[Show abstract][Hide abstract] ABSTRACT: Pyrethroids are widely used as commercial and domestic insecticides. Prallethrin is a type I pyrethroid compound and is used as a liquid mosquito repellant. Despite extensive use, there are relatively few reports of human pyrethroid poisoning. This report describes the management of a 20 year-old male patient who had consumed prallethrin. Prallethrin is related to allethrin, a type I pyrethroid and is used as a liquid mosquito repellant. It has a basic cyclopropane carboxylic ester structure. Pyrethroids are widely used as commercial and domestic insecticides. It is available as a liquid mosquito repellant to be applied on the skin. Generally, pyrethroids are considered safe for human use because they have poor dermal absorption and rapid metabolism with little tissue accumulation, which have resulted in few reports of human toxicity. We are reporting a case of prallethrin poisoning due to deliberate self ingestion. A young 20 year old male was admitted to our intensive care unit (ICU) in April 2010 with a history of vomiting, abdominal pain, dizziness, generalized convulsions and altered sensorium following intentional ingestion of approximately 25ml of liquid mosquito repellant, four hours before coming to hospital. Examination revealed a pulse rate of 121/beats/min following a dose of atropine, blood pressure of 132/68 mmHg, respiratory rate (RR) of 32 breaths/min, glasgow coma score (GCS)-E1, V1, M3, and bilateral crepitations. Pupils were semi-dilated with sluggish reaction to light, SpO2 was 75% on room air. The patient was intubated and ventilated. Blood samples were sent for serum electrolytes, haemogram, blood urea, serum creatinine and arterial blood gas (ABG) analysis. ABG analysis showed metabolic acidosis. Remaining blood investigations were in the normal range. Chest X-Ray revealed features of interstitial pulmonary oedema. Mechanical ventilation with positive end-expiratory pressure was continued and 20mg of frusemide was given intravenously. The patient was given broad spectrum antibiotic coverage. The condition of the patient improved over 48 hours and was gradually weaned off the ventilator on the 4 th day. The patient complained of mild headache, dizziness and excessive fatigue which gradually improved. The patient was referred to a psychiatrist for counseling and was discharged on the 6 th day.
Sri Lankan Journal of Anaesthesiology 03/2011; 19(1). DOI:10.4038/slja.v19i1.1879
[Show abstract][Hide abstract] ABSTRACT: The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular) regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30) or medial clavicular approach (group M, n = 30) with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4), discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05). More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L). Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.
Indian journal of anaesthesia 01/2010; 54(3):210-4. DOI:10.4103/0019-5049.65362
[Show abstract][Hide abstract] ABSTRACT: Patient controlled epidural analgesia (PCEA) is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 microg.ml(-1) of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8) required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable & prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine, it did not affect maternal or neonatal safety.
Indian journal of anaesthesia 12/2009; 53(6):649-53.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of a single preoperative dose of 600 mg of gabapentin for reducing postoperative pain and tramadol consumption after minilap open cholecystectomy.
A total of 120 adult patients of either sex were randomly assigned to receive 600 mg of gabapentin or a matched placebo orally 2 h before operation in a double-blind manner. All the patients received gabapentin using the same technique. Postoperative analgesia was provided with intravenous patient-controlled analgesia with tramadol using a 50-mg initial bolus dose, 20-mg incremental dose, 15-min lockout interval and 4-h limit of 240 mg. Patients were assessed at 0, 2, 4, 8, 12, 24 and 48 h after operation for verbal analogue pain scores at rest and at movement. Consumption of tramadol on first and second postoperative days and any adverse effects were also recorded.
Verbal analogue pain scores were significantly lower on first postoperative day at all times of observation both at rest and at movement in gabapentin group than in placebo group (P<0.01). Tramadol consumption was also reduced by 33% in gabapentin group. But pain scores and tramadol consumption were similar in two groups on second postoperative day. Sedation was common but the incidence of postoperative nausea and vomiting was significantly lower in gabapentin group.
Preoperative administration of 600 mg of gabapentin resulted in significant reduction in postoperative verbal analogue pain scores at rest and at movement as well as tramadol consumption compared with placebo on first postoperative day. Lower incidence of nausea and vomiting was an additional advantage. Sedation was the commonest side effect.
European Journal of Anaesthesiology 11/2009; 27(4):331-5. DOI:10.1097/EJA.0b013e328334de85 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This preliminary study on I-gel™ (Intersurgical Ltd, Wokingham, U K) was conducted on 50 consecutive patients of ASA physical status I-III, to determine the ease of insertion, time to achieve effective airway, oropharyngeal seal pressure and airway stability on head and neck movement.
After premedication with midazolam and fentanyl, induction was done with propofol and I-gel was inserted according to manufacturer's instruction. An effective airway was confirmed by bilateral chest movement, square wave on capnograph and SpO2>95%.
The success rate at first attempt was 90% with a median insertion time of 11 sec (range 8-45sec). Five patients (10%) needed second attempt while none needed 3rd attempt. The manipulation needed to achieve effective airway were increasing the depth of insertion of I-gel in 4 (8%) cases, jaw thrust or chin lift in 2(4%) cases. Oropharyngeal seal pressure was 20 cm of H2O (16-40 cm of H2O). Gastric tube placement was done in 50% of the cases; it was easy and successful in all the cases. No significant adverse event was noted in any of the patient in perioperative period.
Our initial experience showed that I-gel is a simple, easy to use supraglottic airway device with a high success rate at first time insertion.
Indian journal of anaesthesia 02/2009; 53(1):52-6.
[Show abstract][Hide abstract] ABSTRACT: AIM #ENTITYSTARTX00026;
To find if direct laryngoscopy (DL) could be done without using succinylcholine and secondly, to acertain the appropriate anesthetic regimen.
In a double blind placebo controlled study 67 patients aged 40-75 years of age, of both sex requiring direct laryngoscopy (DL) either for diagnosis or for biopsy were enrolled. The patients were randomly divided in three groups. The patients in group F and S received Fentanyl or Sufentanil respectively along with Propofol, whereas those in group N received normal saline (placebo) and propofol. The conditions of laryngoscopy, hemodynamic parameters and any adverse events were recorded. Good or fair conditions for laryngoscopy were achieved in 91% (21), 87% (19) and 73% (16) of patients in groups F, S and N respectively (p < 0.05) in favor of group F and S. During DL arterial pressure and pulse rate changes were minimal when propofol was administered along with opioids, (group F and S) compared to group N where only propofol was used.
No serious side effects were seen in the three groups. Hence by these findings we concluded that better conditions of DL are achieved during anesthesia with propofol and fentanyl and sufentanil alone. The opioids provided additional benefit of stable hemodynamics.
Indian Journal of Otolaryngology and Head & Neck Surgery 12/2008; 60(4):314-6. DOI:10.1007/s12070-008-0106-x · 0.05 Impact Factor