Journal of Anaesthesiology Clinical Pharmacology

Publications in this journal

• Article: Efficacy and safety of thoracic epidural analgesia after major abdominal surgery for acute post-operative pain.

  Anirban Hom Choudhuri, Aastha Dhingra, Rajeev Uppal
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):123.
• Article: Phenobarbital use in an infant requiring extracorporeal membrane life support.

  Brian Schloss, Don Hayes, Joseph D Tobias
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  ABSTRACT: Over the past two decades, there has been an increased use of extracorporeal membrane life support (ECLS) for critically ill neonates and infants. Approximately 20% of these children will experience seizures as a complication of ECLS or the comorbid condition which necessitated extracorporeal support. While phenobarbital is one of the most common drugs used to treat seizures in children, little is known about its dosing while on ECLS. We present a 3-month-old girl who required ECLS after cardiac arrest in the postoperative period following surgery for complex congenital heart disease. The patient subsequently developed seizure activity, which was treated with phenobarbital. Following an initial loading dose of 30 mg/kg, the serum concentration was 47.9 mcg/ml. A supplementary loading dose of 10 mg/kg was administered 8 h later with an increase of the maintenance dose to 8 mg/kg/day. The phenobarbital serum concentrations were 65.9 and 72.8 mcg/ml on the subsequent days. Despite therapeutic levels of phenobarbital, the patient continued to exhibit clinical and electroencephalographic evidence of seizure activity and a midazolam infusion was started at 0.3 mg/kg/h. Because of continued seizure activity, the patient ultimately required titration of midazolam to 1.2 mg/kg/h by day 7 of ECLS to control seizure activity. Due to severe intracerebral bleeding on day 9, ECLS was withdrawn and the patient expired. Our experience demonstrates some of the challenges of medication titration during ECLS. Previous reports of phenobarbital dosing during ECLS are reviewed and considerations for the dosing of anticonvulsant medications during extracorporeal support are discussed.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):92-94.
• Article: Bigger and bigger challenges: Evidence-based or expert-opinion based practice?

  Ashish C Sinha, Basavana G Goudra
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):4-5.
• Article: Pediatric cuffed endotracheal tubes.

  Neerja Bhardwaj
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  ABSTRACT: Endotracheal intubation in children is usually performed utilizing uncuffed endotracheal tubes for conduct of anesthesia as well as for prolonged ventilation in critical care units. However, uncuffed tubes may require multiple changes to avoid excessive air leak, with subsequent environmental pollution making the technique uneconomical. In addition, monitoring of ventilatory parameters, exhaled volumes, and end-expiratory gases may be unreliable. All these problems can be avoided by use of cuffed endotracheal tubes. Besides, cuffed endotracheal tubes may be of advantage in special situations like laparoscopic surgery and in surgical conditions at risk of aspiration. Magnetic resonance imaging (MRI) scans in children have found the narrowest portion of larynx at rima glottides. Cuffed endotracheal tubes, therefore, will form a complete seal with low cuff pressure of <15 cm H2O without any increase in airway complications. Till recently, the use of cuffed endotracheal tubes was limited by variations in the tube design marketed by different manufacturers. The introduction of a new cuffed endotracheal tube in the market with improved tracheal sealing characteristics may encourage increased safe use of these tubes in clinical practice. A literature search using search words "cuffed endotracheal tube" and "children" from 1980 to January 2012 in PUBMED was conducted. Based on the search, the advantages and potential benefits of cuffed ETT are reviewed in this article.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):13-18.
• Article: Anesthetic management of a patient with Rosai-Dorfman Disease and atrial septal defect for orbital surgery.

  Virender K Mohan, Amit Rai
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):134-135.
• Article: Safe removal of an epidural catheter 72 hours after clopidogrel and aspirin administrations guided by platelet function analysis and thromboelastography.

  Eric Glenn, Judson Mehl, Francis A Rosinia, Henry Liu
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  ABSTRACT: Management of neuraxial anesthesia/analgesia in anticoagulated patient can be challenging. The shortest safe time to remove epidural catheter, after a patient receives long-acting dual antiplatelet agents (clopidogrel and aspirin), is unclear. American Society of Regional Anesthesiology (ASRA) guidelines recommend seven days interval for the epidural placement after clopidogrel administration. However ASRA Guideline did not specify the time for epidural catheter removal, and did not specify how much time elapse necessary after dual antiplatelet therapy with clopidogrel and aspirin. We report a case of safe removal of epidural catheter 72 hours after oral dose of clopidogrel and aspirin with a normal platelet function analysis and normal thromboelastography before removal.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):99-101.
• Article: Using stylet in airtraq optical laryngoscope for armored tube intubation: A new experience.

  Qazi E Ali, Obaid A Siddiqui, Syed H Amir, Tariq R Chaudhri
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):124.
• Article: Comparison of clinical performance of the I-gel with LMA proseal.

  Gaurav Chauhan, Pavan Nayar, Anita Seth, Kapil Gupta, Mamta Panwar, Nidhi Agrawal
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  ABSTRACT: To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryngeal mask airway (PLMA)] and to observe any associated complications. This prospective, randomized study was conducted in 80 patients [Group I - I-gel insertion (n = 40) and Group P - LMA Proseal insertion (n =40)] of ASA grades I/II, of either sex in the age group 18-65 years. Both groups were compared with respect to ease of insertion, insertion attempts, fiberoptic assessment, airway sealing pressure, ease of gastric tube placement, and other complications. All patients were asked to fast overnight. Patients were given alprazolam 0.25 mg orally at 10 p.m. the night before surgery and again 2 hours prior to surgery with 1-2 sips of water. Glycopyrrolate 0.2 mg, metoclopramide 10 mg, and ranitidine 50 mg were administered intravenously to the patients 45 minutes prior to the surgery. Once adequate depth of anesthesia was achieved either of the 2 devices, selected using a random computerized table, was inserted by an experienced anesthesiologist. In group I, I-gel was inserted and in patients of group P, PLMA was inserted. Student t-test and Mann-Whitney test were employed to compare the means; for categorical variables, Chi-square test was used. Mean insertion time for the I-gel (11.12 ± 1.814 sec) was significantly lower than that of the PLMA (15.13 ± 2.91 sec) (P = 0.001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (29.55 ± 3.53 cm H2O) was significantly higher than in the I-gel group (26.73 ± 2.52 cm H2O; P = 0.001). Ease of gastric tube insertion was significantly higher in the I-gel group (P = 0.001). Incidence of blood staining of the device, sore throat and dysphagia were observed more in PLMA group. No other complications were observed in either of the groups.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):56-60.
• Article: Comparison of oral fiberoptic intubation via a modified guedel airway or a laryngeal mask airway in infants and children.

  Elsa Varghese, R Nagaraj, R Shwethapriya
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  ABSTRACT: Though fiberoptic intubation (FOI) is considered the gold standard for securing a difficult airway in a child, it may be technically difficult in an anesthetized child. The hypothesis for this study was that it would be easier to perform FOI via a laryngeal mask airway (LMA) than a modified oropharyngeal airway with the advantage of maintaining anesthesia and oxygenation during the process. 30 children aged 6 months to 5 years undergoing elective surgery under general anesthesia were randomized to two groups to have fiberoptic bronchoscope (FOB) guided intubation either via a modified Guedel airway (FOB-ORAL) or a classic LMA (FOB-LMA). In the FOB-LMA group, the LMA was removed when a second smaller endotracheal tube was anchored to the proximal end of the tracheal tube in place. Oral fiberoptic intubation was successful in all children. The first attempt success rate was 11/15 (73.33%) in the FOB-LMA group and 3/15 (20%) in the FOB-ORAL group (P = 0.012). Subsequent attempts at intubation were successful after 90° anticlockwise rotation of the endotracheal tube over the FOB. The time taken for fiberoptic bronchoscopy was significantly less in FOB-LMA group (59.20 ± 42.85 sec vs 108.66 ± 52.43 sec). The incidence of desaturation was higher in the FOB-ORAL group (6/15 vs 0/15). In children, fiberoptic bronchoscopy and intubation via an LMA has the advantage of being easier, with shorter intubation time and continuous oxygenation and ventilation throughout the procedure. Removal of the LMA following intubation requires particular care.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):52-55.
• Article: Measurement of prevalence of 'major depressive syndrome' among Indian patients attending pain clinic with chronic pain using PHQ-9 scale.

  Debjyoti Dutta, Saswata Bharati, Chinmoy Roy, Gautam Das
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  ABSTRACT: Presence of major depressive syndrome (MDS) in chronic pain patients (CPPs) requires more attention from the clinicians because of its clinical nature, association of suicidal thoughts and their actual completion, and treatment difficulties. The prevalence of MDS among Indian CPPs is not well studied. To determine the prevalence of MDS among Indian CPPs visiting pain clinic. In this prospective study, 476 patients who attended a pain clinic in a metropolitan city of India for chronic pain (pain more than six months) were included. They were assessed by 'PHQ-9 depression scale' for presence of MDS. Intensity of pain was assessed by 'Visual analogue scale' (VAS). Patient details (viz. age, sex), duration and site of pain, and scores of PHQ-9 depression scale and VAS, were noted and statistically analyzed. 146 out of 476 CPPs (30.67%) were found to suffer from MDS. Women were more prone (F: M =3:2) to develop MDS while suffering from chronic pain. Among 146 CPPs who were suffering from MDS, 108 (73.97%) patients also had suicidal thought. The prevalence of suicidal thought among all CPPs was found to be 22.69%. The depression severity was found to be strongly associated with intensity of pain (P = 0.005 < 0.05) but not associated with the duration of pain (P = 0.159 > 0.05) and age of the patient (P = 0.24 > 0.05). We found a high prevalence of MDS among CPPs from India and majority of them also harbored suicidal thought. Therefore, for successful outcome in chronic pain management routine psychological assessment in CPPs should be done to exclude the presence of MDS and suicidal thought.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):76-82.
• Article: A prospective, randomized, double blind and placebo- control study comparing the additive effect of oral midazolam and clonidine for postoperative nausea and vomiting prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystectomy.

  Ghanshyam Yadav, Biranchi Narayan Pratihari, Gaurav jain, Anil kumar Paswan
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):61-65.
• Article: Use of a laryngoscope, held sideways, as an aid in perforsming an intraoral glossopharyngeal nerve block.

  Glen Atlas, Anthony Sifonios, José Otero
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):129-130.
• Article: A philatelic history of anesthesiology.

  K C Sekhar
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  ABSTRACT: Thematic or topical philately deals with stamp collection based on a particular topic or theme. This article deals with a thematic depiction of the history of anesthesia from ancient to modern times using stamps, postal stationery and cancellations.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):19-25.
• Article: Perioperative eye protection under general anesthesia.

  Smita Prakash
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):138-139.
• Article: Effects of repeat exposure to inhalation anesthetics on liver and renal function.

  Tomoki Nishiyama
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  ABSTRACT: Cross hypersensitivity to inhalation anesthetics has not been studied. The aim of this study was to investigate it by comparing liver and renal function after repeated anesthesia with sevoflurane and isoflurane retrospectively. The adult patients who received general anesthesia twice within the interval of 14 days to 1 year were retrospectively analyzed. Those who received sevoflurane anesthesia twice (SS group, 53 cases), isoflurane anesthesia twice (II group, 31 cases), sevoflurane followed by isoflurane anesthesia (SI group, 29 cases), isoflurane followed by sevoflurane anesthesia (IS group, 35 cases), and propofol-fentanyl anesthesia twice (PP group, 58 cases) were enrolled. Serum concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (Bil), gamma-glutamyl transpeptidase (γ-GTP), blood urea nitrogen (BUN), and creatinine (Cr) measured 1-3, 5-8, and 12-16 days after surgery were investigated. In the IS group, the number of the patients with abnormal values of ALT and γ-GTP 5-8 days after surgery were significantly smaller at second anesthesia compared to the first anesthesia. The number of the patients with abnormal values of AST, ALT, and γ-GTP were significantly larger in the II group than the SS and PP groups. The number of patients who had higher values in each parameter at second anesthesia compared to the first anesthesia was not different among the groups. Sevoflurane and isoflurane might have no cross hypersensitivity. Both anesthetics might not have any additional risks to increase liver and renal damage by second anesthesia.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):83-87.
• Article: Anesthetic management in removal of neglected tracheobronchial foreign body.

  S Rangalakshmi, Nischala Dixit
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):127-128.
• Article: A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome.

  Neerja Bhardwaj, Kajal Jain, Suman Arora, Neerja Bharti
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  ABSTRACT: Maintaining systolic blood pressure (SBP) at 100% of baseline is best for fetal and maternal outcome. We hypothesized that irrespective of the vasopressor used, maintaining SBP at 100% of baseline with phenylephrine (P), metaraminol (M), or ephedrine (E) will produce the best fetal pH after cesarean section (LSCS) under subarachnoid block (SAB). Ninety ASA 1 women scheduled for elective LSCS were randomly allocated to receive P, M, or E. SAB was established with patient in left lateral position using 2.5 cc of 0.5% hyperbaric bupivacaine. Immediately following SAB, patients received a bolus of the study drug (E = 5 mg, M = 0.5 mg, P = 30 mcg) followed by infusion (E = 2.5 mg/min, M = 0.25 mg/min, P = 15 mcg/min) to maintain SBP at 100% baseline. Umbilical blood gases, maternal hemodynamic parameters, and complications were recorded. The umbilical pH was comparable in all the three groups (P > 0.05). The mean SBP from spinal block until delivery was similar over time for all the three groups. The incidence of reactive hypertension was more in group M (P < 0.05) than in group E and group P. Total drug consumption to meet target blood pressure till delivery was 39.3 ± 14.6 mg in group E, 1.7 ± 0.9 mg in group M, and 283.6 ± 99.8 mcg in group P. The incidence of nausea and vomiting was comparable in the three groups. All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anesthesia for cesarean section without any detrimental effects on fetal and maternal outcome.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):26-31.
• Article: Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery.

  Amandeep Kaur, Anil Kumar Jain, Raminder Sehgal, Jayashree Sood
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  ABSTRACT: Morbidly obese patients are prone for intraoperative hemodynamic disturbances and postoperative airway complications. Comparison of intraoperative hemodynamics and postoperative recovery characteristics of desflurane versus sevoflurane in morbidly obese patients undergoing laparoscopic bariatric surgery. Randomized controlled trial. After institutional ethics committee approval and written informed consent, 40 morbidly obese patients (BMI > 35 kg/m(2)) were randomized to receive desflurane or sevoflurane as part of a standardized general anesthesia technique. Volatile anesthetic concentration was titrated to maintain electroencephalographic bispectral index score (BIS) in the range of 40-60. Mean arterial pressure (MAP) and heart rate (HR) were recorded preoperatively, at induction and intubation, then at regular intervals. After extubation, early recovery was recorded by time to emergence and orientation to time and place. In post anesthesia care unit, intermediate recovery was assessed by modified Aldrete Score and Digit Symbol Substitution Test (DSST). Intraoperative MAP and HR did not differ between the two groups (P > 0.05). The time to response to painful stimuli, obeying verbal commands and spontaneous eye opening was shorter (P = 0.001) and modified Aldrete Score was higher after desflurane anesthesia than after sevoflurane anesthesia (P = 0.049). DSST also returned towards normal faster after desflurane (28.50 ± 6.30 min vs. 35.0 ± 5.62 min, P = 0.03). Both desflurane and sevoflurane produce similar hemodynamic changes but the immediate and intermediate recovery was significantly faster after desflurane thus contributing to fast tracking and early discharge of patients.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):36-40.
• Article: ProSeal™ laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery.

  Bimla Sharma, Rajat Gupta, Raminder Sehgal, Archna Koul, Jayashree Sood
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  ABSTRACT: The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours. One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded. The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups. The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide.
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):47-51.
• Article: ICU management of Methemoglobinemia due to unknown compound poisoning.

  Ca Tejesh, Shivakumar Shivanna, Ac Manjunath, Pt Prathima
  Journal of Anaesthesiology Clinical Pharmacology 01/2013; 29(1):139-140.