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   2017| April-June  | Volume 11 | Issue 2  
    Online since March 27, 2017

 
 
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ORIGINAL ARTICLES
A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy: A prospective, double-blind, randomized, placebo-controlled study
Ali Jendoubi, Imed Ben Naceur, Abderrazak Bouzouita, Mehdi Trifa, Salma Ghedira, Mohamed Chebil, Mohamed Houissa
April-June 2017, 11(2):177-184
DOI:10.4103/1658-354X.203027  PMID:28442956
Background: Recently, there has been increasing interest in the use of analgesic adjuncts such as intravenous (IV) ketamine and lidocaine. Objectives: To compare the effects of perioperative IV lidocaine and ketamine on morphine requirements, pain scores, quality of recovery, and chronic pain after open nephrectomy. Study Design: A prospective, randomized, placebo-controlled, double-blind trial. Settings: The study was conducted in Charles Nicolle University Hospital of Tunis. Methods: Sixty patients were randomly allocated to receive IV lidocaine: bolus of 1.5 mg/kg at the induction of anesthesia followed by infusion of 1 mg/kg/h intraoperatively and for 24 h postoperatively or ketamine: bolus of 0.15 mg/kg followed by infusion of 0.1 mg/kg/h intraoperatively and for 24 h postoperatively or an equal volume of saline (control group [CG]). Measurements: Morphine consumption, visual analog scale pain scores, time to the first passage of flatus and feces, postoperative nausea and vomiting (PONV), 6-min walk distance (6MWD) at discharge, and the incidence of chronic neuropathic pain using the “Neuropathic Pain Questionnaire” at 3 months. Results: Ketamine and lidocaine reduced significantly morphine consumption (by about 33% and 42%, respectively) and pain scores compared with the CG (P < 0.001). Lidocaine and ketamine also significantly improved bowel function in comparison to the CG (P < 0.001). Ketamine failed to reduce the incidence of PONV. The 6 MWD increased significantly from a mean ± standard deviation of 27 ± 16.2 m in the CG to 82.3 ± 28 m in the lidocaine group (P < 0.001). Lidocaine, but not ketamine, reduced significantly the development of neuropathic pain at 3 months (P < 0.05). Conclusion: Ketamine and lidocaine are safe and effective adjuvants to decrease opioid consumption and control early pain. We also suggest that lidocaine infusion serves as an interesting alternative to improve the functional walking capacity and prevent chronic neuropathic pain at 3 months after open nephrectomy.
  4,461 461 11
Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and/or adenoidectomy
Ahmed Mostafa Abd El-Hamid, Hany Mahmoud Yassin
April-June 2017, 11(2):137-143
DOI:10.4103/1658-354X.203020  PMID:28442950
Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children during recovery from general anesthesia and may result in postoperative complications. This study investigated safety and effectiveness of intranasal dexmedetomidine in reducing the incidence and severity of EA. Methods: This prospective, randomized double-blinded controlled trial included 86 patients scheduled for the tonsillectomy and/or adenoidectomy der general anesthesia with sevoflurane. They were randomly allocated into two groups. Group D received intranasal dexmedetomidine at 1 μg/kg, and Group C received intranasal saline 0.9% after the induction of general anesthesia. Four-point agitation scale and Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain assessment were measured at six time points (after extubation, leaving the operating room, on arrival to postanesthesia care unit [PACU], 10, 20, and 30 min after arrival in PACU). Extubation, emergence, and discharge times were recorded in addition to any adverse effects. Results: There was a significant difference in the incidence of EA between Groups D and C (6.98% and 58%, respectively, with P = 0.001). The median four-point agitation scales and the median scores of FLACC pain scales of Group D were significantly lower than those of Group C at the all six time points with P< 0.05. Extubation, emergence, and discharge times were comparable in both groups, and none of the subjects reported any adverse effects. Conclusion: This study demonstrates that a 1 μg/kg dose of intranasal dexmedetomidine administered after the induction of anesthesia reduces post-sevoflurane incidence and severity of EA in children undergone tonsillectomy and/or adenoidectomy with no adverse effects and smooth recovery profile.
  3,618 303 10
Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions
Giath Gazal, Rashdan Alharbi, Wamiq Musheer Fareed, Esam Omar, Albraa Badr Alolayan, Hassan Al-Zoubi, Ahmad A Alnazzawi
April-June 2017, 11(2):152-157
DOI:10.4103/1658-354X.203017  PMID:28442952
Objective: To investigate the speed of action and injection discomfort of 4% articaine and 2% mepivacaine for upper teeth extractions. Materials and Methods: Forty-five patients were included in the articaine 4% group, and 45 in the mepivacaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Furthermore, the discomfort of the injections were recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm). Results: There were significant differences in the meantime of first numbness to associated palatal mucosa and tooth of patients between mepivacaine and articaine buccal infiltration (BI) groups P = 0.01 and 0.01. Patients in the articaine group recorded earlier palatal mucosa and teeth numbness than those in the mepivacaine group. With regards to the discomfort of the needle injections, palatal injection was significantly more painful than BI (t-test: P< 0.001). Articaine buccal injection was significantly more painful than mepivacaine buccal injection (t-test: P<0.001). However, articaine palatal injection was less painful than articaine BI. Clinically, anesthesia onset time was faster in anterior upper teeth than upper middle and posterior teeth. Conclusions: BIs with 4% articaine was faster in achieving palate and teeth anesthesia than 2% mepivacaine for extraction of upper maxillary teeth. Patients in mepivacaine BI and articaine palatal injection groups reported less pain with needle injection. Failure of anesthesia was noticeable with maxillary multiple-rooted teeth.
  3,033 259 6
Evaluation of different doses of dexmedetomidine alone versus the combination of dexmedetomidine and fentanyl in sedation during awake fiberoptic intubation in oral cancer surgery patients: A prospective, randomized, double-blind clinical trial
Mohamed Elsayed Hassan, Essam Mahran
April-June 2017, 11(2):196-202
DOI:10.4103/1658-354X.203013  PMID:28442959
Background: Awake fiberoptic intubation (AFOI) is one of the principal techniques in the management of difficult airway in oral cancer surgery. We hypothesized that the addition of a small dose of fentanyl could improve the sedative criteria of dexmedetomidine during AFOI technique, without the need to increase the dose of dexmedetomidine which may be associated with airway compromise. Patients and Methods: One hundred and fifty American Society of Anesthesiologists physical status 1 and 2 patients planned for AFOI for oral cancer surgery patients were allocated into three groups (fifty patients each). Group D1: Received an infusion of 1 μcg/kg dexmedetomidine diluted in 50 ml saline over 20 min. Group D2: Received an infusion of 2 μcg/kg dexmedetomidine diluted in 50 ml saline over 20 min. Group DF: Received an infusion of 1 μcg/kg dexmedetomidine added to 1 μcg/kg fentanyl diluted in 50 ml saline over 20 min. AFOI was done by topical anesthesia and with the same technique in all patients. All patients were assessed for: airway obstruction, intubation scores (vocal cord movement, coughing, and limb movement), fiberoptic intubation scores, and hemodynamic variables. Any episode of bradycardia or hypoxia was recorded and managed. Results: Group D2 showed more incidence of airway obstruction than the other two groups. Limb movement scores were more in Group D1 compared to the other two groups. All groups were comparable as regard fiberoptic intubation scores, coughing, and vocal cord opening scores. Conclusion: Adding a low dose of fentanyl (1 μcg/kg) to a low dose of dexmedetomidine can prevent the risk of airway obstruction associated with increasing the dose of dexmedetomidine while achieving the same favorable intubation scores.
  2,983 237 1
LETTERS TO EDITOR
Ultrasound-guided thoracolumbar interfascial plane block for spine surgery
Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, UK Bhadani
April-June 2017, 11(2):248-249
DOI:10.4103/1658-354X.203052  PMID:28442976
  2,985 207 3
ORIGINAL ARTICLES
Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging
Kirti Kamal, Unnati Asthana, Teena Bansal, Jagdish Dureja, Geeta Ahlawat, Saloni Kapoor
April-June 2017, 11(2):163-168
DOI:10.4103/1658-354X.203014  PMID:28442954
Background: A deep level of sedation is required for magnetic resonance imaging (MRI) in children to ensure optimum image quality. The present study was conducted to evaluate the efficacy and safety of dexmedetomidine versus propofol for sedation in children undergoing MRI. Materials and Methods: A total of sixty children aged 2–10 years, having physical status 1 or 2 according to the American Society of Anesthesiologists, undergoing MRI were included in the study. Group D: (n = 30) received injection dexmedetomidine 2 μg/kg for 10 min followed by continuous infusion of 1.0 μg/kg/h. Group P (n = 30) received injection propofol 1 mg/kg bolus followed by continuous infusion of 100 μg/kg/min. Results: The mean time for onset of sedation in Group D was much longer than in Group P (P = 0.000). Mean duration of sedation was comparable in the two groups. The number of patients requiring increased infusion of study drug was significantly higher in Group D (30%) as compared to Group P (16.7%) (P < 0.05). The average recovery time in Group D was much longer than in Group P (P < 0.001). Conclusion: Propofol had an advantage of providing rapid onset of sedation and quicker recovery time. Dexmedetomidine resulted in a better preservation of respiratory rate and oxygen saturation, so it may be more suitable in children who are prone to respiratory depression. Hence, both the drugs could achieve required sedation in children posted for MRI.
  2,765 223 10
LETTERS TO EDITOR
Ultrasound-guided trigeminal nerve block for faciomaxillary surgeries
Amarjeet Kumar, Ajeet Kumar, Chandni Sinha, Akhilesh Kumar Singh
April-June 2017, 11(2):246-247
DOI:10.4103/1658-354X.203033  PMID:28442975
  2,779 160 3
CASE REPORTS
A case report of suspected malignant hyperthermia where patient survived the episode
Asif Iqbal, Shoaib Badoo, Ruqsana Naqeeb
April-June 2017, 11(2):232-235
DOI:10.4103/1658-354X.203057  PMID:28442967
Malignant hyperthermia is rare inherited disorder in our part of the world; there are only few cases reported in literature in India who were suspected of having this condition. The overall incidence of malignant hyperthermia during general anesthesia is estimated to range from 1: 5000 to 1: 50,000–100,000 and mortality rate is estimated to be <5% in the presence of standard care. In India, there is no center where in vitro halothane caffeine contraction test is performed to confirm diagnosis in suspected cases. Second, dantrolene drug of choice for this condition is not freely available in market in India and is stored only in some hospitals in few major cities. Among the cases reported of suspected of malignant hyperthermia in India almost 50% have survived the condition despite nonavailability of dantrolene emphasizing role of early detection and aggressive management in these cases.
  2,765 155 1
Successful management of a broken epidural catheter!!!
Amruta Vinod Hippalgaonkar, Amala G Kudalkar, Smita M Gaikwad, Shailendra Modak, Hema B Gupta, Bharati A Tendolkar
April-June 2017, 11(2):228-231
DOI:10.4103/1658-354X.203029  PMID:28442966
Breakage of epidural catheter though rare is a well-known but worrisome complication. Visualization of retained catheter is difficult even with modern radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its removal which led to surgical intervention.
  2,535 284 1
“Graded” epidural anesthesia for renal transplant in a patient with dilated cardiomyopathy and severe left ventricle systolic dysfunction
Rupesh Yadav, Sohan Lal Solanki
April-June 2017, 11(2):222-224
DOI:10.4103/1658-354X.203022  PMID:28442964
Dilated cardiomyopathy with decreased contractility of left or both ventricles impose a serious risk to patient posted for major surgery. Even after best medical optimization, careful perioperative management with risk and benefit of general and regional anesthesia should be discussed beforehand. We here reporting a case of successful management of a patient with dilated cardiomyopathy with ejection fraction of 15% posted for renal transplant surgery under graded epidural anesthesia.
  2,625 131 1
LETTERS TO EDITOR
An indigenous in-line metered dose inhaler actuation device
Neha Gupta, Ajay Kumar Goila, Rajesh Sood
April-June 2017, 11(2):243-245
DOI:10.4103/1658-354X.203032  PMID:28442973
  2,570 90 -
ORIGINAL ARTICLES
Efficacy and safety of intravenous thiopental for sedation during magnetic resonance imaging in pediatric patients: A retrospective analysis
Yunus O Atalay, Tomak Leman, Joseph Drew Tobias
April-June 2017, 11(2):185-189
DOI:10.4103/1658-354X.203086  PMID:28442957
Introduction: Although the administration of rectal thiopental for sedation during magnetic resonance imaging (MRI) has been well described, there are limited data regarding its intravenous (IV) use in this clinical scenario. The aim of this study was to investigate the efficiency of IV thiopental for sedation during MRI in the pediatric population. Methods: A retrospective review was conducted over a 12-month period of pediatric patients who received IV thiopental for sedation during MRI. Data collected included the procedure length, the induction dose, the time to sedation, recovery time, total sedation time, and adverse events. The parents were telephoned and questioned regarding any adverse effect after discharge and their satisfaction (yes = satisfied; no = not satisfied) regarding the sedation process. Results: A total of 300 (American Society of Anesthesiology I–II status) pediatric patients received IV thiopental for sedation during MRI. The average age of the patients was 4.7 ± 3 years. Thiopental was administered as an initial IV bolus dose of 3 mg/kg, followed by additional bolus doses of thiopental (1 mg/kg) as needed to achieve a Ramsay sedation score of 4. The average procedure length was 20.7 ± 11.9 min. The average total dose of thiopental during the procedure was 5.6 ± 0.9 mg/kg. Patients recovered in an average time of 11 ± 5.6 min after a total sedation time of 31.7 ± 14.2 min. None of the patients had oxygen desaturation, adverse effects before or after discharge, and no patient required unplanned hospital admission. All parents were satisfied with the sedation process. Conclusion: IV thiopental is an effective, safe, and inexpensive medication for the sedation of children undergoing MRI.
  2,491 155 4
REVIEW ARTICLE
Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program
Abeer Arab, Abdulaleem Alatassi, Elias Alattas, Usamah Alzoraigi, Zaki AlZaher, Abdulaziz Ahmad, Hesham Albabtain, Abdulaziz Boker
April-June 2017, 11(2):208-214
DOI:10.4103/1658-354X.203059  PMID:28442961
The educational programs in the Saudi Commission for Health Specialties are developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. This review highlights the critical need and importance of integrating simulation into anesthesia training and assessment. Furthermore, it describes the current utilization of simulation in anesthesia and critical care assessment process.
  2,476 161 -
ORIGINAL ARTICLES
Renal water conservation determines the increase in body weight after surgery: A randomized, controlled trial
Robert G Hahn
April-June 2017, 11(2):144-151
DOI:10.4103/1658-354X.203018  PMID:28442951
Background: The present study was undertaken to identify factors that correlate with the gain in body weight after surgery. Methods: Twenty-one patients (median age of 49 years) were randomized to receive either Ringer × s acetate or 6% dextran 70 as their first infusion fluid during cholecystectomy or hysterectomy. Each patient's body weight was measured before the surgery and on the first postoperative morning. Blood and urine samples were analyzed for signs of stress, inflammation, and kidney injury. The fluid retention index (FRI), which reflects how strongly the kidneys excrete or retain fluid, was also calculated. Results: The body weight increased by a median of 0.4 kg in the crystalloid fluid group and by 1.0 kg in the colloid fluid group (maximum 2.5 kg, P< 0.01). This difference was due to less urinary excretion after surgery in the colloid group (P < 0.03). The increase in body weight did not correlate with the infused fluid volume, the plasma concentrations of C-reactive protein or cortisol, or the urinary excretion of albumin, cortisol, or neutrophil gelatinase-associated lipocalin. However, the body weight increased with the postoperative FRI score (r = 0.64; P< 0.003) and with the surgery-induced change in FRI score (r = 0.72; P< 0.002). Conclusion: How strongly the kidneys excrete or retain fluid, which can be assessed by urine sampling, was the strongest indicator of the increase in body weight during the day of surgery. The amount of fluid alone did not correlate with the gain in body weight.
  2,525 101 4
Role of flupirtine in reducing preoperative anxiety of patients undergoing craniotomy procedure
Ghanshyam Yadav, Gaurav Jain, Malkhan Singh
April-June 2017, 11(2):158-162
DOI:10.4103/1658-354X.203028  PMID:28442953
Background: Kv7 neuronal channels are recognized as a potential drug target for anxiolytic effects. We hypothesize that flupirtine as a potassium channel opener would effectively reduce the preoperative anxiety of patients undergoing craniotomy procedure. Methods: In prospective-double-blinded fashion, 124 counseled patients were randomized to receive 5 sequential doses of capsule flupirtine 100 mg (F Group) or physically similar starch capsules (C Group), at 12 h intervals during preoperative hospitalization. Primary outcome included various aspects of patient anxiety measured by visual analog scale (VAS) just before preoperative counseling and 2 h after the completion of drug regimen under trial. Statistical tool included Mann–Whitney U-test and Wilcoxon signed rank test. Results: Baseline VAS scores were higher for fear of surgical harm, being at the mercy of medical staff, and not awakening after surgery. A significant decline in VAS scores was observed after the completion of drug regime, but to a higher extent in flupirtine-treated patients; it achieved statistical significance in comparison to Group C. No side effects were observed in any patient. Conclusion: Flupirtine is a useful premedication in conjunction with behavioral therapy to alleviate patient anxiety during the preoperative period.
  2,477 131 5
Cricoid ring: Shape, size, and variability in infants and children
Tariq M Wani, Bruno Bissonnette, Mahmood Rafiq, Melissa Moore-Clingenpeel, Mazen Al Sohaibani, Joseph D Tobias
April-June 2017, 11(2):203-207
DOI:10.4103/1658-354X.203051  PMID:28442960
Background: Knowledge regarding the shape, size, and variability of the cricoid ring is important to properly choose the correct endotracheal tube (ETT) in the pediatric patient. Studies have measured the size of the cricoid ring using methodologies such as moulages, magnetic resonance imaging, and video-bronchoscopy. In the present study, computed tomography (CT) -based images were used to determine the shape, size, and configuration of the cricoid ring in the pediatric population taking into considerations growth and development. Methods: This is a retrospective review using 130 CT images of children ranging in age from 1 month to 10 years undergoing radiological evaluation unrelated to airway symptomatology. The CT scans were obtained in spontaneously breathing patients during either natural sleep or procedural sedation. Anteroposterior (AP) and transverse (T) diameters were measured at the cricoid ring using these images. Results: The cricoid ring is generally round in children older than 1 year with a T/AP ratio ranging between 0.98 and 1.01. However, in infants (1–12 months of age), the cricoid ring is elliptical with the AP dimension an average of 0.31 mm larger than the T dimension with a T/AP ratio of 0.95. A statistically significant difference between the T and AP dimensions was only observed in infancy (P < 0.05). Conclusion: The cricoid ring is round in children older than 1 year of age. In infants, the cricoid shape presents a more elliptical configuration because the T-axis is narrower than the AP dimension. CT is recognized as the most accurate technique to study cricoid ring configuration, and the present data may help clinicians determine the appropriate type, size, and shape of ETTs, particularly in infants.
  2,339 142 2
CASE REPORTS
Sugammadex to reverse neuromuscular blockade and provide optimal conditions for motor-evoked potential monitoring
Mehdi Trifa, Senthil Krishna, Ajay D'Mello, Mumin Hakim, Joseph Drew Tobias
April-June 2017, 11(2):219-221
DOI:10.4103/1658-354X.203024  PMID:28442963
Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade (NMB) via a mechanism that differs completely from acetylcholinesterase inhibitors. By encapsulating rocuronium, sugammadex can provide recovery of neuromuscular function even when there is a profound degree of NMB. We report anecdotal experience with the use of sugammadex to reverse NMB to facilitate intraoperative neurophysiological monitoring (motor evoked potentials) in an adolescent with scoliosis during posterior spinal fusion. Its potential application in this unique clinical scenario is discussed, and potential dosing schemes are reviewed.
  2,363 111 6
LETTERS TO EDITOR
“Anesthesia bubbles:” Demystifying the enigma!
Dheeraj Kapoor, Ankur Dhal, Jasveer Singh, Manpreet Singh
April-June 2017, 11(2):252-254
DOI:10.4103/1658-354X.203054  PMID:28442979
  2,338 90 -
ORIGINAL ARTICLES
Physiological and operative severity score for the enumeration of mortality and morbidity scoring systems for assessment of patient outcome and impact of surgeons' and anesthesiologists' performance in hepatopancreaticobiliary surgery
Argyro Fassoulaki, Konstantinos Chondrogiannis, Chryssoula Staikou
April-June 2017, 11(2):190-195
DOI:10.4103/1658-354X.203025  PMID:28442958
Context: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system used to predict morbidity and mortality. Aims: We compared the physiological and operative risk, the expected morbidity and mortality, and the observed postoperative mortality among patients operated by different surgeons and anesthetized by different anesthesiologists. Settings and Design: This was a retrospective, single center study. Subjects and Methods: The anesthetic records of 159 patients who underwent hepatopancreaticobiliary surgery were analyzed for the physiological and operative severity, POSSUM morbidity, POSSUM and Portsmouth POSSUM (P-POSSUM) mortality scoring systems, observed mortality in 30-days, 3, 6, and 12 months postoperatively, duration of surgery, and units of packed red blood cells (PRBC) transfused. These variables were compared among patients operated by five different surgeons and anesthetized by seven different anesthesiologists. Statistical Analysis: One-way analysis of variance was used for normally and Kruskal–Wallis test for nonnormally distributed responses. Differences in percentages of postoperative mortality were assessed by Chi-squared test. Results: The physiological severity, POSSUM morbidity, POSSUM and P-POSSUM mortality scores, and observed mortality at 1, 3, 6, and 12 months postoperatively did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. Duration of surgery (P < 0.001), PRBC units transfused (P = 0.002), and operative severity (P = 0.001) differed significantly among patients operated by different surgeons. Conclusions: The physiological severity score, POSSUM and P-POSSUM scores did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. The different operative severity scores did not influence the observed mortality in the postoperative period.
  2,240 127 4
LETTERS TO EDITOR
Incidental detection of spontaneous floating internal jugular vein thrombosis with acute pulmonary embolism
Ali Jendoubi
April-June 2017, 11(2):238-239
DOI:10.4103/1658-354X.203026  PMID:28442970
  2,189 64 1
CASE REPORTS
Unusual airways management during one-lung ventilation in thoracic surgery
Paolo Primieri, Paolo Ancona, Elisabetta Gualtieri
April-June 2017, 11(2):225-227
DOI:10.4103/1658-354X.203015  PMID:28442965
Airways management in thoracic surgery is usually more difficult than in other surgery. We reported a case of a patient who underwent surgery of evacuation of empyema where after a correct insertion of a left double-lumen tube 37 Fr (DLT), one-lung ventilation was not permitted by the high airways pressure. In fact, the hole of bronchial tip was just against the left bronchial wall retracted probably from inflammatory process. We introduced blindly an Arndt blocker 9 Fr inside the tracheal lumen of DLT until the orifice of the right upper lobe bronchus, the distance was checked before. After the positioning of the blocker, the DLT was pulled up to above the carina, and the single-lung ventilation was permitted. Sometimes, an unusual use of different devices permits to manage complications. In fact, in this case, the Arndt bronchial blocker helps us to solve an important ventilatory problem.
  2,136 96 1
EDITORIAL
Combined preincisional periportal and preperitoneal infiltration with bupivacaine in pain relief after laparoscopic surgery
Abdullah Aldohayan, Abdelazeem Eldawlatly
April-June 2017, 11(2):135-136
DOI:10.4103/sja.SJA_153_17  PMID:28442949
  2,016 191 -
LETTERS TO EDITOR
The value of ultrasound sliding sign technique in predicting adhesion-related complications: The point of view of the gynecologist and the anesthesiologist
Amira Ayachi, Ali Jendoubi, Lassaad Mkaouer, Mechaal Mourali
April-June 2017, 11(2):250-252
DOI:10.4103/1658-354X.203053  PMID:28442978
  1,989 91 -
Perioperative steroid supplementation: Controversies continues!!
Priyanka Sethi, Deepak Choudhary, Pradeep Bhatia, Pooja Bihani
April-June 2017, 11(2):249-250
DOI:10.4103/1658-354X.203055  PMID:28442977
  1,911 98 -
Balloon occlusion of internal iliac arteries in placenta accreta!
Abhijit S Nair
April-June 2017, 11(2):245-246
DOI:10.4103/1658-354X.203034  PMID:28442974
  1,790 74 -
Safety issues of endobronchial intubation for one-lung ventilation in video-assisted thoracoscopic surgery in neonates: Can we extubate on the table?
Lokesh Kashyap, Neisevilie Nisa, Apala Roy Chowdhury, Punit Khanna
April-June 2017, 11(2):254-255
DOI:10.4103/1658-354X.203058  PMID:28442980
  1,781 77 -
Prevertebral abscess and airway obstruction
Sarasa Kumar Sahoo, Sriganesh Kamat
April-June 2017, 11(2):237-238
DOI:10.4103/1658-354X.203023  PMID:28442969
  1,744 70 -
Sonographic detection of tracheal or esophageal intubation: A cadaver study
Ayse B Ozer, Mustafa Ozdemir, Sibel Ozcan
April-June 2017, 11(2):236-236
DOI:10.4103/1658-354X.203019  PMID:28442968
  1,719 88 -
A simple method to reduce pulse oximetry interference by surgical optical navigation systems
Tetsuhito Hara, Masaaki Satoh, Mamoru Takeuchi
April-June 2017, 11(2):257-257
DOI:10.4103/sja.SJA_622_16  PMID:28442982
  1,735 71 -
COMMENTARY
No-show as a cause of surgical cancellation: A mini review from a Middle Eastern perspective
Mohamed Mohamed Elawdy
April-June 2017, 11(2):262-263
DOI:10.4103/sja.SJA_8_17  PMID:28442986
  1,701 63 -
LETTERS TO EDITOR
Is dexmedetomidine safe?
Om Prakash Sanjeev, Deepak Malviya, Manoj Tripathi, Prakash Kumar Dubey
April-June 2017, 11(2):258-258
DOI:10.4103/sja.SJA_9_17  PMID:28442983
  1,674 85 -
Screening ultrasound: A valuable tool to detect central venous thrombosis in a patient with multiple previous cannulation attempts
Pooja Bihani, Deepak Choudhary, Nikhil Kothari, Shilpa Goyal
April-June 2017, 11(2):241-243
DOI:10.4103/1658-354X.203031  PMID:28442972
  1,676 58 -
A case of ingested laryngoscope bulb during emergency endotracheal intubation
Shiyad Muhamed, Shaji Mathew, Battina Maheshwara Rao, Handigodu Duggappa Arunkumar
April-June 2017, 11(2):259-259
DOI:10.4103/sja.SJA_10_17  PMID:28442984
  1,624 75 -
Stroke complicating penetrating heart injury: Keys to the diagnostic workup and management
Ali Jendoubi, Belgacem Bourguiba, Ali Gaja, Mohamed Houissa
April-June 2017, 11(2):239-241
DOI:10.4103/1658-354X.203030  PMID:28442971
  1,637 61 -
Intracardiac thrombosis after liver transplantation: Can be detected before surgery?
Ahmet Selim Ozkan, Osman Kacmaz, Sedat Akbas, Mahmut Sahin, Mahmut Durmus
April-June 2017, 11(2):255-256
DOI:10.4103/1658-354X.203056  PMID:28442981
  1,622 64 -
Why should a “gasless” oncologic robotic procedure be performed?
Fabrizio Dal Moro, Angelo Mangano
April-June 2017, 11(2):260-261
DOI:10.4103/sja.SJA_53_17  PMID:28442985
  1,614 59 1
ORIGINAL ARTICLES
No preemptive analgesic effect of preoperative ketorolac administration following total abdominal hysterectomy: A randomized study
Beatriz Nistal-NuÑo
April-June 2017, 11(2):169-176
DOI:10.4103/1658-354X.203011  PMID:28442955
Background: Experimental models using short-duration noxious stimuli have led to the concept of preemptive analgesia. Ketorolac, a nonsteroidal anti-inflammatory drug, has been shown to have a postoperative narcotic-sparing effect when given preoperatively and alternatively to not have this effect. This study was undertaken to determine whether a single intravenous (IV) dose of ketorolac would result in decreased postoperative pain and narcotic requirements. Methods: In a double-blind, randomized controlled trial, 48 women undergoing abdominal hysterectomy were studied. Patients in the ketorolac group received 30 mg of IV ketorolac 30 min before surgical incision, while the control group received normal saline. The postoperative analgesia was performed with a continuous infusion of tramadol at 12 mg/h with the possibility of a 10 mg bolus for every 10 min. Pain was assessed using the visual analog scale (VAS), tramadol consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 h postoperatively. We quantified times to rescue analgesic (morphine), adverse effects, and patient satisfaction. Results: There were neither significant differences in VAS scores between groups (P > 0.05) nor in the cumulative or incremental consumption of tramadol at any time point (P > 0.05). The time to first requested rescue analgesia was 66.25 ± 38.61 min in the ketorolac group and 65 ± 28.86 min in the control group (P = 0.765). There were no significant differences in systolic blood pressure (BP) between both groups, except at 2 h (P = 0.02) and 4 h (P = 0.045). There were no significant differences in diastolic BP between both groups, except at 4 h (P = 0.013). The respiratory rate showed no differences between groups, except at 8 h (P = 0.017), 16 h (P = 0.011), and 24 h (P = 0.049). These differences were not clinically significant. There were no statistically significant differences between groups in heart rate (P > 0.05). Conclusions: Preoperative ketorolac neither showed a preemptive analgesic effect nor was it effective as an adjuvant for decreasing opioid requirements or postoperative pain in patients receiving IV analgesia with tramadol after abdominal hysterectomy.
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CASE REPORTS
Migrated esophageal stent posing a challenge for ventilation
Nita D'souza, Sachin Arbhi, Amit Dikshit, Murarji Ghadge, Smriti Jha
April-June 2017, 11(2):215-218
DOI:10.4103/1658-354X.203016  PMID:28442962
Self-expandable esophageal stents are being commonly used for palliative treatment in advanced esophageal cancer patients to relieve dysphagia, prevent tracheoesophageal fistula, and facilitate symptomatic betterment. The modern covered stents reduce the ingrowth of the tumor but have seen an increase in the incidence of stent migrations. We report a rather complicated presentation of an esophageal stent for esophageal dilatation and a challenging management of a difficult tracheostomy.
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