Bronchospasm in spinal anesthesia is uncommon. We are reporting two cases of bronchospasm under s... more Bronchospasm in spinal anesthesia is uncommon. We are reporting two cases of bronchospasm under spinal anesthesia in patients with hyper-reactive airways who had no respiratory signs or symptoms preoperatively. Case 1: A 50 yr old male, known case of bronchial asthma on treatment underwent emergency fasciotomy for cellulitis on his left leg under spinal anesthesia, after receiving steroid prophylaxis for his asthma. Case 2: A 27 year old male, underwent debridement and k wire fixation of his right medial malleolus under spinal anesthesia. This patient had a history of allergic rhinitis which was not revealed on preanesthetic evaluation. Both of them received subarachnoid block with 10 mg 0.5% hyperbaric bupivacaine and a block height of T8 and T10 was achieved in case 1 & 2 respectively. In these cases severe bronchospasm (coughing, wheezing, desaturation) occurred 15 min and 5 min after spinal injection in the respective cases. Both were successfully treated with bronchodilators an...
Journal of Obstetric Anaesthesia and Critical Care, 2011
... attitude and acceptance of antenatal women toward labor analgesia and caesarean section in a ... more ... attitude and acceptance of antenatal women toward labor analgesia and caesarean section in a medical college hospital in India Udita Naithani 1 , Prerna Bharwal 1 ... 28. 29. Naithani U, Purohit D, Bajaj P. Public awareness about anaesthesia and anaesthesiologists: A survey. ...
Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their co... more Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity (bilateral fracture tibia). Bilateral mid-thigh tourniquets (Esmarch bandage) were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation (CPCR) was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time (<2 hours) and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided.
Critical incident monitoring is useful in detecting new problems, identifying 'near misses... more Critical incident monitoring is useful in detecting new problems, identifying 'near misses' and analyzing factors or events leading to mishaps, which can be instructive for trainees. This study was aimed at investigating potential risk factors and analyze events leading to peri-operative critical incidents in order to develop a critical incident reporting system. We conducted a one year prospective analysis of voluntarily reported 24- hour-perioperative critical incidents, occurring in patients subjected to anaesthesia. During a one year period from December 2006 to December 2007, 14,134 anaesthetics were administered and 112(0.79%) critical incidents were reported with complete recovery in 71.42%(n=80) and mortality in 28.57% (n=32) cases. Incidents occurred maximally in 0-10 years age (23.21%), ASA 1(61.61%), in general surgery patients (43.75%), undergoing emergency surgery (52.46%) and during day time (75.89%). Incidence was more in the operating theatre (77.68%), during...
Postdural puncture headache (PDPH) in children has rarely been registered, but some recent studie... more Postdural puncture headache (PDPH) in children has rarely been registered, but some recent studies indicate that children may also develop headache after lumbar puncture. We report two cases of PDPH that occurred in male children aged 6 yr (20 kg) and 10 yr (25 kg) who received subarachnoid block under sedation for herniotomy using 27 G Quincke spinal needle at L4-L5 space with 0.5% hyperbaric bupivacaine at a dose of 0.3 mg/kg. They developed typical postural headache after 24 hr & 48 hr respectively. They were successfully managed with complete bed rest, forced hydration, coffee drink twice, oral analgesics; and were discharged uneventfully. We conclude that now a days spinal anesthesia is being used in children and PDPH can occur in this population which can be treated on same lines as in adults. We believe that parents need to be informed about PDPH as there is inability of children to verbalise this pain.
Background and Aims: In Functional Endoscopic Sinus Surgery (FESS), hypotensive anaesthesia is be... more Background and Aims: In Functional Endoscopic Sinus Surgery (FESS), hypotensive anaesthesia is becoming increasingly popular now a days. This study evaluated the effect of Dexmedetomidine in minimising surgical blood loss, on intraoperative haemodynamics as well as its effect on reducing isoflurane requirement during FESS. Material and Methods: in this study 48 patients undergoing FESS were divided into two groups. Group C / Control Group (n=24) received bolus of 100 ml normal saline over 10 mins followed by placebo infusion @ 0.2 mcg/kg/hr whereas Group D / Dexmedetomidine Group (n=24) received dexmedetomidine as a loading dose of 1mcg/kg over 10 min followed by maintenance infusion of 0.2 mcg/kg/hr. The Primary outcome measure was to see the efficacy of dexmedetomidine in providing bloodless surgical field in terms of bleeding score whereas secondary outcome measures were its effect on haemodynamic variables as well as reduction in dose requirements of isoflurane. The qualitative ...
International Journal of Health Sciences and Research, 2016
Takayasu’s arteritis (TA) is a rare, inflammatory panarteritis involving aorta and its major bran... more Takayasu’s arteritis (TA) is a rare, inflammatory panarteritis involving aorta and its major branches. Anesthetic implications of TA include uncontrolled hypertension, end organ dysfunction and difficulty in the monitoring of arterial pressure. We are reporting a case of 30 yr. old parturient having TA with schizophrenia and very bad obstetric history, who was managed in high dependency unit from 24 weeks onward under supervision of multidisciplinary team, as lives of both mother and fetus were at stake. She successfully underwent cesarean section in low dose spinal anesthesia using 7.5mg hyperbaric bupivacaine with 25 mcg fentanyl intrathecally. This report highlights that low dose spinal anesthesia remains a good option if mean arterial pressure is maintained to prevent end organ damage. As the patient remains awake, it allows monitoring of cerebral perfusion without the need of sophisticated cerebral function monitor.
Background: Adequate postoperative analgesia following tonsillectomy in children is still a chall... more Background: Adequate postoperative analgesia following tonsillectomy in children is still a challenge. Recently the use of topical analgesia at tonsillectomy site is being developed as a modality of analgesia. Survey across the literature gives a very sparse data regarding efficacy of topical tramadol application. Hence we conducted this study to evaluate the effects of topical tramadol on postoperative pain in children undergoing tonsillectomy Methods: A double blind, prospective, randomised, controlled clinical trial was conducted in 56 children between 4 and 12 years scheduled for elective tonsillectomy or adenotonsillectomy, who were randomized into two groups. Group T received swabs soaked in tramadol 2 mg/kg diluted in 10 ml saline and Group C swabs soaked in saline 10 ml, which were applied for 5 min in the tonsillar fossa after tonsillectomy. All patients received oral paracetamol (20 mg/kg) in form of pediatric suspensions/tablets at 6 hrs postoperatively, repeated every 6 ...
Journal of Evolution of medical and Dental Sciences, 2013
BACKGROUND: Wound infiltration with local anesthetics and opioids is increasingly being used as a... more BACKGROUND: Wound infiltration with local anesthetics and opioids is increasingly being used as a part of multimodal postoperative analgesia. OBJECTIVES: A prospective randomized double blind placebo controlled study was conducted to investigate the efficacy of wound infiltration using bupivacaine versus ropivacaine with fentanyl for postoperative analgesia. METHOD: 93 female patients of ASA grade I/II posted for abdominal hysterectomy under spinal anesthesia were randomly divided into three groups destined to receive wound infiltration at the end of surgery using 14.5 ml 0.5% isobaric solution of either bupivacaine or ropivacaine along with 0.5 ml (25 mcg) fentanyl in group BF and RF respectively, and with 15 ml normal saline in control group (Group S). All patients received diclofenac 75 mg I.M. (B.D.) and rescue analgesic butorphanol 1 mg was given if pain occurs. Postoperative analgesia in terms of visual analogue score rescue opioids consumption in 24 hour period, and satisfact...
Objective: Alpha-2 adrenoceptors have recently been used perioperatively for their sedative, anal... more Objective: Alpha-2 adrenoceptors have recently been used perioperatively for their sedative, analgesic,sympatholytic and cardiovascular stabilizing effects. The efficacy of clonidine as an adjuvant in providingmonitored anesthesia care (MAC) for ear, nose and throat (ENT) surgeries has not been much investigated,so we conducted this study.Methodology: In this prospective double blind randomized placebo controlled study, 90 patients postedfor elective ENT surgeries under local anesthesia with MAC were included and divided into 3 groups of 30each. In Group CBI patients received clonidine 3 μg/kg intravenous bolus followed by clonidine infusionat 0.3 μg/kg/hr. Patients of Group CB received clonidine 3 μg/kg bolus followed by placebo infusion andin Group P patients received placebo bolus followed by placebo infusion. All three Groups receivedsimilar premedication of intravenous midazolam 0.03 mg/kg and fentanyl 2 μg/kg. Demographic data,intraoperative vital parameters, observer’s assess...
Background: Levobupivacaine is an S (-) enantiomer of bupivacaine having less cardiotoxic and cen... more Background: Levobupivacaine is an S (-) enantiomer of bupivacaine having less cardiotoxic and central nervous system effects. Use of isobaric levobupivacaine in spinal anesthesia has recently been started. Objective: To compare the anesthetic efficacy and safety of isobaric levobupivacaine versus hyperbaric bupivacaine in spinal anesthesia for lower limb orthopedic surgeries. Materials and methods: 60 healthy patients were randomized into two groups of 30 each to receive intrathecal injection of 3ml 0.5% (15mg) of hyperbaric bupivacaine in group B and 3ml 0.5% (15mg) of isobaric levobupivacaine in group L. Both groups were compared regarding sensory- motor block characteristics, hemodynamic profile, adverse effects, supplemental analgesia and success rate. Results: Both agents produced effective spinal anesthesia to accomplish surgery without supplementation in all 30 (100%) patients of group B and almost all (n=29, 97.6%) patients of group L. Peak sensory level was significantly hi...
Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We repor... more Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three cases of vaginal hysterectomy performed under combined spinal epidural anesthesia (CSE) using 3 ml of 0.5% hyperbaric bupivacaine (15 mg) in subarachnoid space followed by epidural analgesia top up after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that patients with epidural catheter should be monitored and on appearance of any ...
BACKGROUND: Effect of adding intrathecal tramadol and nalbuphine to local anaesthetics in spinal ... more BACKGROUND: Effect of adding intrathecal tramadol and nalbuphine to local anaesthetics in spinal anaesthesia is not much studied. STUDY DESIGN: A prospective, randomised double blind placebo controlled study. METHODS: 90 adult patients of ASA grade I-II scheduled for lower limb orthopaedic surgery under spinal anaesthesia were randomised to three groups of 30 each destined to receive 2.5ml (12.5mg) hyperbaric bupivacaine (0.5%) along with 1 ml of either normal saline (Group C) 50mg tramadol (Group T) or 2mg nalbuphine (Group N), making intrathecal drug volume to 3.5ml in each group. Sensory-motor block characteristics, postoperative analgesia in terms of VAS score, time to first rescue analgesic (duration of analgesia) and rescue analgesic consumption (tramadol) in 24 hours were compared in three groups. RESULTS: All three groups were comparable regarding onset and extent of sensory and motor block, (p>0.05). However, time to two dermatomal regression and time for complete motor ...
BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and ... more BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anaesthetic practice which can be reduced by identification of potential difficult intubation. OBJECTIVE: We aimed the present study to know the incidence of difficult intubation, factors associated with it and the predictive value of various airway predictors in anticipating difficult visualization of larynx and difficult intubation. METHODS: 435 adult patients (>18 year) undergoing general anaesthesia with intubation were examined preoperatively for demographic details (age, sex, weight), dentition, airway pathology and six airway predictors i.e. Inter Incisor Gap (IIG), Modified Mallampatti Grading (MMPG), Upper lip bite test (ULBT), Thyromental distance (TMD), Sternomental distance (SMD) and subluxation of mandible (SLM). All patients were anaesthetized using standard protocol with thiopentone (5mg/kg) and succinylcholine (1.5 mg/kg). On direct laryngoscopy, Cormack L...
Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitati... more Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients. A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P-Injpropofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K-Injketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation.The supplementation dose required was significantly h...
Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniqu... more Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniques are increasingly being practiced in children for different surgeries. These RA techniques are often combined with moderate degree of sedation to remain child calm and immobile. With limited literature available, we planned a prospective study to evaluate the effectiveness of dexemedetomidine as an intraoperative sedative agent with RA considering its short term sedation and least respiratory depression property. Materials and Methods: Fifty children of 1-8 year of age, ASA grade 1&2 undergoing below umbilical surgery under RA (caudal epidural anaesthesia) were selected and studied. After giving Inj. Ketamine (1mg/kg) intravenously, RA was performed with Inj. Bupivacaine. Then inj. Dexemedetomidine (1mcg/kg) IV was administered as bolus over 10 min followed by continuous infusion (0.4 mcg/kg/hr) till completion of surgery. Perioperative sedation score, vital parameters, peripheral oxygen saturation, respiratory rate and surgeon's satisfaction were observed. The Study was considered complete till stay of patient in PACU for 2hrs. Recovery time and any complications were noted. Results: The quality of sedation and surgeon's satisfaction were good in all children except three children who needed extra dose of sedative. The only adverse effects reported were bradycardia and hypotension in 3 patients which were well managed by reducing the infusion rate. Conclusion: Dexemedetomidine offers an adequate level of sedation in most of the children without haemodynamic or respiratory side effects when used intraoperatively with RA.
Currently, the safety of spinal anaesthetic techniques is well established for caesarean section ... more Currently, the safety of spinal anaesthetic techniques is well established for caesarean section in pregnancy induced hypertension (PIH) patient. Addition of fentanyl to local anaesthetic allows achievement of adequate anaesthesia with lower dose of local anaesthetic in spinal anaesthesia, thereby reducing the occurence of hypotension and need for vasopressor. A prospective, randomized, double blind, case control study was carried out in 80 parturients having PIH undergoing caesarean section in spinal anaesthesia were randomized into 2 groups depending on intrathecal drug received by them as Group C (Conventional dose group- received hyperbaric bupivacaine 10 mg)and Group L{low dose group, hyperbaric bupivacaine (7.5 mg) with fentanyl (25 mcg)} and compared regarding sensory- motor block characteristics, incidence of hypotension (fall in MAP > 25% from baseline) vasopressor requirement Phenylephrine and Ephedrine. Patient in Group L had significantly less number of hypotension ep...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Levobupivacaine has equal potency as bupivacaine but lower CVS and CNS toxicity. Aim w... more BACKGROUND Levobupivacaine has equal potency as bupivacaine but lower CVS and CNS toxicity. Aim was to evaluate clinical efficacy of isobaric levobupivacaine with or without fentanyl in spinal anaesthesia for inguinal hernia surgeries regarding sensory-motor block characteristics, haemodynamic profile and complications. MATERIALS AND METHODS After approval from institutional ethical committee (IEC) and informed written consent, a randomised double blinded controlled trial was conducted during 1 year period. 60 patients of ASA I-II of age 20-60 years, weight 40-90 kg, were divided into two groups 30 each, to receive either 4 mL of 0.5% isobaric levobupivacaine (group L) or 4 mL of 0.5% isobaric levobupivacaine + 25 μg fentanyl (group LF) intrathecally. Exclusion criteria-uncooperative patient and patient refusal, h/o allergy to study drugs, vertebral deformity, morbid obesity and any other associated systemic illness. Patients were monitored for sensory and motor block characteristics, postoperative analgesia, haemodynamics, side effects and complications. Data analysed by using Student t test and Chi square test; p<0.05 was considered as statistically significant. RESULTS Onset of sensory block and time to reach peak sensory level was shorter in group LF (6.40 ± 0.67 and 7.17 ± 0.79 min.) as compared to group L (8.20 ± 0.76 and 9.27 ± 0.98 min.) (p=0.00). Onset of motor block was shorter in group LF (8.57 ± 1.04 min.) compared to group L (9.10 ± 0.92 min.). Duration of analgesia was prolonged in Group LF (152 ± 3.89 min.) compared to Group L (142.30 ± 18.4 min.), (p=0.007). Haemodynamic variables and demographic data were comparable in both groups. CONCLUSION Isobaric levobupivacaine in spinal anaesthesia produces effective sensory-motor block of sufficient duration with stable haemodynamic profile in lower abdominal surgeries. Addition of fentanyl to levobupivacaine results in shortening of onset time, increased peak sensory level and prolonged duration of analgesia.
Bronchospasm in spinal anesthesia is uncommon. We are reporting two cases of bronchospasm under s... more Bronchospasm in spinal anesthesia is uncommon. We are reporting two cases of bronchospasm under spinal anesthesia in patients with hyper-reactive airways who had no respiratory signs or symptoms preoperatively. Case 1: A 50 yr old male, known case of bronchial asthma on treatment underwent emergency fasciotomy for cellulitis on his left leg under spinal anesthesia, after receiving steroid prophylaxis for his asthma. Case 2: A 27 year old male, underwent debridement and k wire fixation of his right medial malleolus under spinal anesthesia. This patient had a history of allergic rhinitis which was not revealed on preanesthetic evaluation. Both of them received subarachnoid block with 10 mg 0.5% hyperbaric bupivacaine and a block height of T8 and T10 was achieved in case 1 & 2 respectively. In these cases severe bronchospasm (coughing, wheezing, desaturation) occurred 15 min and 5 min after spinal injection in the respective cases. Both were successfully treated with bronchodilators an...
Journal of Obstetric Anaesthesia and Critical Care, 2011
... attitude and acceptance of antenatal women toward labor analgesia and caesarean section in a ... more ... attitude and acceptance of antenatal women toward labor analgesia and caesarean section in a medical college hospital in India Udita Naithani 1 , Prerna Bharwal 1 ... 28. 29. Naithani U, Purohit D, Bajaj P. Public awareness about anaesthesia and anaesthesiologists: A survey. ...
Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their co... more Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity (bilateral fracture tibia). Bilateral mid-thigh tourniquets (Esmarch bandage) were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation (CPCR) was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time (<2 hours) and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided.
Critical incident monitoring is useful in detecting new problems, identifying 'near misses... more Critical incident monitoring is useful in detecting new problems, identifying 'near misses' and analyzing factors or events leading to mishaps, which can be instructive for trainees. This study was aimed at investigating potential risk factors and analyze events leading to peri-operative critical incidents in order to develop a critical incident reporting system. We conducted a one year prospective analysis of voluntarily reported 24- hour-perioperative critical incidents, occurring in patients subjected to anaesthesia. During a one year period from December 2006 to December 2007, 14,134 anaesthetics were administered and 112(0.79%) critical incidents were reported with complete recovery in 71.42%(n=80) and mortality in 28.57% (n=32) cases. Incidents occurred maximally in 0-10 years age (23.21%), ASA 1(61.61%), in general surgery patients (43.75%), undergoing emergency surgery (52.46%) and during day time (75.89%). Incidence was more in the operating theatre (77.68%), during...
Postdural puncture headache (PDPH) in children has rarely been registered, but some recent studie... more Postdural puncture headache (PDPH) in children has rarely been registered, but some recent studies indicate that children may also develop headache after lumbar puncture. We report two cases of PDPH that occurred in male children aged 6 yr (20 kg) and 10 yr (25 kg) who received subarachnoid block under sedation for herniotomy using 27 G Quincke spinal needle at L4-L5 space with 0.5% hyperbaric bupivacaine at a dose of 0.3 mg/kg. They developed typical postural headache after 24 hr & 48 hr respectively. They were successfully managed with complete bed rest, forced hydration, coffee drink twice, oral analgesics; and were discharged uneventfully. We conclude that now a days spinal anesthesia is being used in children and PDPH can occur in this population which can be treated on same lines as in adults. We believe that parents need to be informed about PDPH as there is inability of children to verbalise this pain.
Background and Aims: In Functional Endoscopic Sinus Surgery (FESS), hypotensive anaesthesia is be... more Background and Aims: In Functional Endoscopic Sinus Surgery (FESS), hypotensive anaesthesia is becoming increasingly popular now a days. This study evaluated the effect of Dexmedetomidine in minimising surgical blood loss, on intraoperative haemodynamics as well as its effect on reducing isoflurane requirement during FESS. Material and Methods: in this study 48 patients undergoing FESS were divided into two groups. Group C / Control Group (n=24) received bolus of 100 ml normal saline over 10 mins followed by placebo infusion @ 0.2 mcg/kg/hr whereas Group D / Dexmedetomidine Group (n=24) received dexmedetomidine as a loading dose of 1mcg/kg over 10 min followed by maintenance infusion of 0.2 mcg/kg/hr. The Primary outcome measure was to see the efficacy of dexmedetomidine in providing bloodless surgical field in terms of bleeding score whereas secondary outcome measures were its effect on haemodynamic variables as well as reduction in dose requirements of isoflurane. The qualitative ...
International Journal of Health Sciences and Research, 2016
Takayasu’s arteritis (TA) is a rare, inflammatory panarteritis involving aorta and its major bran... more Takayasu’s arteritis (TA) is a rare, inflammatory panarteritis involving aorta and its major branches. Anesthetic implications of TA include uncontrolled hypertension, end organ dysfunction and difficulty in the monitoring of arterial pressure. We are reporting a case of 30 yr. old parturient having TA with schizophrenia and very bad obstetric history, who was managed in high dependency unit from 24 weeks onward under supervision of multidisciplinary team, as lives of both mother and fetus were at stake. She successfully underwent cesarean section in low dose spinal anesthesia using 7.5mg hyperbaric bupivacaine with 25 mcg fentanyl intrathecally. This report highlights that low dose spinal anesthesia remains a good option if mean arterial pressure is maintained to prevent end organ damage. As the patient remains awake, it allows monitoring of cerebral perfusion without the need of sophisticated cerebral function monitor.
Background: Adequate postoperative analgesia following tonsillectomy in children is still a chall... more Background: Adequate postoperative analgesia following tonsillectomy in children is still a challenge. Recently the use of topical analgesia at tonsillectomy site is being developed as a modality of analgesia. Survey across the literature gives a very sparse data regarding efficacy of topical tramadol application. Hence we conducted this study to evaluate the effects of topical tramadol on postoperative pain in children undergoing tonsillectomy Methods: A double blind, prospective, randomised, controlled clinical trial was conducted in 56 children between 4 and 12 years scheduled for elective tonsillectomy or adenotonsillectomy, who were randomized into two groups. Group T received swabs soaked in tramadol 2 mg/kg diluted in 10 ml saline and Group C swabs soaked in saline 10 ml, which were applied for 5 min in the tonsillar fossa after tonsillectomy. All patients received oral paracetamol (20 mg/kg) in form of pediatric suspensions/tablets at 6 hrs postoperatively, repeated every 6 ...
Journal of Evolution of medical and Dental Sciences, 2013
BACKGROUND: Wound infiltration with local anesthetics and opioids is increasingly being used as a... more BACKGROUND: Wound infiltration with local anesthetics and opioids is increasingly being used as a part of multimodal postoperative analgesia. OBJECTIVES: A prospective randomized double blind placebo controlled study was conducted to investigate the efficacy of wound infiltration using bupivacaine versus ropivacaine with fentanyl for postoperative analgesia. METHOD: 93 female patients of ASA grade I/II posted for abdominal hysterectomy under spinal anesthesia were randomly divided into three groups destined to receive wound infiltration at the end of surgery using 14.5 ml 0.5% isobaric solution of either bupivacaine or ropivacaine along with 0.5 ml (25 mcg) fentanyl in group BF and RF respectively, and with 15 ml normal saline in control group (Group S). All patients received diclofenac 75 mg I.M. (B.D.) and rescue analgesic butorphanol 1 mg was given if pain occurs. Postoperative analgesia in terms of visual analogue score rescue opioids consumption in 24 hour period, and satisfact...
Objective: Alpha-2 adrenoceptors have recently been used perioperatively for their sedative, anal... more Objective: Alpha-2 adrenoceptors have recently been used perioperatively for their sedative, analgesic,sympatholytic and cardiovascular stabilizing effects. The efficacy of clonidine as an adjuvant in providingmonitored anesthesia care (MAC) for ear, nose and throat (ENT) surgeries has not been much investigated,so we conducted this study.Methodology: In this prospective double blind randomized placebo controlled study, 90 patients postedfor elective ENT surgeries under local anesthesia with MAC were included and divided into 3 groups of 30each. In Group CBI patients received clonidine 3 μg/kg intravenous bolus followed by clonidine infusionat 0.3 μg/kg/hr. Patients of Group CB received clonidine 3 μg/kg bolus followed by placebo infusion andin Group P patients received placebo bolus followed by placebo infusion. All three Groups receivedsimilar premedication of intravenous midazolam 0.03 mg/kg and fentanyl 2 μg/kg. Demographic data,intraoperative vital parameters, observer’s assess...
Background: Levobupivacaine is an S (-) enantiomer of bupivacaine having less cardiotoxic and cen... more Background: Levobupivacaine is an S (-) enantiomer of bupivacaine having less cardiotoxic and central nervous system effects. Use of isobaric levobupivacaine in spinal anesthesia has recently been started. Objective: To compare the anesthetic efficacy and safety of isobaric levobupivacaine versus hyperbaric bupivacaine in spinal anesthesia for lower limb orthopedic surgeries. Materials and methods: 60 healthy patients were randomized into two groups of 30 each to receive intrathecal injection of 3ml 0.5% (15mg) of hyperbaric bupivacaine in group B and 3ml 0.5% (15mg) of isobaric levobupivacaine in group L. Both groups were compared regarding sensory- motor block characteristics, hemodynamic profile, adverse effects, supplemental analgesia and success rate. Results: Both agents produced effective spinal anesthesia to accomplish surgery without supplementation in all 30 (100%) patients of group B and almost all (n=29, 97.6%) patients of group L. Peak sensory level was significantly hi...
Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We repor... more Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three cases of vaginal hysterectomy performed under combined spinal epidural anesthesia (CSE) using 3 ml of 0.5% hyperbaric bupivacaine (15 mg) in subarachnoid space followed by epidural analgesia top up after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that patients with epidural catheter should be monitored and on appearance of any ...
BACKGROUND: Effect of adding intrathecal tramadol and nalbuphine to local anaesthetics in spinal ... more BACKGROUND: Effect of adding intrathecal tramadol and nalbuphine to local anaesthetics in spinal anaesthesia is not much studied. STUDY DESIGN: A prospective, randomised double blind placebo controlled study. METHODS: 90 adult patients of ASA grade I-II scheduled for lower limb orthopaedic surgery under spinal anaesthesia were randomised to three groups of 30 each destined to receive 2.5ml (12.5mg) hyperbaric bupivacaine (0.5%) along with 1 ml of either normal saline (Group C) 50mg tramadol (Group T) or 2mg nalbuphine (Group N), making intrathecal drug volume to 3.5ml in each group. Sensory-motor block characteristics, postoperative analgesia in terms of VAS score, time to first rescue analgesic (duration of analgesia) and rescue analgesic consumption (tramadol) in 24 hours were compared in three groups. RESULTS: All three groups were comparable regarding onset and extent of sensory and motor block, (p>0.05). However, time to two dermatomal regression and time for complete motor ...
BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and ... more BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anaesthetic practice which can be reduced by identification of potential difficult intubation. OBJECTIVE: We aimed the present study to know the incidence of difficult intubation, factors associated with it and the predictive value of various airway predictors in anticipating difficult visualization of larynx and difficult intubation. METHODS: 435 adult patients (>18 year) undergoing general anaesthesia with intubation were examined preoperatively for demographic details (age, sex, weight), dentition, airway pathology and six airway predictors i.e. Inter Incisor Gap (IIG), Modified Mallampatti Grading (MMPG), Upper lip bite test (ULBT), Thyromental distance (TMD), Sternomental distance (SMD) and subluxation of mandible (SLM). All patients were anaesthetized using standard protocol with thiopentone (5mg/kg) and succinylcholine (1.5 mg/kg). On direct laryngoscopy, Cormack L...
Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitati... more Most common drug used for outpatient procedural sedation and analgesia is propofol, with limitations like systemic hypotension. Combining propofol with ketamine preserves sedation efficacy, minimizing their respective adverse effects. So, we aimed to compare ketofol (ketamine+propofol) versus propofol regarding their total drug consumption, recovery profile, effect on haemodynamic and respiratory parameters in brachytherapy patients. A prospective, randomized, controlled double blind study was carried out in 100 female patients between 20-60 years, 30-70kg, ASA I-III undergoing brachytherapy as outpatient procedure on elective basis, after ethical clearance from institutional committee. These were randomly divided into 2 groups (50 each). Group P-Injpropofol (10mg/ml) 2mg/kg for induction and 20mg as supplementation. Group K-Injketofol (10mg/ml) (ketamine 50mg+propofol 100mg, 1:2) 2mg/kg for induction and 20 mg as supplementation.The supplementation dose required was significantly h...
Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniqu... more Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniques are increasingly being practiced in children for different surgeries. These RA techniques are often combined with moderate degree of sedation to remain child calm and immobile. With limited literature available, we planned a prospective study to evaluate the effectiveness of dexemedetomidine as an intraoperative sedative agent with RA considering its short term sedation and least respiratory depression property. Materials and Methods: Fifty children of 1-8 year of age, ASA grade 1&2 undergoing below umbilical surgery under RA (caudal epidural anaesthesia) were selected and studied. After giving Inj. Ketamine (1mg/kg) intravenously, RA was performed with Inj. Bupivacaine. Then inj. Dexemedetomidine (1mcg/kg) IV was administered as bolus over 10 min followed by continuous infusion (0.4 mcg/kg/hr) till completion of surgery. Perioperative sedation score, vital parameters, peripheral oxygen saturation, respiratory rate and surgeon's satisfaction were observed. The Study was considered complete till stay of patient in PACU for 2hrs. Recovery time and any complications were noted. Results: The quality of sedation and surgeon's satisfaction were good in all children except three children who needed extra dose of sedative. The only adverse effects reported were bradycardia and hypotension in 3 patients which were well managed by reducing the infusion rate. Conclusion: Dexemedetomidine offers an adequate level of sedation in most of the children without haemodynamic or respiratory side effects when used intraoperatively with RA.
Currently, the safety of spinal anaesthetic techniques is well established for caesarean section ... more Currently, the safety of spinal anaesthetic techniques is well established for caesarean section in pregnancy induced hypertension (PIH) patient. Addition of fentanyl to local anaesthetic allows achievement of adequate anaesthesia with lower dose of local anaesthetic in spinal anaesthesia, thereby reducing the occurence of hypotension and need for vasopressor. A prospective, randomized, double blind, case control study was carried out in 80 parturients having PIH undergoing caesarean section in spinal anaesthesia were randomized into 2 groups depending on intrathecal drug received by them as Group C (Conventional dose group- received hyperbaric bupivacaine 10 mg)and Group L{low dose group, hyperbaric bupivacaine (7.5 mg) with fentanyl (25 mcg)} and compared regarding sensory- motor block characteristics, incidence of hypotension (fall in MAP > 25% from baseline) vasopressor requirement Phenylephrine and Ephedrine. Patient in Group L had significantly less number of hypotension ep...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Levobupivacaine has equal potency as bupivacaine but lower CVS and CNS toxicity. Aim w... more BACKGROUND Levobupivacaine has equal potency as bupivacaine but lower CVS and CNS toxicity. Aim was to evaluate clinical efficacy of isobaric levobupivacaine with or without fentanyl in spinal anaesthesia for inguinal hernia surgeries regarding sensory-motor block characteristics, haemodynamic profile and complications. MATERIALS AND METHODS After approval from institutional ethical committee (IEC) and informed written consent, a randomised double blinded controlled trial was conducted during 1 year period. 60 patients of ASA I-II of age 20-60 years, weight 40-90 kg, were divided into two groups 30 each, to receive either 4 mL of 0.5% isobaric levobupivacaine (group L) or 4 mL of 0.5% isobaric levobupivacaine + 25 μg fentanyl (group LF) intrathecally. Exclusion criteria-uncooperative patient and patient refusal, h/o allergy to study drugs, vertebral deformity, morbid obesity and any other associated systemic illness. Patients were monitored for sensory and motor block characteristics, postoperative analgesia, haemodynamics, side effects and complications. Data analysed by using Student t test and Chi square test; p<0.05 was considered as statistically significant. RESULTS Onset of sensory block and time to reach peak sensory level was shorter in group LF (6.40 ± 0.67 and 7.17 ± 0.79 min.) as compared to group L (8.20 ± 0.76 and 9.27 ± 0.98 min.) (p=0.00). Onset of motor block was shorter in group LF (8.57 ± 1.04 min.) compared to group L (9.10 ± 0.92 min.). Duration of analgesia was prolonged in Group LF (152 ± 3.89 min.) compared to Group L (142.30 ± 18.4 min.), (p=0.007). Haemodynamic variables and demographic data were comparable in both groups. CONCLUSION Isobaric levobupivacaine in spinal anaesthesia produces effective sensory-motor block of sufficient duration with stable haemodynamic profile in lower abdominal surgeries. Addition of fentanyl to levobupivacaine results in shortening of onset time, increased peak sensory level and prolonged duration of analgesia.
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Papers by Udita Naithani