Indian Anaesthetists Forum最新文献

{"title":"Preprocedural ultrasound assessment of landmarks of paramedian approach for subarachnoid block in geriatric population","authors":"Tapan Ray, Shlok Saxena, A. Panda","doi":"10.4103/theiaforum.theiaforum_97_21","DOIUrl":"https://doi.org/10.4103/theiaforum.theiaforum_97_21","url":null,"abstract":"Background: Paramedian spinal anesthesia is the preferred anesthetic technique in the elderly. This conventional approach is occasionally challenged by difficulty in identifying landmarks accurately. Neuraxial ultrasound aims to overcome these inaccuracies. Objective: The objective was that the routine use of preprocedural ultrasound assessment of landmarks for paramedian spinal in geriatric population improves the efficacy of spinal anesthesia by reducing the number of attempts and redirections. Materials and Methods: Sixty consenting elderly patients aged 60 year or above, posted for elective surgery under spinal anesthesia, were enrolled in the study. Participants were assigned at random to receive spinal anesthesia by the paramedian approach by either conventional landmark guidance (Group CP) or preprocedural ultrasound-assisted (Group PP) technique. Results: The number of needle redirections was not significant and the success rate at the first attempt with no redirection was higher in the ultrasound compared with the landmark group. However, the mean insertion attempts were indifferent. The preprocedural ultrasound-assisted approach required an insignificantly shorter time for administering spinal anesthesia than the landmark-guided technique (48.87s [67.65] vs. 50.67s [50.19]) [P = 0.90]. The periprocedural pain scores (2.90[2.07] vs. 2.87[1.57]) [P = 0.94] and willingness for a similar future intervention (66.7 vs. 66.7%) were comparable among the groups. Conclusion: The use of preprocedural ultrasonography for paramedian approach to spinal anesthesia is not superior to the conventional landmark guidance in achieving successful dural tap at L3-L4 interspace in elderly adult population and should be limited to a setting with expert operators and selected patients for whom conventional methods may be technically challenging.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47230358","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 0.125% and 0.2% ropivacaine in continuous lumbar plexus block for postoperative analgesia after total hip arthroplasty","authors":"M. Raghuraman, A. Murugesan, D. Gurunathan, Daivam Indumathi, MThiriloga Sundary","doi":"10.4103/TheIAForum.TheIAForum_34_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_34_21","url":null,"abstract":"Background: Lower concentrations of ropivacaine in continuous lumbar plexus block (LPB) have not been studied adequately. Thus, we designed this prospective, randomized, comparative study to evaluate the two different concentrations of ropivacaine (0.125% and 0.2%) in continuous LPB for postoperative pain relief following total hip arthroplasty (THA). Materials and Methods: Fifty patients undergoing THA under standardized subarachnoid block have been randomly allocated to receive a continuous infusion of either 0.125% (Group 1) or 0.2% (Group 2) of ropivacaine in LPB done under the guidance of peripheral nerve stimulator. The primary outcome was consumption of tramadol during the first 24 h and the secondary outcomes were quality of sensory and motor blockade and consumption of ropivacaine. Results: The total amount of tramadol did not differ significantly (P = 0.442) between the two groups. Furthermore, the duration of sensory and motor blockade did not differ significantly between the two groups. However, the average consumption of ropivacaine was significantly lower in Group 1 when compared to Group 2 (238.80 mg vs. 380.64 mg, P = 0.0001). Conclusion: Administration of 0.125% of ropivacaine can be a better alternative as it would decrease the total amount of the local anesthetic in continuous LPB.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47868519","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 ropivacaine (0.2%) and ropivacaine (0.125%) with 2 μg/ml fentanyl for epidural labor analgesia: A randomized controlled study","authors":"Kalyani Rapeti, Santhi Mulam, B. Lakshmi, Ankur Sharma","doi":"10.4103/TheIAForum.TheIAForum_156_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_156_20","url":null,"abstract":"Aim: The aim of this study was to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. Objective: Among various labor analgesic techniques, epidural analgesia is the most effective form of analgesia. This study aimed to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine, both with fentanyl 2 μg/ml for epidural labor analgesia. Materials and Methods: A total of 50 term parturients of American Society of Anesthesiologists physical status Grade I and II with vertex presentation in active labor were randomly assigned to two groups, Group R1 and Group R2, which received 10 ml of 0.125% ropivacaine with injection fentanyl 2 μg/ml and 10 ml of 0.2% ropivacaine with fentanyl 2 μg/ml, respectively, as an initial bolus dose and intermittent top-up doses epidurally. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with the Visual Analog Scale score. The maternal and fetal outcomes were recorded. Results: Maternal demographic characteristics were comparable. Although both the concentrations are effective in providing optimal labor analgesia, decreasing the concentration of ropivacaine has resulted in an increased number of repetition of doses and thus an increased consumption of fentanyl. There were no significant differences between the two groups regarding motor block, hemodynamic, and neonatal outcomes. Conclusion: We conclude that 0.2% ropivacaine was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids. Hence, we conclude that the use of 0.2% ropivacaine is superior to 0.125% ropivacaine with fentanyl.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46349558","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":"Ultrasound-guided intermediate cervical plexus block added to thoracic epidural for pain management in multiple ribs and clavicle fracture","authors":"Hariprasad Ramalingam, Ankur Sharma, S. Goyal, Nikhil Kothari","doi":"10.4103/TheIAForum.TheIAForum_26_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_26_21","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44097404","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":"Overcoming the obstruction, anesthetic management of hypertrophic obstructive cardiomyopathy: The prudent paradox of less is more!","authors":"J. Monteiro, Unmesh Bedekar, C. Ponde, M. Sankhe","doi":"10.4103/TheIAForum.TheIAForum_42_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_42_21","url":null,"abstract":"Hypertrophic obstructive cardiomyopathy (HOCM) is a genetically mediated disease causing left ventricular outflow tract obstruction (LVOTO) predisposing the patient to systolic and diastolic dysfunction leading to arrhythmias and sudden cardiac deaths in the perioperative period. This case report describes the anesthetic management of a 76-year-old female posted for a semi-emergent three level lumbar canal decompression with severe HOCM with dynamic LVOTO with an initial resting gradient >70 mmHg, noninsulin-dependent diabetes mellitus, bronchial asthma, deep-vein thrombosis, and hypothyroidism as comorbidities. Preoperative evaluation of the risks, cardiac optimization, interdisciplinary shared decision making, preoperative invasive monitoring, preanesthetic placement of defibrillator pads, careful titration of anesthetic agents, with meticulous perioperative monitoring, and perioperative intensive care collaboration contributed to a successful outcome.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44754648","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 an infant with uncorrected pentalogy of Fallot undergoing emergency exploratory laparotomy","authors":"N. Choudhary, R. Magoon, S. Wadhawan","doi":"10.4103/TheIAForum.TheIAForum_78_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_78_21","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42775315","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 bougie as a foreign body","authors":"Mahak Kakkar, Sushil Guria, Swati Jain, S. Bairagi","doi":"10.4103/TheIAForum.TheIAForum_161_20","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_161_20","url":null,"abstract":"","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46735523","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":"Demographic profile and clinical characteristics of surgical patients operated in COVID-19 operation theater in a tertiary care hospital","authors":"Sapna Bathla, M. Mehta, Akshaya Das, Parul Mullick, D. Meena, U. Ganapathy","doi":"10.4103/TheIAForum.TheIAForum_53_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_53_21","url":null,"abstract":"Background and Aim: Surgical procedures in patients with COVID-19 disease are associated with increased perioperative morbidity and mortality. A retrospective study was conducted to evaluate the demographic and clinical data of surgical patients with suspected or confirmed COVID-19 disease. Methods: After taking hospital ethics committee approval, medical records of surgical patients operated during the period from May 2020 to November 2020 in a COVID-19-designated tertiary care hospital of northern India were assessed. The demographic data such as age, gender, associated comorbidities, type of surgery, intraoperative complications, and data on the postoperative status of the patients were collected and analyzed. Results: Ninety-four patients underwent surgical procedures during the study period. Out of all patients, 87.2% were females. The median age of patients was 28 years (range: 1 month–59 years). The emergency cesarean section was the most common surgery performed. The subarachnoid block was the most commonly used anesthesia technique. Out of 94 patients, 70 patients were confirmed COVID-19 positive, and 24 were suspected cases. Most of the patients were American Society of Anesthesiologists II (83%) and 43.6% of patients had comorbidities. Conclusion: The cesarean section was the most commonly performed surgical procedure. The most common anesthesia technique used was the subarachnoid block. The patients operated under subarachnoid block had a better prognosis and did not require intensive care unit stays in the postoperative period.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42065335","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":"The comparison of arm and forearm double tourniquet in terms of the onset and duration of analgesia, tourniquet pain, and the return of sensation and movement in distal upper extremity surgery: A randomized clinical trial","authors":"H. Modir, Esmail Moshiri, Amirreza Modir, Saide Shakeri, Amir Moradi","doi":"10.4103/TheIAForum.TheIAForum_70_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_70_21","url":null,"abstract":"Aims: The current study aimed at comparing arm and forearm double tourniquet in terms of the onset and duration of analgesia, tourniquet pain, and the return of sensation and movement in distal upper extremity surgery. Methods: This double-blind clinical trial was performed on 70 patients who were candidates for distal upper extremity orthopedic surgeries. The patients were randomized into two groups of arm and forearm double tourniquet. The onset time and duration of sensory and motor blocks were recorded. The pain level was recorded by visual Analog Scale (VAS) after inflating the tourniquet every 15 min till the end of operation at 15, 30, and 45 min as well as every 30 min for 2 h (at 30, 60, 90, and 120 min.) and at 6, 12, and 24 h after deflating the tourniquet. SPSS version 20 was used to analyze the data. Results: During 8–24 h after the surgery, the pain in arm double- tourniquet group was less than that in the other group (P < 0.05). There was no statistically significant difference in the time to onset of sensory–motor block between the two groups (P > 0.05). The duration of sensory block in arm double tourniquet was longer than that in forearm double tourniquet group (P = 0.002). In addition, the duration of motor block in arm double tourniquet was also longer than that in forearm double tourniquet group (P = 0.001). The pain level was equal in both the groups at all times except for the time interval of 8–24 h after the operation in arm double tourniquet group. Furthermore, there was no statistically significant difference in the pain level, and the time to onset of sensory–motor block was the same in both the groups as well. However, the duration of sensory–motor block was longer in the arm double tourniquet group, while no complication was found in either group. Conclusion: Both the techniques are applicable in hand and distal upper extremity surgeries provided that the surgical duration is not too long. Using forearm double tourniquet technique is preferable to arm double tourniquet, but the surgical duration should not exceed 60 min. That is because less amount of anesthetic drugs is needed in forearm double tourniquet technique, hence leading to a decrease in the potential side effects.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43446043","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":"An encounter with Nager's syndrome: A case report of pediatric airway challenge","authors":"R. Kadni, KVarghese Zachariah, Madhuri Maganthi, LG Shyamsundar","doi":"10.4103/TheIAForum.TheIAForum_10_21","DOIUrl":"https://doi.org/10.4103/TheIAForum.TheIAForum_10_21","url":null,"abstract":"Nager acrofacial dysostosis is a rare genetic syndrome. It has a potential threat of obstructed airway from birth. Associated with severe micrognathia, it poses a difficult airway challenge to the anesthesiologist. Tracheostomy may be required for the survival of these patients. We report a case of a 2½-month-old infant with Nager's syndrome for lip reconstruction and club foot management.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42023090","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}