Indian Journal of Anesthesia and Analgesia

 The patients with spine abnormalities, present unique challenges to the health care provider responsible for administrating sedation and anaesthesia during surgical and technical procedures. Spinal deformities may cause difficulties with both tracheal intubation and regional anaesthesia. This report describes the anaesthetic management for orthopaedic procedure that were performed in a patient with severe thoracolumbar kyphoscoliosis. After examining the risk factors, spinal block by injecting single dose hyperbaric local anaesthetic solution to intrathecal space was chosen to provide anaesthesia. Interathecal hyperbaric bupivacaine 0.5% 10mg (2ml) was used, motor and sensory blockade T10 was achieved. The patient reported satisfactory anaesthesia and developed no complications. In conclusion, spinal anaesthesia can be successful even in case of thoracolumbar kyphoscoliosis.

Keywords: Kyphoscoliosis; Spinal Anaesthesia.

 Acute pneumothorax occurring under general anaesthesia with positive pressure ventilation especially when using nitrous oxide can rapidly become life­threatening tension pneumothorax. As the diagnosis is often difficult or delayed in this situation, a high index of suspicion and clinical examination aided by monitors are necessary for the diagnosis, which may be confirmed by radiography or ultrasonography. Immediate stoppage of nitrous oxide with prompt release of the pneumothorax by needle aspiration or intercostals drainage is needed to save the life of the patient. This is a case report of an un­anticipated acute pneumothorax which occured soon after the induction of general anaesthesia, which was diagnosed and managed successfully in time.

Keywords: Acute Pneumothorax; General Anaesthesia; Nitrous Oxide.

 Systemic lupus erythematosus is characterized by chronic, inflammatory, multi-organ symptoms caused by immune complexes and auto antibodies. The disease is having wide clinical presentation involving cardiovascular system, respiratory system, gastrointestinal system, renal, hematologic, central nervous system, musculoskeletal and dermatologic system pathologies. Commonly the onset of this disease is in the third to fourth decade of life. In pregnancy systemic lupus erythematosus may exacerbate causing spontaneous abortions, intrauterine death, pre-eclampsia and eclampsia, intrauterine growth retardation, preterm delivery. This case report summarizes the peri-operative course and anaesthetic management in a parturient with SLE with bad obstetric history who underwent elective caesarean section [LSCS].

Keywords: Autoimmune; LSCS; Pregnancy; Systemic Lupus Erythematosus; ANA.

 Introduction:Two possible respiratory muscle strategies can be considered during pregnancy. 1) Higher inspiratory intercostal and accessory muscle recruitment, since the increased thoracic volume displacement and pleural pressure swings could also be a consequence of their enhanced action. 2) Similar relative contribution between the diaphragm and the inspiratory intercostal muscles, since the slope of the Pgaversus Poes curve remains constant . Methodology: Study was conducted in 60 female patients .These patients were divided into two groups Group I consisted of 30 pregnant women posted for cesarean section under general anaesthesia. Group II consisted of 30 non pregnant women posted for General Surgeries under General anaesthesia. Results: the distribution of Wilson Risk­Sum­Values in both the groups. In groupI, 21 out of the 30 patients belonged to Wilson score 0 (70%) compared to 23 out of the 30 patients in group II (76.7%). In group I, 6 out of 30 patients belonged to Wilsons score 2 (10%) compared to 2 out of the 30 patients in group II (6.7%). Using chi­square test it was found that there was no statistically changes in Wilsons risk­sumvalues between two groups (P>0.05). Conclusion: The prediction of difficult airway in an obstetric patient is best done using Modified Mallampatti classification in the preoperative period.

Keywords: Pregnancy; Airway Changes; Wilsons RiskS um­Values.

 Introduction: The risk of failed intubation in obstetrics has been estimated to be eight folds compared to the general surgical cases (i.e.,) an incidence of 1:250 in obstetric compared to 1:20,000 in general surgical cases.As there is an attempt to lower caesarean section rates and a higher percentage are performed using regional technique individual practitioners have less experience with general anesthesia in obstetrics. Methodology: 60 female patients were divided into two groups Group I consisted of 30 pregnant women posted for cesarean section under general anaesthesia. Group II consisted of 30 non pregnant women posted for General Surgeries under General anaesthesia. Results: Cormack and Lehaneslar-yngoscopic view grading in both in group, in group I, 24 out of the 30 patients had Grade A (80%) compared to 28 out of the 30 patients in group II (93.3%). Conclusion: Statistically significant changes were not seen in the Cormack and Lehanes grading of the laryngoscopic view.

Keywords: Intubation; Pregnancy; LSCS.     

 The apparent lack of laryngeal stimulation makes the LMA a potentially attractive alternative for airway management in children with upper respiratory tract infection. Upto 40% of children presenting for anaesthesia have a recent upper respiratory tract infection (URI). Although there is an increased risk of perioperative respiratory complications after a recent URI, anaesthesiologists often proceed with their management for two reasons­ It is uncertain how long to postpone the procedure after a URI, and there are adverse economic and emotional impacts resulting from cancellation of the procedure. Children weighing between 10 to 20 kg undergoing operative procedures in Kasturba Medical College Hospital, Attavar, Kasturba Medical College Hospital, Ambedkar Circle, Government Wenlock Hospital were the study subjects. The ease of insertion and number of attempts for insertion was compared in both groups. It was found that intubation was successful in first attempt in 92% of patients in endotracheal tube group and in 84% of patients in laryngeal mask airway group.

Keywords: Laryngeal Mask Airway; Endotracheal Intubation; Children.

 Background: This study was conducted to compare efficiency of different concentrations of lidocaine in intravenous regional anesthesia in terms of onset and duration of sensory and motar blockade. Methods: Sixty patients were divided in to 2 groups; the first group received 0.5% concentration of 30-40 ml of lidocaine and the second group received 2% of lidocaine 12-15ml.preoperative and intraoperative hemodynamic parameters were monitored and recorded at 1,5,10,20,30,40 minutes after anesthesia. Results: The onset time of sensorial block was shorter and duration of sensorial block was longer in group 2 than group 1.the onset of motor blockade and duration of motor blockade was longer in group 2 than group 1.there was no comparatively significant differences in hemodynamic vital parameters in both groups. Conclusions: IVRA with 2% ligocaine is effective and safer than the 0.5% ligocaine.

Keywords: IVRA; 0.5% Lignocaine; 2%Lignocaine; Regional Anaesthesia.

 Introduction: Heart rate does not change after induction dose of propofol because it resets or inhibits the baroreceptor reflex, thus reducing tachycardia response to hypotension. Propofol decrease the sympathetic activity to a greater extent than parasympathetic activity. Methodology: A thorough preanaesthetic evaluation was done to assess the general condition and status of cardiovascular, respiratory and central nervous system. Routine investigations like hemoglobin percentage, total leucocyte counts, differential leucocyte counts, bleeding time, clotting time and chest X-ray was done and checked. A written informed consent was taken from parents. Results: The systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were compared between the two groups following induction and intubation using unpaired student’s t-test; statistically there were no significant differences between the two groups. Conclusion: propofol and sevoflurane effectively blunted the systolic, diastolic and mean arterial pressure

Keywords: Propofol; Sevoflurane; Hemodynamic.

 Introduction: Non­depolarizing neuromuscular blocking agents are alternative but are slower in onset and have a prolonged neuromuscular blockade [3] and also an inability to reverse the paralysis quickly if airway management via mask or tracheal intubation is not possible. Methodology: The study group consisted of 80 patients of both sexes, between the age of l­10years and belonging to ASA Physical status 1 and 2 who were scheduled for cleft lip/cleft palate/cleft alveolus surgery under general anaesthesia. Results: Regarding position of vocal cords, they were open in 50% of children, moving in 35% and closing in 15% of children in group A. In group B, vocal cords were open in 72.5% moving in 20%, closing in 5% and closed in 2.5% of children. Conclusion: A combination of sevofluranehad more acceptable intubating conditions compared to combination of propofol.

Keywords: Sevoflurane; Propofol; Intubation.

 Introduction: This prospective comparative trial was under­taken to compare the effects of insertion of laryngeal mask airway (LMA) and Endotracheal tube on heart rate response, evaluate the safety and efficacy of LMA as an airway device, and evaluate the changes in heart rate in pediatrics patients undergoing elective surgeries under general anaesthesia. Material and Methods: 60 cases which met all the inclusion criteria were selected and the study was carried out on patients of ASA I and II, aged 2 ­ 14 years of either sex, weighing 3­45kg undergoing elective surgery GroupL: LMA for airway management Group­E: Endotracheal Tube (ETT) for airway management. Results: Both ETT and LMA cause increase in heart rate (HR), but the magnitude and duration of response is less in LMA. The heart rate response to LMA insertion has reached the basal values in 3 minutes where as in endotracheal group it was still higher even in 5 minutes. Mean difference in the heart rate at different intervals with that of basal values showed significant results. Conclusion: Heart response is less and short lived with LMA as compared to endotracheal intubation. Therefore LMA is a suitable alternative to endotracheal intubation for elective surgical procedures in paediatric patients.

Keywords: Heart Rate Response; Laryngeal Mask Airway; Endotracheal Intubation; Children.

 Background: Central neuraxial anaesthesia may need to be supplemented with benzodiazapines, alpha2 blockers etc. for sedation and analgesia. In the present study, we compared the effects of intravenous dexmedetomidine and midazolam on sedation, postoperative analgesia, and spinal block duration in lower abdominal surgeries like inguinal hernias and appendicectomies performed under spinal anaesthesia. Methods: This prospective randomized controlled double blind study was carried out in 60 patients. Group D (n=30) received IV premedication with Dexmedetomidine 0.5mcg/kg while Group M (n=30) received IV Midazolam 0.05mg/kg fifteen minutes prior to subarachnoid block with bupivacaine 0.5% 3.5ml. Onset and duration of sensory and motor blockade, level of sedation, cardiorespiratory parameters and quality of postoperative analgesia were recorded. Results: The duration of sensory blockade was significantly prolonged in group D (280.00 ± 31.62 minutes) as compared to group M (263.00 ± 30.30 minutes) (p<0.05). The duration of analgesia was significantly prolonged in group D (261.50 ± 90.85minutes) than group M (213.67 ± 49.02minutes). The sedation scores were higher in group D as compared to group M in the beginning but comparable later on. The pulse rate was significantly decreased in group D than in group M. The systolic, diastolic and mean arterial pressures were significantly decreased in group M. There was no significant difference in respiratory rates in both the groups. Conclusion: IV premedication with dexmedetomidine 0.5 mcg/kg prolongs the duration of sensory blockade as compared to IV midazolam 0.05 mg/kg. Dexmedetomidine produces sedation with easy arousability, and provides better analgesia than midazolam.

Keywords: DexmedetoMidine; Midazolam; Premedication; Sedation; Spinal Anesthesia.

 Not Provided.