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Indian Journal of Clinical Anaesthesia

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1 HISTORY OF ANAESTHESIA, Dr. Rakesh Sadhu
Indian Journal of Clinical Anaesthesia (IJCA) publishes definitive, peer-reviewed articles devoted to the clinical practice of anaesthesia. IJCA publishes a wide range of articles in the discipline of anaesthesiology including basic science, translational medicine, education, and clinical research to create a platform for the authors to make their contribution towards the field without restrictions/barriers of subscription and language. IJCA addresses all aspects of anaesthesia practice, including anaesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anaesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. This Journal is an Open Access journal and aims to publish research articles, reviews, case studies, commentaries, short communications, and letters to the editor on various aspects of anaesthesiology and perioperative medicine and making them freely available worldwide. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anaesthesiology and critical care to clarify how new insights can improve daily practice. Aims & Scope: Indian Journal of Clinical Anaesthesia (IJCA) is broad based, aimed at two key tenets: To publish the most exciting research outcome with respect to Anaesthesia and the role of clinical research in it. Secondly, to provide a rapid and quick review process to facilitate publication so that information is freely available for research, teaching and reference purposes. It is basically aimed at the Clinical Practitioners, medical/ health practitioners, students, professionals and researchers and professional bodies and institutions.
2 COMPARISON OF INTUBATION BY LMA CTRACH VS INTUBATION BY DIRECT LARYNGOSCOPY IN PATIENT WITH NORMAL AIRWAY, Dr. Deepti Yadav, Dr. Sadik Mohammed, Dr. U D Sharma, Dr. Rakesh Karnawat, Dr. Ghansham Biyani
Background: The LMA CTrachTM system is a new device for airway management and endotracheal intubation under direct vision in both anticipated and unexpected difficult intubation situations. This randomized controlled study was undertaken to compare the hemodynamic effects, ease of intubation, time taken for intubation, upper airway morbidity following tracheal intubation through LMA CTrachTM with that of conventional Macintosh laryngoscope. Material and Method: Eighty adult patients of age 16-72 years and ASA I and ASA II grade scheduled to undergo elective surgery under GA were randomly allocated to one of the group i.e. Group A: LMA CTrachTM (Laryngeal Mask Airway CTrachTM) and Group B: DLS (Direct Laryngoscopy). The patients were intubated orally using either equipment after induction of general anaesthesia. Results: In both the groups, there was a significant increase in heart rate and blood pressure from base line values after tracheal intubation. The rise in heart rate and SBP was significantly more in group B as compared to group A. The success rate of intubation were comparablein both the groups. The time required for successful intubation was significantly more in group A as compared to group B. The upper airway injury was more in group A than in group B. Conclusion: LMA CTrachTM can be used for tracheal intubation with equal success rate as of DLS in patient with normal airway though it is more time consuming. It offers advantage over DLS for minimizing hemodynamic response to tracheal intubation in normotensive patients.
3 CHANGES IN CEREBRAL OXYGENATION DURING CORONARY ARTERY BYPASS GRAFTING AND ITS DEPENDENCE ON HAEMATOCRIT, MEAN ARTERIAL PRESSURE AND PARTIAL PRESSURE OF OXYGEN IN ARTERIAL BLOOD, Dr. Sarvesh Pal Singh, Dr. Minati Choudhury, Dr. Ujjwal Kumar Chowdhury, Dr. Sandeep Chauhan
Background: Cerebral protection has always been an important concern during cardiac surgery. Near infrared spectroscopy (NIRS) can continuously monitor cerebral oxygenation and is increasingly being used as a surrogate measure to ensure the wellbeing of brain. This prospective observational study was designed to observe the changes in cerebral oxygenation in patients undergoing coronary artery bypass surgery (CABG) with the aid of cardiopulmonary bypass (CPB) during hypothermia and normothermia, and to determine if there was any correlation between the cerebral oximetry values and variables like hematocrit (Hct), mean arterial pressure (MAP), partial pressure of oxygen in blood (PaO2), CPB flows and temperature. Methods: Forty patients scheduled to undergo elective CABG with the aid of CPB were enrolled in this study. The regional cerebral oxygen saturation (rso2), haematocrit, (MAP), PaO2, temperature and pump flows during CPB were measured at following time points during the surgery -T1:Baseline before induction of anaesthesia (on room air), T2:After induction of anaesthesia with a FiO2 of 100% , T3:After induction of anaesthesia with a FiO2 of 50% , T4:At the initiation of CPB (the lowest value of rso2 at the time of initiation of CPB), T5:On CPB at 35C , T6:On CPB at 32C, T7:On CPB after rewarming at 36C , T8:After weaning from CPB with a FiO2 of 100% (after protamine administration) and T9:After weaning from CPB with a FiO2 of 50% (just before sternal closure). During CPB, pump flows were also recorded to find any deviation from the standard protocol. Results: The mean baseline rso2 values were 64.35 and 64.97 for right and left frontal lobes, respectively and there was a relative increase in rso2 values with increase in PaO2 levels in the preCPB period. There was a maximum relative decrease of 12% in rso2 values with the initiation of CPB and the values remained below baseline throughout the hypothermic CPB. An insignificant decrease in rso2 values occurred with hypothermia which reversed at rewarming. The rso2 values reached baseline values in the post-CPB period. Based on post hoc analysis we observed that rso2 values could be predicted as 0.329 X per unit change in haematocrit; 0.133 X per unit change in MAP and 0.005 X per unit change in PaO2. Conclusion: In patients undergoing cardiac surgery with CPB cerebral oximetry values were well maintained with maximal decrease of 12% at the time of initiation of CPB. Mild decrease in rso2 occurred with institution of CPB which reversed by the end of rewarming. The rso2 values differ insignificantly during hypothermic CPB. Cerebral oxygenation appears to be influenced by haematocrit, mean arterial pressure and partial pressure of oxygen in blood in pre, during and post CPB period.
4 COMPARISON OF EMERGENCE AND RECOVERY CHARACTERISTICS OF SEVOFLURANE AND DESFLURANE IN PEDIATRIC PATIENTS UNDERGOING AMBULATORY SURGERY, Dr. Richa Agrawal, Dr. Pushkar Desai, Dr. Manjula Sarkar
Introduction: Emergence and recovery is a common problem after general anesthesia especially in the pediatric age group. Sevoflurane and desflurane both provide smooth and rapid recovery with minimal side effects. So we decided to compare both agents in terms of emergence and recovery characteristics to find out the better agent. Materials and methods: This prospective, randomized, double blind study involved 80 children divided into two groups (n=40 each). Patients were induced with IV propofol 2mg/kg, fentanyl 2 ?g/kg and inj atracurium 0.5mg/kg. Group I was maintained with oxygen: air: sevoflurane and group II on oxygen: air: desflurane. Emergence time defined as the time from discontinuation of anesthetics to extubation. Recovery time was measured from the time of discontinuation of anesthetic until the achievement of Steward Recovery Score of 6. Results: Desflurane exhibited shorter emergence (5.85 + 1.21 vs 11.75 + 1.84 min) and recovery time (11.7 + 2.08 vs 20 + 3.06 min) as compared to sevoflurane. PAED scale score for desflurane was significantly higher (3.35 0.92) compared to that of sevoflurane (1.75 0.71) implying higher incidence of agitation and excitement than sevoflurane. Conclusion: We recommend use of sevoflurane in pediatric patients for ambulatory surgery in view of less incidence of emergence delirium than desflurane.
5 ADDITION OF CLONIDINE REDUCE DOSE OF FENTANYL AND ROPIVACAINE IN EPIDURAL ANAESTHESIA, Dr. Ram Badan Singh, Dr. Richa Prabhakae, Dr. Rajiv Kumar Dubey, Prof. TB Singh
Aim of Study: To find out effect of clonidine on fentanyl and Ropivacaine requirement to produce Epidural Anesthesia. Material and Method: After Institute ethical clearance and consent from patient, 60 patients of ASA I and II were studied in 3 groups. All patients were premedicated with ranitidine and metoclopramide. In operation room epidural catheter was placed. After recording base line hemodynamic parameters, drugs were mixed in 20ml syringe according to 3 different groups and given through epidural catheter. Observation and Result: All patients were monitored for hemodynamic changes and recorded at different time interval. Data were analyzed using different tests. Patients of all 3 group have similar level of anesthesia with lower adverse effects hypotension which was more in clonidine, fentanyl and ropivacaine group. Conclusion: With this study we concluded that adition of clonidine in fentanyl and ropivacaine significantly reduces the amount of ropivacaine and fentanyl required to produce epidural anesthesia.
6 WHEN TO RAISE THE ALARM TO STOP SURGERY, Dr. Tarun Lall
Perioperative myocardial ischaemia and infarction (PMI) is a major cause of short and long term morbidity and mortality is the surgical population. It is estimated that more than one half of postoperative deaths are caused by cardiac events, most of which are ischaemic in origin.
7 THROMBOTIC COMPLICATION OF CENTRAL VENOUS CATHETERISATION IN SUBCLAVIAN VEIN, Dr. Bharat Paliwal, Dr. Manoj Kamal, Dr. Anamika Purohit, Dr. Geeta Singaniya
Central venous catheterization (CVC) has become an integral part for management of patients in intensive care units. It enables invasive monitoring, facilitate atrial pacing and permit delivery of parenteral alimentations and medications. Notwithstanding, CVCs are associated with numerous complications such as mechanical complications, infections and thrombotic complications. We presented a case of 17-year-old male patient who developed massive central venous thrombosis causing superior vena cava (SVC) syndrome after sequential placement of a right and left subclavian vein central venous catheter. Colour Doppler and Computed tomography (CT) angiography showed thrombosis of bilateral subclavian, internal jugular and axillary veins with minimal blood flow. Patient was treated with low molecular weight heparin (LMWH) and warfarin with partial recanalization of veins and resolution of symptoms. Keywords: Central venous catheterization, Central venous thrombosis, superior vena cava syndrome.
8 POSTOPERATIVE MORTALITY IN A PATIENT WITH EISENMENGER`S SYNDROME UNDERGOING EMERGENCY CAESAREAN SECTION: FOREWARNED BUT YET TO BE FOREARMED, Dr. Priyam Saikia, Dr. Mridu Paban Nath, Dr. Marie Ninu, Dr. Ruma Thakuria, Dr. Dipika Choudhury
Eisenmengers syndrome includes pulmonary artery hypertension, reversed or bidirectional shunt associated with an atrial septal defect, ventricular septal defect and patent ductus arteriosus. Death can occur at any time during pregnancy as well in the puerperium. We present here a known case of Ventricular septal defect in Eisenmenger syndrome who presented in 29 weeks of gestation with orthopnea. Elective caesarean section was done with post-operative intensive care under general anesthesia uneventfully. The anesthetic management is discussed here.
9 ENTRAPMENT OF A GUIDE WIRE: AN INCIDENTAL COMPLICATION OF CENTRAL LINE CATHETER PLACEMENT, Dr. Lalit Gupta, Dr. Gaurav Dwivedi
Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. This technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of an entrapped guidewire during central venous catheter insertion followed by a review of the literature on this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.