Anaesthesia

From the desk of the New President S Bala Bhaskar Indian Journal of Anaesthesia 2019 63(1):1-2

The President's inaugural address during ISACON 2018 on November 28, 2018 at Agra Kuchela V Babu Indian Journal of Anaesthesia 2019 63(1):3-5

Endothelial glycocalyx: Role in body fluid homeostasis and fluid management Pankaj Kundra, Shreya Goswami Indian Journal of Anaesthesia 2019 63(1):6-14 Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an essential role in maintaining the normal fluid homeostasis of the body. This highly fragile layer can be damaged by a number of pathophysiological conditions and interventions. Disease state management should be directed to maintain EGL integrity to improve patient's outcome. When intravenous (IV) fluids are used, appropriate type, rate and amount of fluid should be determined by the pathophysiology of the condition and measures to maintain the integrity of the EGL. This review depicts the structure and function of the EGL, its alteration in common pathological states and the rationale of IV fluid management to preserve EGL in such conditions.

Comparison between macintosh, miller and mccoy laryngoscope blade size 2 in paediatric patients – A randomised controlled trial Pratishtha Yadav, Sudeshna Bhar Kundu, Dhurjoti P Bhattacharjee Indian Journal of Anaesthesia 2019 63(1):15-20 Background and Aims: Paediatric airway needs special consideration as it is not a miniature replica of adult airway, rather it has different anatomy with different proportion and angulations. This study was conducted with the aim to find a laryngoscope blade that provides best laryngoscopic and intubation conditions in paediatric patients of age 2–6 years. Methods: This trial was conducted in a total of 75 children age 2–6 years, either gender, with American Society of Anesthesiologists grade I or II scheduled for elective surgery under general anaesthesia. They were randomly allocated to groups A, B and C to be intubated with Macintosh, Miller and McCoy blades, respectively. Intubation Difficulty Score (IDS) was considered as primary outcome, and Cormack–Lehane grade and Percentage of Glottic Opening (POGO) score were taken as secondary outcome. Data were compared by ANOVA or Kruskal-Wallis or chi square test using Statistica, SPSS and GraphPad Prism softwares. P < 0.05 was considered statistically significant. Results: IDS score was significantly lower (P = 0.002) in group B (0.6 ± 0.7) as compared to group A (1.4 ± 0.9) and group C (1.3 ± 1.1); majority of patients in group B (48%) had Cormack–Lehane grade Ι (P = 0.002) unlike group A (0%) and group C (20%) and POGO score (P < 0.001) was higher in group B (86 ± 23.4) when compared with groups A (68.2 ± 20.5) and C (59.8 ± 28.9). Haemodynamic changes and other intubation parameters were comparable among the groups. Conclusion: Miller blade may be considered superior to Macintosh and McCoy blades in terms of glottic visualisation and ease of intubation in paediatric patients.

Correlation of early ROTEM parameters with conventional coagulation tests in patients with chronic liver disease undergoing liver transplant A Hashir, Shweta A Singh, Gopi Krishnan, Rajkumar Subramanian, Subhash Gupta Indian Journal of Anaesthesia 2019 63(1):21-25 Background and Aims: Viscoelastic tests such as rotational thromboelastometry (ROTEM) provide a quick and holistic assessment of coagulation status to guide transfusion during liver transplant (LT). Conventional coagulation tests (CCTs) measure single parameters in isolation, and also the results are delayed hampering management of patients during surgery. We evaluated the correlation of early ROTEM-derived parameters with CCTs and also assessed the ability of ROTEM-derived parameters to predict thrombocytopaenia and hypofibrinogenaemia during LT in patients with end-stage liver disease (ESLD). Methods: This retrospective study was carried out in 100 patients with decompensated ESLD undergoing LT. Correlation between CCTs and ROTEM parameters was analyzed. Receiver operating characteristic curves with area under the curve were used to determine the cut-off values of A5 andA10 on EXTEM and FIBTEM. Results: The values of A5EXTEM and A10EXTEM highly correlated with fibrinogen levels and platelet count, whereas A5FIBTEM and A10FIBTEM correlated well with fibrinogen levels. A5EXTEM<21 mm and A10EXTEM<28 mm correlated with a platelet count <75,000 mm−3, whereas A5EXTEM<18 mm and A10EXTEM<25 mm correlated with a platelet count <50,000 mm−3. Fibrinogen levels <100 mg/dL better correlated with A5FIBTEM<5 mm, A10FIBTEM<6 mm, A5EXTEM<21 mm and A10EXTEM<30 mm. Conclusion: Early ROTEM parameters A5 and A10 of both EXTEM and FIBTEM had an excellent correlation with thrombocytopaenia and hypofibrinogenaemia and may potentially guide early transfusion of relevant blood products during LT.

Existing practice of perioperative management of colorectal surgeries in a regional cancer institute and compliance with ERAS guidelines Angshuman Rudra Pal, Suparna Mitra, Sobhan Aich, Jyotsna Goswami Indian Journal of Anaesthesia 2019 63(1):26-30 Background and Aims: Enhanced recovery after surgery (ERAS) protocol in colorectal surgery has been shown to result in reduced rates of postoperative complications and length of stay (LOS) in the hospital. Although there is clear guideline and evidences available, their implementation into daily clinical practice faces some difficulties. We aimed to audit the existing practice of perioperative care in colorectal surgeries and find out the adherence to ERAS protocol. Methods: We collected data from medical record of 215 patients undergoing colorectal surgery in a regional cancer institute of eastern India. The patient data were retrospectively collected, which included, demographic data, adherence to major components of ERAS pathway, postoperative complications, and length of hospital stay. Results: The median LOS after surgery was 9 days (interquartile range [IQR] 6-12.75). Approximately, 15% patients had postoperative complications. We found good adherence (more than 80%) to certain elements of ERAS such as preoperative counseling and nutritional assessments, selective bowel preparation, antibiotic and antithrombotic prophylaxis, etc. Conclusion: The audit revealed that compliance to individual ERAS elements were variable, which needed urgent modification for better adherence to ERAS guidelines.

Cancer relapse in surgical patients who received perioperative transfusion of blood and blood products: A case-control study R Subha, Kurian Cherian, Archana Nair, Rachel Cherian Koshy, Jagathnath Krishna Indian Journal of Anaesthesia 2019 63(1):31-35 Background and Aims: Immunomodulatory consequences of allogeneic blood transfusion may outweigh the advantages of improved oxygen delivery and tissue perfusion, especially in patients with cancer. In colorectal cancer, there is evidence of cancer relapse in patients who received transfusion. This retrospective analysis was undertaken to evaluate the relationship between perioperative blood transfusion and cancer recurrence in patients undergoing oncosurgery. Methods: In this case-control study, we retrospectively analysed the case sheets of 194 patients who had perioperative transfusion and underwent cancer surgery from March to December 2013(Study group, Cases). They were compared with controls matched for cancer site and TNM staging who did not receive perioperative transfusions (Control Group, Controls). We intended to find out if the Study group had any increased risk of cancer relapse compared with the controls. Records from the institute cancer registry were analysed in 2018 to give a follow-up period of 5 years. Continuous variables were analysed using Student's T test and Mann Whitney U test for normally distributed and skewed data respectively. For Categorical data Fisher's exact test and Chi square test were applied. The risk for recurrence was estimated using odds ratio. Results: The recurrence rate in cases and controls was 53.09% and 19.59% respectively and the odds ratio, 4.647 (CI: 2.954, 7.309). In Cases, significant relapse was noted for carcinomas of ovary, colorectal, bladder, larynx, head of pancreas and liver. Conclusion: In surgical oncology patients, ABT is associated with greater rate of recurrence.

Comparison of weight-based and pinna size–based selection of ProSeal laryngeal mask airway in paediatric population – A prospective exploratory trial Ramya Ravi, VK Mohan, Ashok Shankar Badhe, Sandeep Kumar Mishra, Prasanna Udupi Bidkar Indian Journal of Anaesthesia 2019 63(1):36-41 Background and Aims: Weight-based selection of ProSeal laryngeal mask airway (PLMA) size may be unreliable in some situations. The aim of this study was to compare the ventilation parameters using PLMA during controlled ventilation between weight-based size selection and pinna size–based selection in children. Methods: A total of 204 patients were randomised to receive either pinna size–based (Group P) or weight-based (Group W) size selection of PLMA. We tested the hypothesis that pinna size–based selection of PLMA was better than weight-based selection of PLMA in paediatric patients during controlled ventilation under general anaesthesia in terms of oropharyngeal sealing pressure (the primary end-point) and Brimacombe score. Cuff pressure was maintained at 60 cm of H2O during the study. Secondary outcomes included the number of attempts for successful placement of PLMA, peak airway pressure, gastric tube placement, traumatic insertion, and complications were also compared. Parametric variables were analysed using unpaired t-test and categorical variables were analysed using Mann–Whitney and Chi-square test. Results: In all, 200 patients were analysed. The mean oropharyngeal sealing pressure in Group P was 25.4 ± 3.5 cmH2O and 24.9 ± 3.8 cmH2O in Group W, (P = 0.34). There was no significant difference between the two groups in any of the secondary outcomes. There were no traumatic insertion or complications reported in both the groups. Conclusion: Pinna-based size selection method can be used in PLMA placement in the paediatric population for positive pressure ventilation and it serves as an alternative method to weight-based selection.

Interest and experience of anaesthesiology residents in doing research during residency training Ha T T Truong, Jason J I Chan, Wan Ling Leong, Rehena Sultana, Darren L K Koh, Ban Leong Sng Indian Journal of Anaesthesia 2019 63(1):42-48 Background and Aims: The SingHealth Anaesthesiology Residency Program is a 5-year postgraduate training programme whose curriculum covers clinical and academic training, through research and educational activities. This study aimed to describe the needs of the residents in promoting research participation during residency. Methods: After obtaining ethics committee approval, we conducted an online anonymous survey among all residents in the Residency Program. The questionnaire comprised questions of demographic data, levels of research interest, areas of interest, the obstacles to research and the potential areas where help can be improved. SAS (version 9.4, 2017; SAS Institute Inc.) was used for descriptive analysis and logistic regression. Results: Sixty-seven of the 79 residents (84.8%) in the Program responded with 58 (73.4%) completing the survey. Fifty-six of the 62 (90%) expressed some level of interest in research. The top two areas of research interest were clinical research and medical education research. The top obstacles to research were lack of time (due to competing clinical time and work–life balance) and lack of mentorship. The top three areas of research support needed by residents were supervised research protected time, departmental research manpower support and mentorship with topic expertise. Senior Residents were more likely to have higher research interest, self-initiated research participation and consideration for research as part of career progression, compared with junior residents. Conclusion: Residents faced many obstacles in doing research during residency training. Our findings also highlighted some of the needs for research support reported by the residents during their specialty training.

Comparative evaluation of anaesthetic efficacy and haemodynamic effects of a combination of isobaric bupivacaine with buprenorphine vs. isobaric levobupivacaine with buprenorphine for spinal anaesthesia – A double blinded randomised clinical trial Pushpavathi Ture, Ashwini H Ramaswamy, Safiya I Shaikh, Jagadish B Alur, Ajay V Ture Indian Journal of Anaesthesia 2019 63(1):49-54 Background and Aims: Bupivacaine is the most frequently used local anaesthetic for spinal anaesthesia, however, use of levobupivacaine in clinical practice has advanced recently. This study aimed to compare the anaesthetic potency and haemodynamic effects of intrathecal bupivacaine with buprenorphine versus levobupivacaine with buprenorphine in infraumbilical surgeries. Methods: This prospective randomised double blind study was conducted in seventy patients aged 18&#8211;65 years, American Society of Anesthesiologists grade I-II, scheduled for lower abdominal and lower limb surgery under spinal anaesthesia. The patients either received 0.5&#37; isobaric racemic bupivacaine 3 ml with 2 &#956;g/kg of buprenorphine (Group B) or 0.5&#37; isobaric levobupivacaine 3 ml with 2 &#956;g/kg of buprenorphine (Group L). The time for onset of sensory block between the two groups was the priomary end-point. Other measurements included haemodynamic variables, sensory and motor blockade characteristics, postoperative analgesia, and complications in the first 24 h. Results: There was no significant difference in the onset of sensory block between the two groups. Sensory and motor blockade characteristics were similar between the two groups. However, there was significant fall in the heart rate at 5 min in Group B compared to Group L. There was statistically significant fall in systolic blood pressure in group B compared to Group L from 5 min up to 60 min and fall in diastolic blood pressure from 10 min to 45 min. Conclusion: Our study showed that onset of sensory block is similar between isobaric levobupivacaine with buprenorphine 37 38 and isobaric bupivacaine with buprenorphine.  PRESIDENT MESSAGE   From the desk of the New President p. 1 S Bala Bhaskar DOI:10.4103/ija.IJA_865_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PAST PRESIDENT'S MESSAGE The President's inaugural address during ISACON 2018 on November 28, 2018 at Agra p. 3 Kuchela V Babu DOI:10.4103/ija.IJA_869_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta REVIEW ARTICLE Endothelial glycocalyx: Role in body fluid homeostasis and fluid management  p. 6 Pankaj Kundra, Shreya Goswami DOI:10.4103/ija.IJA_751_18   Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an essential role in maintaining the normal fluid homeostasis of the body. This highly fragile layer can be damaged by a number of pathophysiological conditions and interventions. Disease state management should be directed to maintain EGL integrity to improve patient's outcome. When intravenous (IV) fluids are used, appropriate type, rate and amount of fluid should be determined by the pathophysiology of the condition and measures to maintain the integrity of the EGL. This review depicts the structure and function of the EGL, its alteration in common pathological states and the rationale of IV fluid management to preserve EGL in such conditions. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Comparison between macintosh, miller and mccoy laryngoscope blade size 2 in paediatric patients – A randomised controlled trial p. 15 Pratishtha Yadav, Sudeshna Bhar Kundu, Dhurjoti P Bhattacharjee DOI:10.4103/ija.IJA_307_18   Background and Aims: Paediatric airway needs special consideration as it is not a miniature replica of adult airway, rather it has different anatomy with different proportion and angulations. This study was conducted with the aim to find a laryngoscope blade that provides best laryngoscopic and intubation conditions in paediatric patients of age 2–6 years. Methods: This trial was conducted in a total of 75 children age 2–6 years, either gender, with American Society of Anesthesiologists grade I or II scheduled for elective surgery under general anaesthesia. They were randomly allocated to groups A, B and C to be intubated with Macintosh, Miller and McCoy blades, respectively. Intubation Difficulty Score (IDS) was considered as primary outcome, and Cormack–Lehane grade and Percentage of Glottic Opening (POGO) score were taken as secondary outcome. Data were compared by ANOVA or Kruskal-Wallis or chi square test using Statistica, SPSS and GraphPad Prism softwares. P < 0.05 was considered statistically significant. Results: IDS score was significantly lower (P = 0.002) in group B (0.6 ± 0.7) as compared to group A (1.4 ± 0.9) and group C (1.3 ± 1.1); majority of patients in group B (48%) had Cormack–Lehane grade Ι (P = 0.002) unlike group A (0%) and group C (20%) and POGO score (P < 0.001) was higher in group B (86 ± 23.4) when compared with groups A (68.2 ± 20.5) and C (59.8 ± 28.9). Haemodynamic changes and other intubation parameters were comparable among the groups. Conclusion: Miller blade may be considered superior to Macintosh and McCoy blades in terms of glottic visualisation and ease of intubation in paediatric patients. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Correlation of early ROTEM parameters with conventional coagulation tests in patients with chronic liver disease undergoing liver transplant p. 21 A Hashir, Shweta A Singh, Gopi Krishnan, Rajkumar Subramanian, Subhash Gupta DOI:10.4103/ija.IJA_334_18   Background and Aims: Viscoelastic tests such as rotational thromboelastometry (ROTEM) provide a quick and holistic assessment of coagulation status to guide transfusion during liver transplant (LT). Conventional coagulation tests (CCTs) measure single parameters in isolation, and also the results are delayed hampering management of patients during surgery. We evaluated the correlation of early ROTEM-derived parameters with CCTs and also assessed the ability of ROTEM-derived parameters to predict thrombocytopaenia and hypofibrinogenaemia during LT in patients with end-stage liver disease (ESLD). Methods: This retrospective study was carried out in 100 patients with decompensated ESLD undergoing LT. Correlation between CCTs and ROTEM parameters was analyzed. Receiver operating characteristic curves with area under the curve were used to determine the cut-off values of A5 andA10 on EXTEM and FIBTEM. Results: The values of A5EXTEM and A10EXTEM highly correlated with fibrinogen levels and platelet count, whereas A5FIBTEMand A10FIBTEM correlated well with fibrinogen levels. A5EXTEM<21 mm and A10EXTEM<28 mm correlated with a platelet count <75,000 mm−3, whereas A5EXTEM<18 mm and A10EXTEM<25 mm correlated with a platelet count <50,000 mm−3. Fibrinogen levels <100 mg/dL better correlated with A5FIBTEM<5 mm, A10FIBTEM<6 mm, A5EXTEM<21 mm and A10EXTEM<30 mm. Conclusion:Early ROTEM parameters A5 and A10 of both EXTEM and FIBTEM had an excellent correlation with thrombocytopaenia and hypofibrinogenaemia and may potentially guide early transfusion of relevant blood products during LT. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Existing practice of perioperative management of colorectal surgeries in a regional cancer institute and compliance with ERAS guidelines  p. 26 Angshuman Rudra Pal, Suparna Mitra, Sobhan Aich, Jyotsna Goswami DOI:10.4103/ija.IJA_382_18   Background and Aims: Enhanced recovery after surgery (ERAS) protocol in colorectal surgery has been shown to result in reduced rates of postoperative complications and length of stay (LOS) in the hospital. Although there is clear guideline and evidences available, their implementation into daily clinical practice faces some difficulties. We aimed to audit the existing practice of perioperative care in colorectal surgeries and find out the adherence to ERAS protocol. Methods: We collected data from medical record of 215 patients undergoing colorectal surgery in a regional cancer institute of eastern India. The patient data were retrospectively collected, which included, demographic data, adherence to major components of ERAS pathway, postoperative complications, and length of hospital stay. Results: The median LOS after surgery was 9 days (interquartile range [IQR] 6-12.75). Approximately, 15% patients had postoperative complications. We found good adherence (more than 80%) to certain elements of ERAS such as preoperative counseling and nutritional assessments, selective bowel preparation, antibiotic and antithrombotic prophylaxis, etc. Conclusion: The audit revealed that compliance to individual ERAS elements were variable, which needed urgent modification for better adherence to ERAS guidelines. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Cancer relapse in surgical patients who received perioperative transfusion of blood and blood products: A case-control study p. 31 R Subha, Kurian Cherian, Archana Nair, Rachel Cherian Koshy, Jagathnath Krishna DOI:10.4103/ija.IJA_409_18   Background and Aims: Immunomodulatory consequences of allogeneic blood transfusion may outweigh the advantages of improved oxygen delivery and tissue perfusion, especially in patients with cancer. In colorectal cancer, there is evidence of cancer relapse in patients who received transfusion. This retrospective analysis was undertaken to evaluate the relationship between perioperative blood transfusion and cancer recurrence in patients undergoing oncosurgery. Methods: In this case-control study, we retrospectively analysed the case sheets of 194 patients who had perioperative transfusion and underwent cancer surgery from March to December 2013(Study group, Cases). They were compared with controls matched for cancer site and TNM staging who did not receive perioperative transfusions (Control Group, Controls). We intended to find out if the Study group had any increased risk of cancer relapse compared with the controls. Records from the institute cancer registry were analysed in 2018 to give a follow-up period of 5 years. Continuous variables were analysed using Student's T test and Mann Whitney U test for normally distributed and skewed data respectively. For Categorical data Fisher's exact test and Chi square test were applied. The risk for recurrence was estimated using odds ratio. Results: The recurrence rate in cases and controls was 53.09% and 19.59% respectively and the odds ratio, 4.647 (CI: 2.954, 7.309). In Cases, significant relapse was noted for carcinomas of ovary, colorectal, bladder, larynx, head of pancreas and liver. Conclusion: In surgical oncology patients, ABT is associated with greater rate of recurrence. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparison of weight-based and pinna size–based selection of ProSeal laryngeal mask airway in paediatric population – A prospective exploratory trial p. 36 Ramya Ravi, VK Mohan, Ashok Shankar Badhe, Sandeep Kumar Mishra, Prasanna Udupi Bidkar DOI:10.4103/ija.IJA_423_18   Background and Aims: Weight-based selection of ProSeal laryngeal mask airway (PLMA) size may be unreliable in some situations. The aim of this study was to compare the ventilation parameters using PLMA during controlled ventilation between weight-based size selection and pinna size–based selection in children. Methods: A total of 204 patients were randomised to receive either pinna size–based (Group P) or weight-based (Group W) size selection of PLMA. We tested the hypothesis that pinna size–based selection of PLMA was better than weight-based selection of PLMA in paediatric patients during controlled ventilation under general anaesthesia in terms of oropharyngeal sealing pressure (the primary end-point) and Brimacombe score. Cuff pressure was maintained at 60 cm of H2O during the study. Secondary outcomes included the number of attempts for successful placement of PLMA, peak airway pressure, gastric tube placement, traumatic insertion, and complications were also compared. Parametric variables were analysed using unpaired t-test and categorical variables were analysed using Mann–Whitney and Chi-square test. Results: In all, 200 patients were analysed. The mean oropharyngeal sealing pressure in Group P was 25.4 ± 3.5 cmH2O and 24.9 ± 3.8 cmH2O in Group W, (P = 0.34). There was no significant difference between the two groups in any of the secondary outcomes. There were no traumatic insertion or complications reported in both the groups. Conclusion: Pinna-based size selection method can be used in PLMA placement in the paediatric population for positive pressure ventilation and it serves as an alternative method to weight-based selection. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Interest and experience of anaesthesiology residents in doing research during residency training p. 42 Ha T T Truong, Jason J I Chan, Wan Ling Leong, Rehena Sultana, Darren L K Koh, Ban Leong Sng DOI:10.4103/ija.IJA_543_18   Background and Aims: The SingHealth Anaesthesiology Residency Program is a 5-year postgraduate training programme whose curriculum covers clinical and academic training, through research and educational activities. This study aimed to describe the needs of the residents in promoting research participation during residency. Methods: After obtaining ethics committee approval, we conducted an online anonymous survey among all residents in the Residency Program. The questionnaire comprised questions of demographic data, levels of research interest, areas of interest, the obstacles to research and the potential areas where help can be improved. SAS (version 9.4, 2017; SAS Institute Inc.) was used for descriptive analysis and logistic regression. Results: Sixty-seven of the 79 residents (84.8%) in the Program responded with 58 (73.4%) completing the survey. Fifty-six of the 62 (90%) expressed some level of interest in research. The top two areas of research interest were clinical research and medical education research. The top obstacles to research were lack of time (due to competing clinical time and work–life balance) and lack of mentorship. The top three areas of research support needed by residents were supervised research protected time, departmental research manpower support and mentorship with topic expertise. Senior Residents were more likely to have higher research interest, self-initiated research participation and consideration for research as part of career progression, compared with junior residents. Conclusion: Residents faced many obstacles in doing research during residency training. Our findings also highlighted some of the needs for research support reported by the residents during their specialty training. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparative evaluation of anaesthetic efficacy and haemodynamic effects of a combination of isobaric bupivacaine with buprenorphine vs. isobaric levobupivacaine with buprenorphine for spinal anaesthesia – A double blinded randomised clinical trial p. 49 Pushpavathi Ture, Ashwini H Ramaswamy, Safiya I Shaikh, Jagadish B Alur, Ajay V Ture DOI:10.4103/ija.IJA_667_17   Background and Aims: Bupivacaine is the most frequently used local anaesthetic for spinal anaesthesia, however, use of levobupivacaine in clinical practice has advanced recently. This study aimed to compare the anaesthetic potency and haemodynamic effects of intrathecal bupivacaine with buprenorphine versus levobupivacaine with buprenorphine in infraumbilical surgeries. Methods: This prospective randomised double blind study was conducted in seventy patients aged 18–65 years, American Society of Anesthesiologists grade I-II, scheduled for lower abdominal and lower limb surgery under spinal anaesthesia. The patients either received 0.5% isobaric racemic bupivacaine 3 ml with 2 μg/kg of buprenorphine (Group B) or 0.5% isobaric levobupivacaine 3 ml with 2 μg/kg of buprenorphine (Group L). The time for onset of sensory block between the two groups was the priomary end-point. Other measurements included haemodynamic variables, sensory and motor blockade characteristics, postoperative analgesia, and complications in the first 24 h. Results: There was no significant difference in the onset of sensory block between the two groups. Sensory and motor blockade characteristics were similar between the two groups. However, there was significant fall in the heart rate at 5 min in Group B compared to Group L. There was statistically significant fall in systolic blood pressure in group B compared to Group L from 5 min up to 60 min and fall in diastolic blood pressure from 10 min to 45 min. Conclusion: Our study showed that onset of sensory block is similar between isobaric levobupivacaine with buprenorphine 37 38 and isobaric bupivacaine with buprenorphine. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORT Weakness of contralateral upper limb after interscalene block – A case report p. 55 Ashok Jadon, Swapnil Nage, Chintala Pavana Swarupa, Mayur Motaka DOI:10.4103/ija.IJA_554_18   We have reported a case of right upper limb injury of shoulder and elbow who was managed with ultrasound-guided interscalene block during surgery and indwelling catheter for postoperative analgesia. He developed weakness in the contralateral upper limb in the postoperative period due to inadvertent spread of local anaesthetic in the cervical epidural space. No serious complication occurred due to timely intervention. The possible pathways of such unwanted epidural spread and methods to reduce such complications have been discussed. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta BRIEF COMMUNICATIONS Comparison between the Quincke's 22-gauge spinal needle and the 22-gauge hypodermic BD needle for the administration of caudal blocks in paediatric regional anaesthesia – A prospective randomised study p. 58 Vrushali C Ponde, Vinit V Bedekar, Ankit P Desai, Rishiraj Borhazowal DOI:10.4103/ija.IJA_114_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ultrasound-guided bilateral subcostal TAP block for epigastric hernia repair: A case series p. 60 Pradeep Bhatia, Pooja Bihani, Swati Chhabra, Vandana Sharma, Rishabh Jaju DOI:10.4103/ija.IJA_594_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTERS TO EDITOR Anaesthetic management of tracheoesophageal fistula with accidental ingestion of button battery cell p. 64 Sushma D Ladi, Abhijit R Kokari, S Swami DOI:10.4103/ija.IJA_516_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Superficial cervical plexus block for urgent tracheostomy p. 65 Rachel C Koshy, Hally Thankamony DOI:10.4103/ija.IJA_559_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Perioperative management of patient with Conn's syndrome and severe hypokalaemia: How low is too low? p. 67 Bandi Joshiraj, Ankur Sharma, Rajeshwari Subramaniam, Varuna Vyas DOI:10.4103/ija.IJA_562_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Management of local anaesthetic systemic toxicity by timely lipid resuscitation in a paraturient - A case report p. 68 Swati Singh, Dusu Lalin, Vinod K Verma DOI:10.4103/ija.IJA_574_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Incidental finding of pulmonary lymphangitis carcinomatosa in a patient of chest trauma p. 70 Vanita Ahuja, Sofia Jaswal, Deepak Aggarwal, Harkirat Kaur DOI:10.4103/ija.IJA_581_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Unilateral giant Internal Jugular Vein impeding brachial plexus nerve block p. 72 Venkata Ganesh, B Naveen Naik, Kamal Kajal DOI:10.4103/ija.IJA_586_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Anaesthetic management of a rare case of paediatric epidermolysis bullosa p. 73 Shalendra Singh, Arijit Ray, Nipun Gupta, Navdeep Sethi DOI:10.4103/ija.IJA_595_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Transient isolated unilateral oculomotor nerve palsy following accidental dural puncture after bilateral total knee replacement p. 75 BG Arun, Chandrashekar Puttaswamygowda, Amardeep Kulkarni DOI:10.4103/ija.IJA_604_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Are we misusing the ILMA tube? A cause of concern? p. 76 Anju Romina Bhalotra DOI:10.4103/ija.IJA_616_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTS ON PUBLISHED ARTICLE A modified Bailey's manoeuvre for supraglottic airway continuum using LMA ProtectorTM p. 78 Massimiliano Sorbello, Gerardo Cortese, Cory Gaçonnet, Marcus Skinner DOI:10.4103/ija.IJA_502_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta