Indian Journal of Anesthesia and Analgesia

Introduction: Primary hyperparathyroidism is a hypercalcemic state due to excessive secretion of parathyroid hormone (PTH). The most common cause being single parathyroid adenoma. Majority of these cases detected by screening of serum calcium concentration, are older individuals who present with  associated  comorbidities. Few patients may present with Hyperparathyroid crisis a serious and potentially life threatening complication ofsevere primary Hyperparathyroidism. Parathyroidectomy leads to the cure of the disease. Parathy-roidectomy for localized adenomas are usually performed under general anaesthesia, however cervical plexus block is also a good alternative. Case Report: We describe the anaesthetic management of a 72 years old, ASA III MP IIImale patient who underwent parathyroid adenoma (right) excision under combined superficial and deep cervical plexus block. Patient was a diagnosed case of primary hyperparathyroidism. Other comorbidities beingmoderate aortic stenosis,ischaemic heart disease, chronic kidney disease, hypertension and cervical spondylosis. Patient was having regular episodes of parathyroid crisis and had to be operated upon, but the patients’ medical condition contradicted general anaesthesia so patient was operated under right sided combined superficial and deep cervical plexus block with awake sedation, resulting in excellent anaesthesia of the operation site, stable haemodynamics, adequate intraoperative analgesia withreduced postoperative analgesic requirement. Discussion: Cervical plexus blocks the motor and sensory nerves originating from C2 to C4 nerve roots. It has been shown to be safe for thyroid and parathyroid surgeries, with cure rates equivalent to general anaesthesia.Parathyroidectomies done under regional anaesthesia significantly reduced post-operative pain, nausea, and vomiting.However the studies available till now on regional versus general anaesthetic approach for parathyroidectomies do not yield definitive information, regarding which technique is superior. Hypercalcemia along with associated muscular weakness was another reason why cervical plexus block was preferred in our patient. Conclusion: Thus cervical plexus block may be used as an alternative to general anaesthesia for thyroid and parathyroid surgeries, especially in patients with multiple co morbidities in whom administering a general anaesthesia may be problematic.

Keywords: Hyperparathy-roidism; Aortic Stenosis; Hyperparathyroid Crisis; Cervical Plexus Block.

Dexmedetomidine is a novel drug which is a selective a2-adrenoceptor agonist. It has unique properties of producing sedation, anxiolysis, amnesia and analgesia but at the same time without respiratory depression.

It provides a unique “conscious sedation” (patients appear to be asleep, but are readily roused), analgesia, without respiratory depression. It decreases central nervous system (CNS) sympathetic outflow in a dose dependent manner and has analgesic effects best described as opioid-sparing. There is increasing evidence of its organ protective effects against ischemic and hypoxic injury, including cardioprotection, neuroprotection and renoprotection.

This article is intended to highlight special situations in cardiac anesthesia (especially paediatric) where dexmedetomidine plays a crucial role.

Keywords: Dexmedetomidine; Cardiac Anesthesia; Pediatric.

Introduction: In spite of tremendous advances in contemporary anesthesia practice, airway management continues to be of paramount importance to anesthesiologist. Methodology: 60 patients of ASA 1 and 2 with BMI <35kg/m2 ,between 18 and 60 yrs. were enrolled into the study. They were randomized into two groups of equal number using the chit-in-a-box method for the use of either i-gel or endotracheal tube for the maintenance of airway during the anesthesia. Both groups were comparable with respect to age, sex,BMI, ASA grading, airway characteristics and anesthesia technique used was same in both groups. Results:    No gastric distension, regurgitation, aspiration, laryngospasm or bronchospasm seen while using the i-gel  or endotracheal tube  during our study. 4 cases reported of having hoarseness of voice and 2 cases reported of having sore throat in endotracheal group but there were no cases of sore throat or hoarseness of voice in i- gel group, which are well known advantages of laryngeal mask air way.Conclusion:Our study supports the use of i-gel during VCV in elective laparoscopic cholecystectomy using low to moderate tidal volumes provided that peak airway pressure is not more than device leak pressure.

Keywords: I-Gel; Leak Fraction; Pneumoperitoneum; Cholecystectomy; Complications.

Background and Objectives: Laryngoscopy and tracheal intubation is invariably associated with a reflexsympathetic pressor response resulting in elevated heart rate and blood pressures. Thismay prove detrimental in high risk patients. The main objectives of the present study are: 

1. To study the effect of intravenous magnesium sulphate 30 mg/kg with intravenous lignocaine 1.5mg/kg,  and intravenous clonidine 3mcg/kg with intravenous  lignocaine 1.5mg/kg on changes in the Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Mean arterial blood pressure (MAP) during laryngoscopy and intubation under general anesthesia. Methods: 60 ASA I and II status normotensive patients scheduled for elective surgical Procedures were selected randomly and divided into three groups of 20 each. Allpatients received premedicationwith studydrug. Induction of anesthesia was standardized for all patients who received, thiopentone 5 mg/kg i.v.and preservative free lignoaine 1.5mg i.v   and were relaxed with succinylcholine 2mg/kg i.v. and laryngoscopy and intubation is done with appropriate sized endotracheal tube. HR, systolic, diastolic blood pressure were recorded noninvasively before induction,  postintubation, 1,3,5, 7 and 10 minutes from the onset of laryngoscopy. ‘ z’ test was used for statistical analysis. Results: The basal and pre laryngoscopy mean SBP and standard deviations in CL group were 122.15 +/- 8.12 and 114.50 +/- 7.30 respectively. In ML group basal systolic blood pressure was 117.30 -+-/- 9.78. After giving study drug prelaryngoscopy SBP decreased by 3mm of mm Hg to 114.15 +1- 15.26. Conclusion: Both study drugs were more effective in attenuation of pressor response to intubation than when lignocaine alone was used.

Keywords: Attenuation; Pressor Response; Laryngoscopy; Intubation; Lignocaine;   Magnesium-sulphate; Clonidines.

Despite advances in anesthetic drugs and techniques, post-operative nausea and vomiting (PONV) remain the second most common post-operative complaint after surgery. Despite the increasing attention to postoperative pain control, PONV is still considered a minor complication. In the absence of antiemetic treatment, the estimate puts the incidence of  PONV at 25-30% for all surgical interventions and patient populations. Pharmacological approaches based on anticholinergics, antihistamines, phenothiazines, butyrophenones, benzamides, corticosteroids and serotonin receptor antagonists have been investigated in the prevention    and treatment of  PONV, with      various results. Dexamethasone may offer additional benefits over traditional antiemetics in improving the surgical outcomes. Compared with placebo, 8 mg          of Dexamethasone given intravenously 90 minutes before laparoscopic cholecystectomy (LC) has been demonstrated to reduce PONV significantly. Combination of  both Propofol and Dexamethasone  may reduce the chances of PONV and additionally decreases incidence of sore throat in patients       operated for laparoscopic cholecystectomy. The limitation of  this study was that we could not measure the cuff pressure and did not use fibre optic bronchoscope to assess the amount of tissue damage. Our study was not designed for extended follow up beyond 24 hours, as the process of acute inflammation usually peaks by 24 hours. Sore throat, hoarseness and cough cannot be assessed objectively and there are inter individual variations and hence, a chance of  bias always exists. The BMI of our patients in the two groups were comparable and we used standard  sized tubes of the same manufacturer to ameliorate the possible error due to different tube size and quality. 

Keywords: Dexamethasone; Propofol; Laparoscopy; Metoclop Ramide.

Background and Objectives: Laryngoscopy and tracheal intubation is invariably associated with a reflexsympathetic pressor response resulting in elevated heart rate and blood pressures. Thismay prove detrimental in high risk patients. The main objectives of the present study was To study the effect of intravenous magnesium sulphate 30 mg/kg with intravenous lignocaine 1.5mg/kg,  and intravenous clonidine 3mcg/kg with intravenous  lignocaine 1.5mg/kg on changes in the heart rate (HR) during laryngoscopy and intubation under general anesthesia. Methods:  60 ASA I and II status normotensive patients scheduled for elective surgicalprocedures were selected randomly and divided into three groups of 20 each. Allpatients received premedicationwith studydrug magnesiumsulphate 30mg/kg or clonidine 3µgm / kg or normal saline (as per double blind study protocol)   prepared by  anaesthesia staff  and  glyopyrrolate 0.2mg i.v., tramadol 3mg /kg 3min before induction . Induction of anesthesia was standardized for all patients who received,thiopentone 5 mg/kg i.v. and preservative free lignoaine 1.5mg i.v   and were relaxed with succinylcholine 2mg/kg i.v. and laryngoscopy and intubation is done with appropriate sized endotracheal tube. HR, systolic, diastolic blood pressure were recorded noninvasively before induction, postintubation, 1,3,5, 7 and 10 minutes from the onset of laryngoscopy. ‘z’ test was used for statistical analysis. Results: In CL group, mean heart rate at 5 min and 10 min were 96.25 and 9.83 respectively. In ML group, mean heart rate at 5 min and 10 min were 100.95 and 97.45 respectively. Conclusion: There was a statistically significant attenuation of heart rate response was observed after giving study drug in CL group

Keywords:Attenuation; Pressor Response; Laryngoscopy; Intubation; Lignocaine; Magnesiumsulphate; Clonidines.

Aims &Objectives: To Compare the effectof IV infusion of Dexmedetomidine and Esmolol  for induced hypotension  during nasal surgeries under general anaesthesia.

To Compare

 Hemodynamic changes 

 Intraoperative surgical field

 Sedation and analgesia in post-operative period between the groups. 

Materials and Methods: 60 patients for nasal surgeries   under ASA I/II were allocated in 2 groups. All the patients were premedicated, induced and maintained  inusual manner. Group D: received Inj. Dexmedetomidine1 µg/kg as a loading dose over 20 minutes followed by an infusion of 0.2-0.6 µg/kg/hr IV. Group E:  received Inj. Esmolol 1mg/kg as a loading dose over 1 minute followed by an infusion of0.4-0.8 mg/kg/hr IV. Intra operative Heart rate, Mean arterial pressure, surgical field ,post-operative  sedation  and  analgesia were evaluated. Results and Summary: There was no significant difference of MAP and Heart rate in both groups intraoperatively , but there was significant difference at the end of surgery.There was no significant difference in the amount of blood loss in both groups. Mean postoperative sedation score was significantly higherin D than in E group. The duration of first analgesic request was significantly longer in D than E group.  No side effects were observed. Conclusion:  Dexmedetomidine or Esmolol is effective in providing ideal surgical field during nasal Surgeries, but compared with Esmolol, Dexmedetomidine offers the advantage of sedation and analgesia.

Keywords: Nasal Surgeries; Dexmedetomidine; Esmolol.

Objective: Endotracheal  intubation  is  an  integral  part  of  administration  of  anesthesia during  surgical  procedure.  The  time  interval  from  suppression  of  protective  reflexes  by induction,  to  accomplishment  of  intubation  is  a  critical  period,  during  which regurgitation  and  aspiration  of  acid  gastric  contents  can  occur.  Rapid  sequence intubation  is  proved  to  be  the  technique  of  choice  in  these  situations.  Method:  We studied  100  patients  of  either  sex  aged  18-70  years  of  ASA  grade- 1  and  2, with  mallampati  grade  1-2  undergoing  elective  surgery.  They  were  randomly  allocated  in two  groups – 50   each  to  compare  the  intubating  condition    of  inj.  Rocuronium  0.9mg/kg in Group 1 to  inj.  Suxamethonium  2mg/kg in Group 2.  Anaesthesia   was   induced  with   fentanyl  2 µg/kg  and   Propofol  2 mg/kg   and   intubating   conditions  were  assessed  60s  after  the  administration  of  the  neuromuscular  blocking  drug.  Intubating  conditions  were  graded on  a  three-point  scale  as  excellent,  good  or  poor,  the  first  two  being  considered clinically  acceptable.  Result: All  patients  were  successfully  intubated  in  both  groups. Overall  intubating  conditions  in  group  1  &  2  were  excellent  in  94%  and  100% patients  while  good  in  06%  and  00%  patients  respectively  with  not quite  statistically  significant  difference  (p>0.05).   Conclusion:  It  is  concluded  that rocuronium  0.9 mg/kg  can  be  used  as  an  alternative  to  suxamethonium  2.0 mg/kg  as part  of  a  rapid  sequence  induction  provided  there  is  no  anticipated  difficulty  in intubation. 

Keywords: Intubating Condition;  Rocuronium;  Suxamethonium;  Rapid Sequence Induction.

 Not Provided.