial oxygenation with parallel decrease in the Ppeak values.
Methods:
Thirty patients with a body mass index ≥40 kg/m
2
scheduled for laparoscopic bariatric surgery were randomized, after creation of pneumoperitoneum, to receive I:E ratio either 1:1 (group 1, 15 patients) or 1:2 (group 2, 15 patients). After a stabilization period of 30 min, patients were crossed over to the other studied I:E ratio. Ppeak, mean airway pressure (Pmean), dynamic compliance (Cdyn), arterial blood gases and hemodynamic data were collected at the end of each stabilization period.
Results:
Ventilation with I: E ratio of 1:1 significantly increased partial pressure of O
2
in the arterial blood (PaO
2
), Pmean and Cdyn with concomitant significant decrease in Ppeak compared to ventilation with I: E ratio of 1:2. There were no statistical differences between the two groups regarding the mean arterial pressure, heart rate, respiratory rate, end tidal CO
2
or partial pressure of CO
2
in the arterial blood.
Conclusion:
Equal ratio ventilation (1:1) is an effective technique in increase PaO
2
during laparoscopic bariatric surgery. It increases Pmean and Cdyn while decreasing Ppeak without adverse respiratory or hemodynamic effects.
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EDITORIALS
Pain management following laparoscopy: Can we do better?
Joseph D Tobias
January-March 2013, 7(1):3-4
DOI
:10.4103/1658-354X.109553
PMID
:23717221
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ORIGINAL ARTICLES
Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries
Bina P Butala, Veena R Shah, K Nived
January-March 2013, 7(1):18-23
DOI
:10.4103/1658-354X.109800
PMID
:23717226
Background:
Intraperitoneal injection of anesthetic has been proposed to minimize postoperative pain after laparoscopic surgery. So a randomized, placebo-controlled study was conducted to compare the effectiveness of intraperitoneal bupivacaine with or without morphine for postoperative analgesia after laparoscopic gynecological surgeries.
Methods:
A total of 90 ASA I and II female patients scheduled for laparoscopic gynecological procedures were enrolled in the randomized double blind prospective study. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. In group BM (
n
=30): 0.25% bupivacaine 30 ml + 2 mg morphine, in group BO (
n
=30) 30 ml 0.25% bupivacaine and in group C (
n
=30) 30 ml of saline was injected intraperitoneally. Postoperative quality of analgesia was assessed by VAS (0-100), for 24 hours and when VAS >40, rescue analgesic was administered. Total dose of rescue analgesia and side effects were noted.
Results
: Intraperitoneal instillation of bupivacaine and morphine significantly reduces immediate postoperative pain (VAS: 23.33±6.04 vs. 45.5±8.57). It also reduces pain at 4 hours after surgery in the BM group (VAS 24±12.13 vs. 41.17±7.27 in the BO group). The time of administration of first rescue analgesic was significantly higher in the BM group (6.15 hours) compared to the BO group (4.51 hours). The total dosage of rescue analgesic was more in the BO and C groups compared to the BM group.
Conclusion:
Addition of morphine to local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 hours without any significant increase in adverse events.
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Granisetron versus tropisetron in the prevention of postoperative nausea and vomiting after total thyroidectomy
Artemisia Papadima, Stavros Gourgiotis, Emmanuel Lagoudianakis, Apostolos Pappas, Charalampos Seretis, Pantelis T Antonakis, Haridimos Markogiannakis, Ira Makri, Andreas Manouras
January-March 2013, 7(1):68-74
DOI
:10.4103/1658-354X.109817
PMID
:23717236
Background:
Postoperative nausea and vomiting (PONV) are frequently encountered after thyroidectomy. For PONV prevention, selective serotonin 5-hydroxytryptamine type 3 (5-HT
3
) receptor antagonists are considered one of the first-line therapy. We report on the efficiency of granisetron and tropisetron, with that of placebo on the prevention of PONV in patients undergoing total thyroidectomy.
Methods:
One hundred twenty-seven patients were divided into three groups and randomized to receive intravenously, prior to induction of anesthesia, tropisetron 5 mg, or granisetron 3 mg, or normal saline. All patients received additionally 0.625 mg droperidol. All episodes of postoperative PONV during the first 24 h after surgery were evaluated.
Results:
Nausea visual analogue scale (VAS) score was lower in tropisetron and granisetron groups than the control group at all measurements (
P
<0.01) except for the 8-h measurement for tropisetron (
P
=0.075). Moreover, granisetron performed better than tropisetron (
P
<0.011 at 4 h and
P
<0.01 at all other points of time) apart from the 2-h measurement. Vomiting occurred in 22.2%, 27.5%, and 37.5% in granisetron, tropisetron, and control groups, respectively (
P
=0.43).
Conclusions:
The combination of the 5-HT
3
antagonists with droperidol given before induction of anesthesia is well tolerated and superior to droperidol alone in preventing nausea but not vomiting after total thyroidectomy.
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CASE REPORTS
Airway management of a difficult airway due to prolonged enlarged goiter using loco-sedative technique
Divya Srivastava, Sanjay Dhiraaj
January-March 2013, 7(1):86-89
DOI
:10.4103/1658-354X.109829
PMID
:23717240
Appropriate airway management is an essential part of anesthesiologist's role. Huge goiters can lead to distorted airway and difficulty in endotracheal intubation. In this report, we present a case of a 67-year-old woman with a huge toxic multinodular thyroid swelling, gradually increasing in size for last 20 years, where trachea was successfully intubated. She had a history of deferred surgery in June 2007 due to inability to intubate, despite 5-6 attempts using different laryngoscopes, bougie, and stylet. Patient was re-admitted in December 2011 for the surgery and was successfully intubated this time with help of fiberoptic intubation using loco-sedative technique. Patient was electively kept intubated postoperatively in view of chances of tracheomalacia due to prolonged large goiter. She was extubated successfully on post-op day 2 after demonstration of leak around trachea following tracheal tube cuff deflation. The different techniques of managing the difficult airway in these patients are discussed.
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ORIGINAL ARTICLES
Dexmedetomidine as anesthetic adjunct for fast tracking and pain control in off-pump coronary artery bypass
Mohamed Essam Abdel-Meguid
January-March 2013, 7(1):6-8
DOI
:10.4103/1658-354X.109557
PMID
:23717223
Objective:
This study was designed to determine the efficacy of dexmedetomidine (a highly selective alpha-2 agonist) in achieving fast tracking and improved postoperative pain control in off-pump coronary artery bypass (OPCAB) patients.
Methods:
Thirty patients scheduled for elective OPCAB were prospectively randomized into two groups: Group I (15 patients) started dexmedetomidine at 0.5 ug/kg/hour after the induction of anesthesia; this was reduced to 0.3 ug/kg/hour on admission in the cardiac intensive care unit and continued for 12 hours post extubation. Group II (15 patients) received a similar volume and infusion rate of normal saline. Visual analog scale (VAS) of 10-100 was explained thoroughly to the patients during the preoperative visit. Postoperative pain was managed with morphine. The total dose of morphine was recorded. Extubation time and VAS was recorded every two hours for 12 hours post extubation.
Results:
Extubation time in group I was 72±8 minutes and 186±22 minutes in group II. Mean total use of narcotics in group II was 23.5±20.7 mg compared to 11.4±6.3 mg in group I. VAS median figures were lower at all data points in group I than in group II.
Conclusion:
Dexmedetomidine showed an effective and safe profile as an anesthetic adjunct in OPCAB, achieving fast tracking of patients and higher quality of pain control with a lower consumption of narcotics.
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3,293
275
Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit
Mohammad Feroz Azfar, Muhammad Faisal Khan, Abdulaziz H Alzeer
January-March 2013, 7(1):33-36
DOI
:10.4103/1658-354X.109805
PMID
:23717229
Background:
Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients.
Objective:
This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients.
Methods:
This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2.
Results:
In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each.
Conclusion:
Protocolized eye care can reduce the risk of corneal complications in ventilated patients.
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348
CASE REPORTS
Low-dose spinal anesthesia for urgent laparotomy in severe myasthenia gravis
Miguel Angel Palomero Rodríguez, Teresa Pérez Mencía, Felipe Villar Álvarez, Yolanda Laporta Báez, Gloria María Santos Pérez, Andrés López García
January-March 2013, 7(1):90-92
DOI
:10.4103/1658-354X.109836
PMID
:23717241
Myasthenia gravis (MG) is an autoimmune disease with an incidence of 2-10/100,000 cases per year, characterized by muscle weakness secondary to destruction of postsynaptic acetylcholine receptors. In these patients, important perioperative issues remain unresolved, namely, optimal administration of cholinesterase inhibitors, risks of regional anesthesia, and prediction of need of postoperative mechanical ventilation. We describe the use of a low-dose spinal anesthesia in a patient with MG who was submitted for emergence exploratory laparotomy. The utilization of low-dose spinal anesthesia allowed us to perform surgery with no adverse respiratory or cardiovascular events in this patient.
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166
EDITORIALS
Intraperitoneal local anesthetic for postoperative pain
Arman Kahokehr
January-March 2013, 7(1):5-5
DOI
:10.4103/1658-354X.109554
PMID
:23717222
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2,799
288
LETTERS TO EDITOR
Parsonage-Turner syndrome after interscalene block for diagnostic arthroscopic surgery of shoulder joint
Gaurav Chauhan, Kapil Gupta, Pavan Nayar
January-March 2013, 7(1):104-105
DOI
:10.4103/1658-354X.109855
PMID
:23717249
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161
CASE REPORTS
Successful lumbar epidural catheter placement through a lower back lipoma
Nahel N Saied, Mohammad Helwani
January-March 2013, 7(1):83-85
DOI
:10.4103/1658-354X.109826
PMID
:23717239
Structural abnormalities of the lumbar spine or the overlying structures may represent a relative contraindication or technical difficulty to neuraxial anesthesia. We report a case of successful epidural catheter placement through a lower back lipoma for vascular bypass surgery of the lower extremity.
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3,002
164
ORIGINAL ARTICLES
What is the exact predictive role of preoperative white blood cell count for new-onset atrial fibrillation following open heart surgery
Seyed Jalil Mirhosseini, Sadegh Ali-Hassan-Sayegh, Seyed Khalil Forouzannia
January-March 2013, 7(1):40-42
DOI
:10.4103/1658-354X.109807
PMID
:23717231
Background:
Atrial fibrillation (AF) occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell (WBC) count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft (CABG) AF in patients with severe left ventricle (LV) dysfunction who underwent elective off-pump coronary artery bypass.
Methods:
This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit (ICU) and hospital stay without postoperative AF were part of the control group.
Results:
The average age of the patients was 68.5±12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340±155 and 8,950±170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188±140 and 9,145±255, respectively (
P
value three days before surgery: 0.04;
P
value on surgical day: 0.01). Of the 54 male patients with postoperative AF (POAF), duration of AF was more in cases with elevated WBC count (12,000-14,000) than in those with lower elevated WBC count (10,000-12,000) (
P
=0.025), but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count (
P
=0.81).
Conclusion:
These findings show that three days before surgery and on surgery day, there was a difference in WBC count between both groups. So, preoperative WBC count may predict the incidence and duration of AF; however, it cannot be a predictor of the frequency of recurrence of AF. Finally, WBC count is an independent marker for POAF and duration of AF.
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163
Assessment of hemostatic changes after crystalloid and colloid fluid preloading in trauma patients using standard coagulation parameters and thromboelastography
Chhavi Sawhney, Arulselvi Subramanian, Manpreet Kaur, Ajaz Anjum, Venencia Albert, Kapil Dev Soni, Ajit Kumar
January-March 2013, 7(1):48-56
DOI
:10.4103/1658-354X.109809
PMID
:23717233
Background:
The choice of an ideal fluid administered post trauma and its subsequent influence on coagulation still poses a clinical dilemma. Hence, this study was designed to assess the influence of
in vivo
hemodilution with various fluid preparations (4% gelatin, 6% hydoxyethyl starch (HES), Ringer's lactate, 0.9% normal saline) on coagulation using standard coagulation parameters and real-time thromboelastography (TEG) in patients undergoing elective surgery post trauma.
Methods:
In a randomized, double-blind study, 100 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective surgeries were allocated into four groups of 25 each according to the type of fluid infused. Group G (4% gelatin), Group N (0.9% normal saline), Group R (Ringer's lactate), and Group H (6% HES) received preloading with 1 L of fluid according to the group. The coagulation status of the patients was assessed during perioperative period (before surgery, after fluid preloading, and at the end of the surgery) using both conventional coagulation analysis and TEG.
Statistical Analysis:
Analysis of variance (ANOVA),
post hoc
and Pearson Chi-square test were used.
Results:
In all the patients preloaded with gelatin, there was a significant increase in prothrombin time index (PTI; 14.88±0.90 vs. 13.78±3.01,
P
0<0.001) and international normalized ratio (INR; 1.12±0.09 vs. 1.09±0.19,
P
<0.05) compared to the baseline value. An increase was observed in these parameters in the postoperative period also. In the HES group, there was statistically significant increase in PT time (15.70±1.51 vs. 13.74±0.75,
P=
0.01) and INR (1.20±0.15 vs. 1.03±0.17,
P
0<0.001) as compared to the baseline. In the intergroup comparisons
,
the patients preloaded with HES had a significant increase in INR (1.20±0.15 vs. 1.12±0.09,
P
=0.04) and reaction time (R time; 6.84±2.55 min vs. 4.79±1.77 min,
P
=0.02) as compared to the gelatin group. The fall in coagulation time (k time; 2.16±0.98 vs. 3.94±2.6,
P
=0.02), rise in maximum amplitude (MA; 61.94±14.08 vs. 50.11±14.10,
P
=0.04), and rise in A20 (56.17±14.66 vs. 43.11±14.24,
P
=0.05) were more in patients preloaded with RL as compared to the HES group. 100% patients in the gelatin group, 84.2% patients in the NS group, 94.4% patients in the RL group, and 66.7% patients in the HES group had hypocoagulable (R time > 14 min) state in the postoperative period.
Conclusion:
Crystalloids are optimal volume expanders in trauma, with RL having beneficial effects on coagulation system (decrease in k time and increase in MA and A20). Among the colloids, HES 6% (130/0.4) affects coagulation parameters (increase in PTI, INR, R time, k time) more than gelatin. Trial registration (protocol number-IEC/NP-189/2011).
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300
CASE REPORTS
A patient of terson's syndrome for ocular surgery: Perianesthetic concerns
Puneet Khanna, Dalim Kumar Baidya, Rakesh Garg, Dilip Shende
January-March 2013, 7(1):93-95
DOI
:10.4103/1658-354X.109843
PMID
:23717242
Terson's syndrome may be challenging for the anesthesiologist in view of its multisystem involvement including neurological, cardiovascular, and ophthalmological involvement. We describe anesthetic management of a 55-year-old male having Terson's syndrome for pars plana viterctomy.
[ABSTRACT]
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2,818
135
ORIGINAL ARTICLES
Caudal epidural blockade in adolescents
Brian Schloss, Venkata R Jayanthi, Tarun Bhalla, Joseph D Tobias
January-March 2013, 7(1):57-60
DOI
:10.4103/1658-354X.109812
PMID
:23717234
Background:
Various options are available for the provision of analgesia following major surgical procedures including systemic opioids and regional anesthetic techniques. Regional anesthetic techniques offer the advantage of providing analgesia while avoiding the deleterious adverse effects associated with opioids including nausea, vomiting, sedation and respiratory depression. Although used commonly in infants and children, there is a paucity of experience with the use of caudal epidural blockade in adolescents.
Methods:
We retrospectively reviewed the perioperative care of adolescents undergoing major urologic or orthopedic surgical procedures for whom a caudal epidural block was placed for postoperative analgesia.
Results:
The cohort for the study included 5 adolescents, ranging in age from 13 to 18 years and in weight from 42 to 71 kilograms. Caudal epidural analgesia was accomplished after the induction of anesthesia and prior to the start of the surgical procedure using 20-25 mL of either 0.25% bupivacaine or 0.2% ropivacaine with clonidine (1 μg/kg). The patients denied pain the recovery room. The time to first request for analgesia varied from 12 to 18 hours with the patients requiring 1-3 doses of analgesic agents during the initial 24 postoperative hours.
Conclusions:
Our preliminary experience demonstrates the efficacy of caudal epidural block in providing analgesia following major urologic and orthopedic surgical procedures. The applications of this technique as a means of providing postoperative analgesia are discussed.
[ABSTRACT]
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1
2,794
284
BRIEF REPORT
Safety of intraneural injection of local anesthetic
Abdelazeem Eldawlatly, Ammar Al Rikabi, Shady Elmasry
January-March 2013, 7(1):80-82
DOI
:10.4103/1658-354X.109821
PMID
:23717238
There is conflicting information in the literature regarding nerve damage following regional anesthesia. Intraneural injection of local anesthetic was described as a safe practice in regional anesthesia. This review focuses on the histopathological and functional assessment of peripheral nerve function following intraneural injection of local anesthetics.
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3,049
246
EDITORIALS
Clinical or technological evaluation of depth of anesthesia at induction time: A simple study for an easy message
Péan Didier, Lejus Corinne
January-March 2013, 7(1):1-2
DOI
:10.4103/1658-354X.109551
PMID
:23717220
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-
2,149
233
LETTERS TO EDITOR
Tuberous sclerosis with head injury
Ranadhir Mitra, Keshav Goyal, Vanitha Rajagopalan, Priyanka Gupta, Navdeep Sokhal
January-March 2013, 7(1):101-102
DOI
:10.4103/1658-354X.109866
PMID
:23717247
[FULL TEXT]
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1,912
119
Anesthetic management in a case of Fraser syndrome
Virender Kumar Mohan, Aanchal Sharma
January-March 2013, 7(1):102-103
DOI
:10.4103/1658-354X.109854
PMID
:23717248
[FULL TEXT]
[PDF]
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3,081
131
Meralgia paresthetica after total hip arthroplasty in supine position
Gaurav Chauhan, Kapil Gupta, Pavan Nayar
January-March 2013, 7(1):105-106
DOI
:10.4103/1658-354X.109857
PMID
:23717250
[FULL TEXT]
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3,162
186
As an analgesic ketamine versus fentanyl for total intravenous anesthesia
Musa Ezici, Azize Bestas, Omer Lutfi Erhan
January-March 2013, 7(1):107-108
DOI
:10.4103/1658-354X.109858
PMID
:23717251
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2,923
297
Drawing a different conclusion
Jamil S Anwari
January-March 2013, 7(1):108-109
DOI
:10.4103/1658-354X.109859
PMID
:23717252
[FULL TEXT]
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-
1,524
113
A failure to reach statistical significance - Magnesium sulfate pretreatment did not reduce the incidence of propofol injection pain
Sijian Wang, Richard E Galgon, Kristopher M Schroeder
January-March 2013, 7(1):109-110
DOI
:10.4103/1658-354X.109860
PMID
:23717253
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2,005
123
Comment on editorial
HS Sarkar
January-March 2013, 7(1):110-110
DOI
:10.4103/1658-354X.109861
PMID
:23717254
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1,540
94
Failure of recommended
in vitro
tests to detect a leak in flexometallic endotracheal tube cuff system: Are we really safe?
Amitabh Kumar, Parul Mullick, Shyam Bhandari, Anoop R Gogia
January-March 2013, 7(1):110-112
DOI
:10.4103/1658-354X.109862
PMID
:23717255
[FULL TEXT]
[PDF]
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1,965
119
A superior drug delivery system for peripheral nerve block procedures
Akshaya N Shetti
January-March 2013, 7(1):96-96
DOI
:10.4103/1658-354X.109849
PMID
:23717243
[FULL TEXT]
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1,885
111
Surgical removal of broken epidural catheter
Safwat Abouhashem
January-March 2013, 7(1):96-98
DOI
:10.4103/1658-354X.109851
PMID
:23717244
[FULL TEXT]
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1,965
160
Spinal anesthesia for hernia surgery in a child with laryngomalacia
Rohini Bhat Pai, Sameer Desai, Raghavendra Rao, Venkatesh Annigeri
January-March 2013, 7(1):98-99
DOI
:10.4103/1658-354X.109852
PMID
:23717245
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2,478
150
Failure to ventilate: Technical error
Vivek Chowdhry, Arun Rath
January-March 2013, 7(1):99-100
DOI
:10.4103/1658-354X.109853
PMID
:23717246
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1,612
138
ORIGINAL ARTICLES
A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation
Ranju Singh, Mahmood Ghazanwy, Homay Vajifdar
January-March 2013, 7(1):24-28
DOI
:10.4103/1658-354X.109801
PMID
:23717227
Background:
Procedural sedation and analgesia is widely being used for female laparoscopic sterilization using combinations of different drugs at varying doses. This study compared the combination of fentanyl and propofol, and ketamine and propofol in patients undergoing outpatient laparoscopic tubal ligation, with respect to their hemodynamic effects, postoperative recovery characteristics, duration of hospital stay, adverse effects, and patient comfort and acceptability.
Settings and Design:
Randomized, double blind.
Methods:
Patients were assigned to receive premixed injection of either fentanyl 1.5 μg/kg + propofol 2 mg/kg (Group PF,
n
0=50) or ketamine 0.5 mg/kg + propofol 2 mg/kg (Group PK,
n
=50). Hemodynamic data, peripheral oxygen saturation, and respiratory rate were recorded perioperatively. Recovery time, time to discharge, and comfort score were noted.
Statistical Analysis:
Chi-square (χ
2
) test was used for categorical data. Student's
t
-test was used for quantitative variables for comparison between the two groups. For intragroup comparison, paired
t
-test was used. SPSS 14.0 was used for analysis.
Results:
Although the heart rate was comparable, blood pressures were consistently higher in group PK. Postoperative nausea and vomiting and delay in voiding were more frequent in group PK (
P
<0.05). The time to reach Aldrete score ≥8 was significantly longer in group PK (11.14±3.29 min in group PF vs. 17.3±6.32 min in group PK,
P
<0.01). The time to discharge was significantly longer in group PK (105.8±13.07 min in group PF vs.138.18±13.20 min in group PK, P<0.01). Patient comfort and acceptability was better in group PF, P<0.01).
Conclusion:
As compared to ketamine-propofol, fentanyl-propofol combination is associated with faster recovery, earlier discharge, and better patient acceptability.
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Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: A case series
Toshio Iwata, Kazuyoshi Nakahashi, Satoki Inoue, Hitoshi Furuya
January-March 2013, 7(1):37-39
DOI
:10.4103/1658-354X.109806
PMID
:23717230
Background:
Ropivacaine, a long-acting local anesthetic agent, has been used for postoperative analgesia in brachial plexus block (BPB) at high doses. However, use of lower doses would reduce the occurrence of adverse effects.
Methods:
We applied BPB with low-dose ropivacaine (10 mL of 0.375% ropivacaine) after induction of general anesthesia for surgery of the upper extremities in 62 patients at our hospital. Ropivacaine was administered via a fluoroscopy-guided supraclavicular method. Analgesic effects during surgery, visual analog scale pain scores, skin sensation, muscle strength, and postoperative patient satisfaction indices were evaluated.
Results:
Fifty-six patients (90.3%) did not require supplemental analgesics during surgery. The remaining six patients were administered fentanyl due to the insufficient analgesic effects of the nerve block. Some adverse effects, including numbness and delayed motor and sensory recovery of the upper extremities, were observed. The mean postoperative patient-evaluated visual satisfaction scale was 94.1.
Conclusions:
Our results suggest that low-dose ropivacaine is clinically acceptable for BPB under general anesthesia.
[ABSTRACT]
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4,804
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