Indian Anaesthetists Forum最新文献

{"title":"Comparison of ketofol (ketamine and propofol) and etomidate in electro convulsive therapy: A double-blinded randomized controlled trial","authors":"C. Joshi, Thapisrija, Basavaraja Ayyanagouda, Narayan R. Mutalik, S. Hulakund, Harini Jalapati","doi":"10.4103/TheIAForum.TheIAForum_98_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_98_20","url":null,"abstract":"Background and Aims: Electroconvulsive therapy (ECT) is the most effective treatment modality for severe and medication-resistant psychiatric disorders. ECT provokes generalized tonic-clonic seizures. Induction of optimal seizures (duration of motor seizures >15 s) is considered as an important goal during the ECT procedure. We compared ketofol and etomidate as induction agents in ECT with respect to the seizure duration and seizure threshold as there is less information available in the literature. Methods: One hundred and twenty patients posted for ECT were randomized into two groups. Group A received ketofol 1:1 (ketamine 0.5 mg/kg + propofol 0.5 mg/kg), while as Group B received etomidate 0.2 mg/kg. After administration of the muscle relaxant (succinylcholine 0.5 mg/kg) ECT was delivered. The primary outcome was seizure duration, and secondary outcomes such as seizure threshold, hemodynamic parameters, recovery profile, and any complications were noted. Motor seizure duration was recorded as the time interval between starting of the seizure episode until the cessation of tonic-clonic motor activity in the isolated upper limb. Data were entered in MS-Excel and analyzed in SPSS V22. Descriptive statistics were represented with percentages, and parametric data were represented with mean with standard deviation. The statistical analysis was carried out using the Chi-square test, independent t-test. A Probability (P) value <0.05 was considered statistically significant. Results: There was a statistically significant difference in seizure duration between two groups with Group A having less meantime 38 ± 14.9 s compared to Group B 45.3 ± 17.5 s with P = 0.014. Seizure threshold, hemodynamic parameters, recovery profile, and complications except myoclonus were not statistically significant between the two groups. Conclusion: Etomidate has the definite advantage of longer seizure duration compared to ketofol, and hence, etomidate is a better induction agent in patients with psychiatric disorders undergoing ECT.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47137537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel SARS-COV-2 virus (COVID-19): Essential insights for perioperative management of suspected or confirmed pediatric cases","authors":"Ridhima Sharma, Ripon Choudhary, N. Gupta, Anju Gupta","doi":"10.4103/TheIAForum.TheIAForum_109_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_109_20","url":null,"abstract":"The COVID-19 is an ongoing global crisis. To deal with it efficiently, health-care system has to gear up to the increasing burden by judicious use of workforce and resources. In the perioperative setting, adequate preventive measures are of prime importance to prevent infection spread among health-care workers. The knowledge regarding the disease is still evolving. In this article, we have outlined the basic epidemiology, pathology, presentation, and diagnosis of COVID-19 along with the considerations for operating room preparedness, personal protective equipment required, airway management, anesthesia conduct, and perioperative concerns when managing positive or suspected COVID-19 pediatric patients and have suggested ways to overcome potential hindrances based on available literature. We have also deliberated upon the specific considerations for a COVID child undergoing regional anesthesia and critically ill COVID-19 pediatric patients. Careful adaptation of working principles based on local needs can help in the prevention of disease spread when optimizing care to the patients.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44073445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic management of a parturient with Wernicke's encephalopathy secondary to hyperemesis gravidarum for cesarean section","authors":"D. Gahlot, M. Agarwal, M. Budoo, N. Prasad, Kuldeep Singh","doi":"10.4103/TheIAForum.TheIAForum_18_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_18_20","url":null,"abstract":"Wernicke's encephalopathy (WE) secondary to hyperemesis gravidarum (HG) is a rare but a known complication. A delay in diagnosis and treatment often results in long-term neurological sequelae. Critical care management of these patients is reported in the literature, but their anesthetic management for cesarean section is lacking. We report the case of a 28-year-old parturient who presented with HG in the first trimester of pregnancy and was managed conservatively. She later developed nystagmus, weakness, and cognitive dysfunction, and a diagnosis of WE secondary to HG was established. The patient was later posted for cesarean section in view of persistent quadriparesis and cognitive impairment at term gestation. General anesthesia was the preferred anesthesia technique of choice. Obstetric patients with preexisting neurological disease for cesarean section become a special subpopulation for anesthesiologists with their unique anesthetic challenges.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44264829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A questionnaire-based cross-sectional pilot survey on adherence to the recognized guidelines by the airway managers during intubation at the time of COVID-19 pandemic","authors":"Debarshi Guha, D. Dwivedi, D. Paul, S. Chakrabarti, J. Talukdar, Shalendra Singh","doi":"10.4103/TheIAForum.TheIAForum_142_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_142_20","url":null,"abstract":"Background and Aims: COVID-19 infection has the potential to spread exponentially during aerosol-generating procedures like intubation. The aim was to find the compliance toward the actual practice as well as the existing knowledge gap and adherence to the guidelines among the medical professionals while attempting intubation in a known or suspected COVID-19 patients. Materials and Methods: A cross-sectional web-based survey format was planned using English questionnaire in an online form (Google® Forms). One hundred and forty valid responses for 27 questions were received. Maximum participation was received from Indian anesthesiologists working in government, semi-government, and private health facilities, performing the intubation routinely. All the valid responses were statistically analyzed by calculating the significant difference in means and proportions, with P < 0.05 being considered statistically significant. Results: Eighty percent of the respondents received training for donning and doffing and regularly wore personal protective equipment for the airway procedure. Scarce simulation training (22.1%), minimum screening before entering into a intubation scene (37.9%), frequent use of bag-mask ventilation (18.2%) or high flow nasal cannula (19.7%) use for preoxygenation, confirmation of the depth of endotracheal tube by auscultation (34.5%), and having no plan B in case of unanticipated difficult airway (27.9%) make the knowledge gap evident. The survey pointed out toward the infrastructural requirement of negative pressure intubation rooms, availability of waveform capnography, and widespread use of videolaryngoscope. Conclusion: This survey gives us an insight into the compliance with existing lacunae and nonuniform practices of the recommended guidelines for the airway management during COVID-19 pandemic with its pragmatic solution.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43834685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of clonidine and dexamethasone as adjuvants to ropivacaine for ultrasound-guided transversus abdominis plane block","authors":"Hemlata, R. Singh, R. Verma, D. Singh, A. Chaudhary, B. Kushwaha","doi":"10.4103/TheIAForum.TheIAForum_105_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_105_20","url":null,"abstract":"Aim: This study aims to study the effect of addition of clonidine and dexamethasone to ropivacaine for ultrasound-guided TAP block in patients undergoing abdominal surgeries. We primarily compared the quality and duration of postoperative analgesia. Materials and Methods: This randomized double-blind study was done after taking approval from Institutional Ethical Committee and written informed consent from all the patients. Sixty patients undergoing abdominal surgery under general anesthesia were enrolled in the study and randomly divided into two groups: Group-RC (n = 30) and Group-RD (n = 30). Patients in both the groups were given bilateral ultrasound-guided TAP block at the end of surgery. Patients in Group-RC received 20 ml ropivacaine 0.2% with 75 μg clonidine on each side and patients in Group-RD received 20 ml ropivacaine 0.2% with 4 mg dexamethasone on each side. Results: Visual analogue scale score for pain was significantly less in Group-RC as compared to Group-RD at all-time intervals (P <.05). Duration of pain relief in Group-RC was significantly greater than in Group-RD (16.50 ± 6.68 vs. 9.67 ± 6.46 h; P = 0.001). Requirement of rescue analgesia was also significantly less in Group-RC as compared to Group-RD (80% vs. 90%; P = 0.014). Except for a higher incidence of nausea in Group-RC, there was no other significant difference in the incidence of complications between the two groups. Conclusion: Addition of Clonidine (75 μg) to ropivacaine for ultrasound-guided TAP block provides better and prolonged postoperative analgesia as compared to addition of dexamethasone (4 mg) without any significant side-effects.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48185519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of modified Mallampati test and thyromental height test for preoperative airway assessment: A prospective observational study","authors":"Ketan K Kataria, S. Chhatrapati, S. Bloria, Nidhi Singh, S. Paul, A. Luthra, Samira Vithani, S. Omar, VKrishna Narayanan Nayanar","doi":"10.4103/TheIAForum.TheIAForum_112_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_112_20","url":null,"abstract":"Background: Prevision of a potentially difficult airway in the preoperative period is imperative. The available tools are evaluation of mouth opening, Mallampati test; atlanto-occipital extension; hyomental, thyromental, and sternomental distances; and upper lip bite test; thyromental height test (TMHT) is a new indicator. Aims: To compare the effectiveness of preoperative anaesthetic airway evaluation methods of TMHT and Modified mallampati test (MMT) to predict the difficulty in intubation. Materials and Methods: A prospective observational study was aimed to compare the effectiveness of preoperative anesthetic airway evaluation methods of TMHT and modified Mallampati test (MMT) to predict the difficulty in intubation. A total of 150 subjects were included in this study. MMT and TMHT were compared, and sensitivity, specificity, predictive values, and accuracy were calculated. Results: On comparison, we found TMHT to be more sensitive (93.33%) than MMT (77.78%); both tests have high specificity (TMHT 91.43%; MMT 81.90%). Positive predictive value was 82.35% for TMHT and 64.81% for MMT. Similarly, negative predictive value was 96.97% for TMHT and 89.58% for MMT. Accuracy was 92.00% for TMHT and 80.66% for MMT. Conclusions: TMHT can predict difficult intubation better than MMT (high positive predictive value). However, both TMHT and MMT predict easy intubations effectively, their negative predictive values being high.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flush valve malfunction of a central venous pressure transducer causing inadvertent excessive fluid administration","authors":"G. Chennakeshavallu, S. Sankar","doi":"10.4103/TheIAForum.TheIAForum_65_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_65_20","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43958630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of dexmedetomidine on hemodynamics and recovery profile in children undergoing laparoscopic Stephen–Fowler's Stage-2 orchidopexy under general anesthesia: A prospective randomized controlled study","authors":"AH Shruthi, G. Anuradha, Y. Chandrika","doi":"10.4103/TheIAForum.TheIAForum_101_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_101_20","url":null,"abstract":"Background: Stephen–Fowler's Stage-2 (SF-2) orchidopexy for high intra-abdominal testes poses the challenge of both laparoscopic and open urogenital surgery to the pediatric anesthesiologist. Balanced anesthesia supplemented with regional analgesia remains the standard technique adopted. Studies involving intravenous (IV) dexmedetomidine as an adjuvant anesthetic in children are sparse. Aims and Objectives: The aim and objective was to study the effect of IV dexmedetomidine on intraoperative hemodynamic stability, airway reflexes, and hemodynamic responses to extubation and postoperative analgesia. Materials and Methods: This prospective randomized controlled study was conducted on thirty children undergoing laparoscopic SF-2 repair to receive balanced anesthesia with isoflurane. Group D patients received IV dexmedetomidine 1 μg/kg bolus over 10 min after induction followed by an infusion at 0.5 μg/kg/h and Group C patients received regional analgesia. Hemodynamic parameters, sedation, agitation, pain scores, time to rescue analgesia, and time to discharge were documented. Results: A significant change was discernible in the heart rate and systolic blood pressure with intraoperative hemodynamic stability in Group D patients, which was comparable to baseline values. Smoother extubation with better hemodynamic stability (P < 0.001) and decreased agitation (P < 0.05) were noted in Group D patients. Children in Group C were observed to have lower sedation scores postoperatively (P < 0.05). Time to rescue analgesia was statistically significantly prolonged in Group D (P < 0.001) without any change in time to discharge from hospital. Conclusion: IV dexmedetomidine 1 μg/kg bolus followed by an infusion of 0.5 μg/kg/h gives better intraoperative hemodynamic stability with smoother extubation and prolonged postoperative analgesia without undue side effects in children undergoing SF-2 orchidopexy.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43818231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative agitation in children: Think beyond inadequate analgesia and emergence delirium","authors":"B. Paliwal, P. Bhatia, S. Chhabra, Rakesh Kumar","doi":"10.4103/TheIAForum.TheIAForum_139_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_139_20","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70844416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure sore with high-flow nasal canula: Another challenge in the COVID-19 pandemic","authors":"S. Mohammed, S. Chhabra, P. Bhatia, B. Paliwal, Lovepriya Sharma","doi":"10.4103/TheIAForum.TheIAForum_3_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_3_21","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45465108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}