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   2016| October-December  | Volume 10 | Issue 4  
    Online since September 21, 2016

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Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method
Mueen Ullah Khan, Rashid Khokar, Sadia Qureshi, Tariq Al Zahrani, Mansoor Aqil, Motasim Shiraz
October-December 2016, 10(4):428-431
DOI:10.4103/1658-354X.179113  PMID:27833487
Objective: To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method. Study Design: Prospective observational study. Place and Duration of Study: Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014–July 2014). Methods: A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia. Patients with anticipated difficult intubation, risk for aspiration, known anatomical laryngotracheal abnormalities, and emergency cases were excluded. Trachea was intubated with size 8 or 8.5 mm and 7.0 or 7.5 mm ETT in male and female patients respectively. The ETT cuff was inflated with air by one of the anesthesia technician. Cuff pressures were measured using aneroid manometer. ETT cuff pressure of 20–30 cm of water was considered as standard. Results: In 69% of the patients, the cuff pressure measurements were above the standard. Age (P = 0.806), weight (P = 0.527), height (P = 0.850), and gender (P = 1.00) were comparable in both groups. The mean cuff pressure in Group-1 and Group-2 was 32.52 ± 6.39 and 38.90 ± 6.60 cm of water (P = 0.001). The cuff inflation with 20 ml syringe resulted in higher cuff pressure as compared to 10cc syringe 37.73 ± 4.23 versus 40.74 ± 5.01 (86% vs. 52%, P = 0.013). Conclusion: The conventional method for ETT cuff inflation and pressure measuring is unreliable. As a routine instrumental cuff pressure, monitoring is suggested.
  4,848 445 8
A comparative study of dexmedetomidine and fentanyl as adjuvants to levobupivacaine for caudal analgesia in children undergoing lower limb orthopedic surgery
SM Elfawal, WA Abdelaal, MR Hosny
October-December 2016, 10(4):423-427
DOI:10.4103/1658-354X.179110  PMID:27833486
Background: Levobupivacaine is an effective local anesthetic agent with less systemic toxicity than racemic bupivacaine, but it has short postoperative analgesic duration. Dexmedetomidine and fentanyl are promising adjuncts to provide excellent and prolonged postoperative caudal analgesia. This study compared the effects of caudal levobupivacaine plus dexmedetomidine and levobupivacaine plus fentanyl for postoperative analgesia and sedation in children undergoing lower limb orthopedic surgery. Patients and Methods: Ninety children, whose age ranged from 1 to 7 years, American Society of Anesthesiologists I-II, undergoing orthopedic lower limb surgery under general anesthesia received caudal block for postoperative analgesia. The children were randomly allocated into three groups: Group L (control) received 0.75 ml/kg levobupivacaine 0.25% diluted in saline; Group LD received 0.75 ml/kg levobupivacaine 0.25% with dexmedetomidine 1 μg/kg; and Group LF received 0.75 ml/kg levobupivacaine 0.25% with fentanyl 1 μg/kg. Following the administration of the drugs; hemodynamic variables, the total anesthesia time, sedation score, Face, Legs, Activity, Cry, Consolability score, duration of analgesia, and side effects were recorded. Results: Demographically, all the groups were comparable, both the baseline and the intraoperative hemodynamic profile were similar in all groups. The mean duration of analgesia and the mean sedation score in the Group LD were significantly greater as compared to both the other groups. Conclusion: Dexmedetomidine may be a better additive to levobupivacaine than fentanyl for caudal postoperative analgesia, arousable sedation with comparable hemodynamic and side effect profile in children.
  4,215 263 2
A comparison of oral midazolam and oral dexmedetomidine as premedication in pediatric anesthesia
V Jannu, RS Mane, MG Dhorigol, CS Sanikop
October-December 2016, 10(4):390-394
DOI:10.4103/1658-354X.177333  PMID:27833480
Context: Oral premedication is widely used in pediatric anesthesia to provide preoperative anxiolysis and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but newer drugs such as the α2-agonists have emerged as alternatives for premedication in children. Aims: The aim of this study was to compare clinical effects of oral midazolam and oral dexmedetomidine on preanesthetic sedation and postoperative recovery profile in children. Settings and Design: Randomized controlled trial. Materials and Methods: We performed a prospective, randomized, controlled study in 60 children, aged 1-7 years undergoing elective, minor, lower abdominal surgeries under general anesthesia. Patients were randomly assigned to receive either oral midazolam 0.75 mg/kg (Group M, n = 30) or oral dexmedetomidine 4 μg/kg (Group D, n = 30) 40 min prior to mask induction. Preoperative sedation and anxiolysis, the response at parental separation, quality of mask acceptance and recovery profile were compared for the two groups. Statistical Analysis Used: Results were analyzed using unpaired Student's t-test and Chi-squared test. P < 0.05 was considered statistically significant. Results: There was no significant difference in the levels of preoperative sedation and anxiolysis between the two groups, but the onset of sedation was significantly faster with midazolam (18.90 ± 3.68 min) than with dexmedetomidine (30.50 ± 4.44 min). Response to parental separation and quality of mask acceptance was comparable between two groups (P > 0.05). The incidence of postoperative agitation was significantly less in the dexmedetomidine group (P< 0.05). Conclusions: In this study, premedication with oral dexmedetomidine produced equally effective preoperative sedation and a better recovery from anesthesia in children in comparison to oral midazolam.
  4,000 402 6
Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries
SG Chavan, S Gangadharan, AK Gopakumar
October-December 2016, 10(4):379-383
DOI:10.4103/1658-354X.177330  PMID:27833478
Background: The effects of rocuronium at two different doses, that is, 0.6 mg/kg (2 × ED95) and 0.9 mg/kg (3 × ED95), were compared with succinylcholine (2 mg/kg) when used for endotracheal intubation in adult patients for elective surgeries under general anesthesia. Materials and Methods: Ninety patients were divided into three groups of 30 each. Groups A, B received injection rocuronium at 0.6 mg/kg, 0.9 mg/kg respectively and Group C received succinylcholine at 2 mg/kg. Onset of action of relaxant, intubation conditions, time taken to intubate and duration of action were compared. Statistical Analysis Used: To compare the statistical difference in the age, weight, height of the study subjects, onset of action of relaxant, intubation conditions, time taken to intubate, and duration of action analysis of variance and unpaired t-test were used. Results: The onset time was considerably shorter with rocuronium 0.9 mg/kg than 0.6 mg/kg. The onset time of rocuronium 0.9 mg/kg was found to be significantly longer than succinylcholine 2 mg/kg. Time taken to intubate was shortest with succinylcholine 2 mg/kg. The time taken to intubate with the rocuronium 0.9 mg/kg was found to be comparable to that of rocuronium 0.6 mg/kg. Intubation score of rocuronium 0.9 mg/kg was the best (17.75), which was comparable with succinylcholine. However, the intubation score obtained with rocuronium 0.6 mg/kg was inferior. Duration of action was shortest with succinylcholine. The duration of action is prolonged when the dose of rocuronium is increased from 0.6 to 0.9 mg/kg. Conclusion: Rapid sequence induction of anesthesia with propofol and fentanyl, succinylcholine allowed a more rapid endotracheal intubation sequence and created superior intubation conditions than rocuronium. However, the technique of using a large dose of rocuronium to achieve perfect conditions for tracheal intubation may have application whenever succinylcholine is relatively contraindicated.
  3,924 372 3
Efficacy of dexmedetomidine as an adjuvant to ropivacaine in pediatric caudal epidural block
Manoj Kamal, Sadik Mohammed, Saroj Meena, Geeta Singariya, Rakesh Kumar, Dilip Singh Chauhan
October-December 2016, 10(4):384-389
DOI:10.4103/1658-354X.177325  PMID:27833479
Context: Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia. Aim: We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries. Settings and Design: Double-blinded randomized controlled trial. Materials and Methods: Sixty patients (2-10 years) were evenly and randomly assigned into two groups in a double-blinded manner. After sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.25% (1 ml/kg) combined with either dexmedetomidine 2 μg/kg in normal saline 0.5 ml, or corresponding volume of normal saline according to group assignment. Hemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, requirement of additional analgesic, sedation, and side effects were assessed during the first 24 h. Results: The duration of postoperative analgesia was significantly longer (P = 0.001) and total consumption of rescue analgesic was significantly lower in Group RD compared with Group R (P < 0.05). Group RD have better quality of sleep and prolonged duration of sedation (P = 0.001). No significant difference was observed in the incidence of hemodynamic changes or side effects. Conclusion: Addition of dexmedetomidine to caudal ropivacaine significantly prolongs analgesia in children undergoing lower abdominal surgeries without an increase in the incidence of side effects.
  3,960 300 3
Preassessment clinic interview and patient anxiety
Stephen Davidson, Douglas McKendrick, Tara French
October-December 2016, 10(4):402-408
DOI:10.4103/1658-354X.177339  PMID:27833482
Background: It is widely recognized that patients have increased anxiety before elective surgery, however, previous research investigating the effect of preassessment clinics (PACs) on anxiety levels has been limited specifically to patient information literature or multimedia use, rather than the consultation process itself. The aim was to investigate the effect attendance at PAC had on patients' anxiety levels, associated with their subsequent surgery and anesthetic. Materials and Methods: This survey consisted of a cross-sectional, questionnaire-based, quantitative study investigating patients' anxiety levels before and after attendance at the PAC. The questionnaire consisted of a series of statements concerning the surgery and anesthetic and rated using a Likert-type scale. All adult patients who attended an appointment at the PAC were eligible to participate in the study. Those unable to read and understand the questionnaire were excluded. Results: Overall 121 participants were included in the study. Participants felt less anxious about their subsequent surgery and anesthetic following consultation at the PAC (P < 0.001). This was true for both gender subgroups (P < 0.05) Concerns about intraoperative complications generated the most anxiety. Postoperatively, male participants were most anxious about pain and females about nausea and vomiting. Participants also reported high satisfaction rates for the service at the PAC. Conclusions: This study contributes to a greater understanding of preoperative anxiety and has important implications for PACs. This clinical survey has been able to demonstrate that consultation at the PAC has a statistically significant positive effect on alleviating patients' anxieties in regards to their surgery and anesthetic.
  3,683 220 4
Cardiac and renal protective effects of dexmedetomidine in cardiac surgeries: A randomized controlled trial
AS Ammar, KM Mahmoud, ZA Kasemy, MA Helwa
October-December 2016, 10(4):395-401
DOI:10.4103/1658-354X.177340  PMID:27833481
Background: Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries. Materials and Methods: Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0.5 μg/kg/h) until 6 h after surgery, whereas the control group received an equivalent volume of physiological saline. Primary outcome measures included myocardial-specific proteins (troponin-I, creatine kinase-MB), urinary-specific kidney proteins (N-acetyl-beta-D-glucosaminidase, alpha-1-microglobulin, glutathione transferase-pi, glutathione transferase alpha), serum proinflammatory cytokines (tumor necrosis factor alpha and interleukin-1 beta), norepinephrine, and cortisol levels. They were measured within 5 min of starting anesthesia (T0), at the end of surgery (T1), 12 h after surgery (T2), 24 h after surgery (T3), 36 h postoperatively (T4), and 48 h postoperatively (T5). Furthermore, creatinine clearance and serum cystatin C were measured before starting surgery as a baseline, and at days 1, 4, 7 after surgery. Results: Dexmedetomidine reduced cardiac and renal injury as evidenced by lower concentration of myocardial-specific proteins, kidney-specific urinary proteins, and pro-inflammatory cytokines. Moreover, it caused higher creatinine clearance and lower serum cystatin C. Conclusion: Dexmedetomidine provided cardiac and renal protection during cardiac surgery.
  3,589 268 10
Perioperative death: Its implications and management
JP Attri, R Makhni, V Chatrath, N Bala, R Kumar, P Jain
October-December 2016, 10(4):436-439
DOI:10.4103/1658-354X.177338  PMID:27833489
Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article.
  3,535 266 1
Transversus abdominis plane block in renal allotransplant recipients: A retrospective chart review
SR Gopwani, MA Rosenblatt
October-December 2016, 10(4):375-378
DOI:10.4103/1658-354X.177326  PMID:27833477
Context: The efficacy of the transversus abdominis plane (TAP) block appears to vary considerably, depending on the surgical procedure and block technique. Aims: This study aims to add to the existing literature and provide a more clear understanding of the TAP blocks role as a postoperative analgesic technique, specifically in renal allotransplant recipients. Settings and Design: A retrospective chart review was conducted by querying the intraoperative electronic medical record system of a 1200-bed tertiary academic hospital over a 5 months period, and reviewing anesthetic techniques, as well as postoperative morphine equivalent consumption. Materials and Methods: Fifty renal allotransplant recipients were identified, 13 of whom received TAP blocks while 37 received no regional analgesic technique. All blocks were performed under ultrasound guidance, with 20 mL of 0.25% bupivacaine injected in the transversus abdominis fascial plane under direct visualization. The primary outcome was postoperative morphine equivalent consumption. Statistical Analysis Used: Morphine consumption was compared with the two-tailed Mann–Whitney U-test. Continuous variables of patient baseline characteristics were analyzed with unpaired t-test and categorical variables with Fischer Exact Test. A P < 0.05 was considered statistically significant. Results: A statistically significant decrease in cumulative morphine consumption was found in the group that received the TAP block at 6 h (2.46 mg vs. 7.27 mg, P = 0.0010), 12 h (3.88 mg vs. 10.20 mg, P = 0.0005), 24 h (6.96 mg vs. 14.75 mg, P = 0.0013), and 48 h (11 mg vs. 20.13 mg, P = 0.0092). Conclusions: The TAP block is a beneficial postoperative analgesic, opiate-sparing technique in renal allotransplant recipients.
  3,504 215 1
Ultrasound-guided injection for plantar fasciitis: A brief review
AS Nair, RK Sahoo
October-December 2016, 10(4):440-443
DOI:10.4103/1658-354X.177334  PMID:27833490
Plantar fasciitis (PF) is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US) imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation.
  3,407 211 2
Anesthetic management of patient with hemophilia a undergoing emergency ventriculoperitoneal shunting: A case report and review of literature
Rashid Saeed Khokhar, Altaf Hussain, Mueen Ullah Khan, Muhammad Hajnour, Sadia Qureshi, Mansoor Aqil
October-December 2016, 10(4):474-476
DOI:10.4103/1658-354X.179120  PMID:27833501
Hemophilia A is a hemorrhagic trend almost exclusively affecting males (X-related recessive disease). In 85% of cases, it is caused by factor VIII deficiency, called hemophilia A or classic hemophilia. Successful anesthetic management depends on the special care and a multidisciplinary team of health professionals informed about the disease, including qualified hematologist, surgeon, and anesthesiologist.
  3,379 155 -
Is it safe to use frova airway intubating device during tracheal intubation in difficult airway patient with multiple and chest trauma?
Waseem M Hajjar, Nourah Alsubaie, Thamer A Nouh, Sami A Al-Nassar
October-December 2016, 10(4):477-479
DOI:10.4103/1658-354X.179121  PMID:27833502
Traumatic chest injury is one of the leading causes of death in motor vehicle accident (MVA). A complete tracheobronchial injury occurred in 1% of trauma cases and most of the cases died before arrival to the emergency department. We report a 37-year-old female involved in MVA presented to the emergency room (ER) with normal vital signs. Ten minutes later, her saturation dropped to 75%, which required ventilation; however, two attempts for endotracheal intubation failed. The third time frova airway intubating introducer used and succeeded. Immediately after tracheal intubation, the patient started to have extensive subcutaneous emphysema and severe hypoxia; chest X-ray showed right side tension pneumothorax which was not relieved by a chest tube insertion. Bronchoscopy confirmed total transection of the right main bronchus and lower tracheal laceration and injury. Emergency thoracotomy and repair of both trachea and the right main bronchus were successful.
  3,136 97 1
Toward competency-based curriculum: Application of workplace-based assessment tools in the National Saudi Arabian Anesthesia training program
AMA Boker
October-December 2016, 10(4):417-422
DOI:10.4103/1658-354X.179097  PMID:27833485
Background: The anesthesia training program of the Saudi Commission for health specialties has introduced a developed competency-based anesthesia residency program starting from 2015 with the utilization of the workplace-based assessment (WBA) tools, namely mini-clinical exercises (mini-CEX), direct observation of procedural skills (DOPS), and case-based discussion (CBD). Objectives: This work aimed to describe the process of development of anesthesia-specific list of mini-CEX, DOPS, and CBD tools within the Saudi Arabian Anesthesia Training Programs. Materials and Methods: To introduce the main concepts of formative WBA tools and to develop anesthesia-specific applications for each of the selected WBA tools, four 1-day workshops were held at the level of major training committees at eastern (Dammam), western (Jeddah), and central (Riyadh) regions in the Kingdom were conducted. Sixty-seven faculties participated in these workshops. Results: After conduction of the four workshops, the anesthesia-specific applications setting of mini-CEX, DOPS, and CBD tools among the 5-year levels were fully described. The level of the appropriate consultation skills was divided according to the case complexity adopted from the American Society of Anesthesiologists physical classification for adult and obstetric and pediatric patient as well as the type of the targeted anesthetic procedure. Conclusion: WBA anesthesia-specific lists of mini-CEX, DOPS, and CBD forms were easily incorporated first into guidelines to help the first stage of implementation of formative assessment in the Saudi Arabian Anesthesia Residency Program, and this can be helpful to replicate such program within other various training programs in Saudi Arabia and abroad.
  3,005 156 3
Acquired hypernatremia in a general surgical Intensive Care Unit: Incidence and prognosis
Mariam A Alansari, Ahmed Abdulmomen, Mohammed Hussein, Ahmad Mohmmad Zubaidi, Jalal T Alswaiti
October-December 2016, 10(4):409-413
DOI:10.4103/1658-354X.177327  PMID:27833483
Purpose: Intensive Care Unit (ICU)-acquired hypernatremia (IAH) is a serious electrolyte disturbance that recently was shown to present an independent risk factor for mortality in critically ill patients. IAH has not been widely investigated in Surgical ICU (SICU) patients. No study has specifically investigated IAH epidemiology in the Kingdome of Saudi Arabia (KSA) in general SICU. The objectives of this study are to assess the epidemiological characteristics and prognostic impact of IAH on SICU mortality and outcome in KSA and compare it with international figures. Materials and Methods: A retrospective observational study on a prospectively collected data of patients (14 years of age or older) admitted to SICU over 2 years, with normal serum sodium on admission and who developed IAH (serum sodium above 145 mmol/L) from day two of admission. Traumatic brain injury patients with therapeutic target sodium level above 145 mmol/L were excluded. Results: Over 2 years study period, 864 patients were admitted to SICU. A total of 50 (5.8%) developed IAH and were included in the study. Twenty-eight ( 56%) patients were male. The median age was 47 (14-84) years. The mean (± standard deviation) Acute Physiology and Chronic Health Evaluation II score was 17 ± 6.5. The incident density (the rate of occurrence of IAH per 100 days care for SICU admission for the first episode) was 0.71. Risk factors include mechanical ventilation, male sex, age ≥50 years, postgastrointestinal surgeries, weekend and night admission. SICU mortality was 40%. The SICU and hospital median (range) length of stay was 8.3 (2-53) and 28.8 (3-95), respectively. Conclusions: IAH is not uncommon in SICU patients and is associated with increased risk of SICU as well as hospital mortality.
  2,878 169 1
Pneumothorax during transportation of patient on Ayres T-piece: A rare but lethal experience!
Sapna A Nikhar, Kewal Krishan Gupta
October-December 2016, 10(4):490-491
DOI:10.4103/1658-354X.179124  PMID:27833509
  2,957 74 1
Saudi anesthesia society conference
Tariq Alzahrani
October-December 2016, 10(4):369-374
DOI:10.4103/1658-354X.191026  PMID:27833476
  2,697 201 -
Vibration sensation as an indicator of surgical anesthesia following brachial plexus block
Seema Jindal, Gurkaran Kaur Sidhu, Dinesh Sood, Anju Grewal
October-December 2016, 10(4):432-435
DOI:10.4103/1658-354X.179114  PMID:27833488
Background: Local anesthetic instillation in close vicinity to nerves anywhere in body blocks sensations in the same order as in central neuraxial blockade. The main purpose of this study was to evaluate the efficacy of vibration sense as criteria to determine the onset of surgical anesthesia following brachial plexus block and its correlation with loss of sensory and motor power. Materials and Methods: This prospective study included fifty patients of American Society of Anaesthesiologist physical status I and II, aged between 18 and 45 years, undergoing elective upper limb surgery under brachial plexus block by supraclavicular approach. The baseline values of vibration sense perception using 128 Hz Rydel–Seiffer tuning fork, motor power using formal motor power of wrist flexion and wrist extension, and sensory score by pinprick method were recorded preoperatively and every 5 min after giving block till the onset of complete surgical anesthesia. Results: The mean ± standard deviation of time (in minutes) for sensory, motor, and vibration block was 13.33 ± 3.26, 21.10 ± 3.26, and 25.50 ± 2.02, respectively (P < 0.05). Although all the patients achieved complete sensory and motor block after 25 min, 14% of the patients still had vibration sensations intact and 100% of the patients achieved complete sensory, motor, and vibration block after 30 min. Conclusions: Vibration sense serves as a reliable indicator for the onset of surgical anesthesia following brachial plexus block. Vibration sense testing with 128 Hz Rydel–Seiffer tuning fork along with motor power assessment should be used as an objective tool to assess the onset of surgical anesthesia following brachial plexus block.
  2,720 143 -
Submandibular intubation in awake patient of panfacial trauma
SK Kamra, HK Khandavilli, P Banerjee
October-December 2016, 10(4):446-448
DOI:10.4103/1658-354X.177341  PMID:27833492
Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems.
  2,678 139 -
Kounis syndrome associated with amoxicillin/clavulanic acid
A Shimi, S Touzani, A Derkaoui, M Khatouf
October-December 2016, 10(4):444-445
DOI:10.4103/1658-354X.177329  PMID:27833491
Kounis syndrome (KS) is a life-threatening medical condition that causes severes allergic reaction and acute coronary syndrome (ACS). We describe the case of 56-year-old woman who developed ACS following an anaphylactic reaction to amoxicillin/clavulanic acid. Immediately after the administration of amoxicillin/clavulanic acid, she presented a chest pain, cutaneous allergic, hypotension, and ST depression on the electrocardiogram. After the necessary diagnostic test, the final diagnosis was variant I of KS.
  2,678 135 -
Peroneal nerve palsy after compression stockings application
Jun Hyun Kim, Won Il Kim, Ji Yeon Kim, Won Joo Choe
October-December 2016, 10(4):462-464
DOI:10.4103/1658-354X.177328  PMID:27833497
Peroneal nerve palsy can be caused by various etiology. We report unilateral peroneal nerve palsy after compression stockings application. A 64-year-old man underwent off-pump coronary bypass graft. Surgeon did not use saphenous vein for the bypass graft. Sedation was stopped after 3 h postoperative. After 16 h, for prophylaxis of deep vein thrombosis, knee-high elastic stocking was applied. After 1 h, he took off right stocking because of numbness but left stocking was kept. After 24 h postoperative, (8 h after stocking application) patient complained suddenly left foot drop. Manual muscle test revealed 0/5 of ankle dorsiflexion, ankle eversion, and toe extension. Sensory was decreased to 70% in lower half of anterolateral aspect of tibia, foot dorsum, and toes. Foot drop and sensory abnormality decreased in 3 weeks. Cardiac surgery patients already have many risk factors for peripheral neuropathy. Clinicians should be careful when applying stockings on those patients.
  2,540 109 1
Anesthesia in a child with Kinsbourne syndrome: Does anesthesia technique matters?
N Nisa, P Talawar, B Vasudevan
October-December 2016, 10(4):468-470
DOI:10.4103/1658-354X.179115  PMID:27833499
Kinsbourne syndrome is a rare neurological paraneoplastic syndrome associated with neuroblastic tumors. There are very few literatures on its anesthetic management and interaction with anesthetic agents. The epileptogenic potential of certain anesthetic agents such as ketamine, etomidate, and meperidine might trigger opsoclonus and myoclonus and have an impact on the long-term neurological outcome. The objective of this case report is to discuss the safety of anesthetic agents and their relationship in a patient with Kinsbourne syndrome. We discuss our experience in the anesthetic management of a child with Kinsbourne syndrome with ganglioneuroblastoma in the thoracic paravertebral space.
  2,539 88 -
Unusual case of inhaled metallic dental bur during dental procedure in a healthy adult
WM Hajjar, RS Aljurayyad, NI Al-Jameel, IS Shaheen, SA Al-Nassar
October-December 2016, 10(4):465-467
DOI:10.4103/1658-354X.177324  PMID:27833498
Bronchial foreign body aspiration (BFBA) is not a rare incident in children. It can be managed successfully with flexible bronchoscopy in most of the cases, except for some cases, which require rigid bronchoscopy or even surgical intervention such as thoracotomy. Here, we report an unusual case of BFBA of metallic dental bur in a healthy 24-year-old dental nurse assistant, who was herself undergoing a dental procedure to remove dental caries, and suddenly the foreign body which was “diamond metallic dental bur” has slipped into her mouth and was aspirated to the bronchial tree. It was successfully removed 5 days after the incident using rigid and fiberoptic bronchoscopy with full recovery.
  2,447 102 1
Drug compliance among hypertensive patients in a teaching hospital
AR Alanzi, DA Aldohayan, AF Alsohaim, KI Alqumaizi
October-December 2016, 10(4):414-416
DOI:10.4103/1658-354X.177322  PMID:27833484
Objective: To determine the compliance rate and associated factors among hypertensive patients in a teaching hospital. Study Design: A cross-sectional study. Materials and Methods: Ethical approval taken from the Institutional Ethics Committee (No. 00101/9/2013). One hundred adult hypertensive patients were interviewed using a pretested, structured, closed ended questionnaire. Inclusion criteria include all adult hypertensive patients attending outpatient clinic from 1st to 28th November 2013 at King Saud Medical City. Exclusion criteria include only if the patient refuse to participate in the study. Results: After calculating the compliance of each patient, we found that 63 of the patients had >80% compliance rate. The most common causes of noncompliance were felt good (reported by 59 patients out of 100), simply forgot (56%), had problems taking pills at specified time (55%), and felt asleep through dose time (52%). Conclusion: The compliance rate with medications was good, but there was a proportion of patients were noncompliant because maybe they need better education and family support.
  2,393 149 -
Postoperative pain management of liver transplantation in cystic fibrosis: Is it time to start US-guided neuraxial blocks?
M Piazza, G Martucci, A Arcadipane
October-December 2016, 10(4):456-458
DOI:10.4103/1658-354X.177343  PMID:27833495
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy. There is a growing evidence that thoracic epidural anesthesia is feasible in pediatric patients. Concerns about coagulopathy and immunosuppression have limited its use in liver transplantation. Ultrasonography is becoming an adjunct tool in neuraxial blocks, allowing faster and easier recognition of the epidural space, and reducing vertebral touch and number of attempts. In pediatric patients, it is still debated whether anesthesia has detrimental effects on cognitive development. Efforts to make regional techniques easier and safer by ultrasonography are ongoing. We report the first case of continuous thoracic epidural analgesia after pediatric liver transplantation in a 10-year-old boy affected with CF with macronodular cirrhosis. Despite a challenging coagulation profile, the echo-assisted procedure was safely performed and allowed extubation in the odds ratio, postoperative awakening and comfort, and quick resumption of respiratory physiotherapy.
  2,410 111 -
Unusual cause of bilateral vocal cord paralysis
WM Hajjar, HA AlShalan, MA Alsowayyan, SA Al-Nassar
October-December 2016, 10(4):459-461
DOI:10.4103/1658-354X.177323  PMID:27833496
The most common cause of vocal cord paralysis (VCP) as a result of recurrent laryngeal nerve compression is malignant tumors. A benign and inflammatory causes of VCP is rarely reported in the literature, and in almost all reported cases it was a unilateral paralysis. We report a rare case of tuberculous mediastinal lymphadenopathy causing bilateral VCP in a young female patient.
  2,377 116 -
C-MAC® video laryngoscope with D-BLADE™ and Frova introducer for awake intubation in a patient with parapharyngeal mass
S Vinayagam, S Dhanger, P Tilak, R Gnanasekar
October-December 2016, 10(4):471-473
DOI:10.4103/1658-354X.179118  PMID:27833500
Parapharyngeal tumors are rare head and neck tumors which can present as an intraoral mass and can pose great challenge to anesthesiologists. The primary concern is the difficult airway due to gross anatomical distortion of the upper airway. Securing the airway in an awake state should be the primary goal of anesthesiologists to avoid catastrophic complications. Herewith, we report the successful use of C-MAC ® video laryngoscope with the acute-angle D-BLADE™ in combination with Frova introducer for awake intubation in a patient with parapharyngeal mass after multiple attempts of failed fiber-optic intubation.
  2,338 124 3
Anesthetic management of a case of Sanjad-Sakati syndrome
AN Alshoaiby, M Rafiq, R Jan, M Shahbaz, A Faqeeh, MA Alsohaibani
October-December 2016, 10(4):453-455
DOI:10.4103/1658-354X.177321  PMID:27833494
Sanjad-Sakati syndrome is an autosomal recessive genetic disorder first described in Saudi Arabia. Anesthetic management of these patients is challenging due to airway difficulties, electrolyte imbalance, growth and mental retardation, and seizures. The anesthetic management of the syndrome is described in this case report.
  2,359 102 1
Postoperative visual loss following dorsal root entry zone rhizotomy: A dreaded complication after a benign procedure
RK Mishra, C Mahajan, A Bindra, K Goyal
October-December 2016, 10(4):449-452
DOI:10.4103/1658-354X.177337  PMID:27833493
Postoperative visual loss (POVL) is a rare but grave postoperative complication. It has been mainly reported in patients undergoing cardiac and spinal surgeries. Dorsal root entry zone (DREZ) is pain relieving procedure performed in patients with refractory neuropathic pain with minimal complication rate. We present a case of unilateral POVL following DREZ rhizotomy in prone position in a patient having brachial plexus neuropathy. Exact etiology of vision loss was though not clear; hypotension, use of vasopressors and hemodilution may have led to vision loss in this patient. This case report highlights the associated risk factors for development of this hazardous complication.
  2,344 96 -
Bifid mandibular canal: Report of 2 cases and review of literature
Ujwala A Brahmankar, Rajeev M Gadgil, Ajay R Bhoosreddy, Ajay Nayak
October-December 2016, 10(4):488-489
DOI:10.4103/1658-354X.179123  PMID:27833508
  2,239 109 -
Peripheral nerve stimulator-guided mandibular nerve block: A report of three cases
Leena Harshad Parate, CA Tejesh, CR Geetha, C. V. R. Mohan
October-December 2016, 10(4):491-492
DOI:10.4103/1658-354X.179126  PMID:27833510
  2,133 99 1
Glass holding technique for bag and mask ventilation: An alternative in neonates and infants
S Prakash, M Dhar, P Ranjan, BK Gupta, VK Pai
October-December 2016, 10(4):487-488
DOI:10.4103/1658-354X.177342  PMID:27833507
  1,955 111 -
Use of WhatsApp for sharing preanesthesia evaluation form among anesthesiologists
Abhijit S Nair, Ravi Kiran Mudunuri, Muthuswamy Ganapathy, Venugopal Kulkarni
October-December 2016, 10(4):480-481
DOI:10.4103/1658-354X.177332  PMID:27833503
  1,886 132 -
Tension pneumothorax as a complication of colonic perforation during colonoscopy: An anesthesiologist's nightmare
Kelika Prakash, Anshuman Singh, Sandeep Sharma, Vijay Kant Pandey
October-December 2016, 10(4):481-483
DOI:10.4103/1658-354X.177331  PMID:27833504
  1,885 94 -
Another utility of signature capnogram: Detection of sodalime canister detachment from anesthesia machine
Sanjay Kumar, Manjaree Mishra, Amrita Bhattacharyya
October-December 2016, 10(4):483-485
DOI:10.4103/1658-354X.177336  PMID:27833505
  1,882 79 -
Commentary to “Hemodynamic response to endotracheal intubation using C-Trach assembly and direct laryngoscopy”
Eugenio Martinez Hurtado, Miriam Sanchez Merchante
October-December 2016, 10(4):485-486
DOI:10.4103/1658-354X.177335  PMID:27833506
  1,776 110 1
Dr. Anis Baraka - 1930–2016
Abdelazeem Eldawlatly
October-December 2016, 10(4):493-493
  1,560 92 -