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   Table of Contents - Current issue
January-June 2022
Volume 1 | Issue 1
Page Nos. 1-51

Online since Friday, May 20, 2022

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Birth of a new journal in anesthesiology p. 1
Kirti Nath Saxena, Sukhyanti Kerai
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Prophylactic intravenous dexamethasone versus dexmedetomidine for postspinal shivering during lower segment cesarean section: A prospective randomized, double-blind study p. 3
Pratibha Jain Shah, KP Ummu Habeeba
Introduction: Shivering is one of the most common encountered little big problems with spinal anesthesia. There are only few published studies comparing intravenous (iv) dexamethasone and dexmedetomidine for the prevention of postspinal shivering (PSS). Aim: The aim of the study is to compare the effectiveness and safety of iv dexamethasone and iv dexmedetomidine in the prevention of PSS during lower segment cesarean section. Methods: Total 160 parturients were randomly allocated into 2 groups by a Sequentially Numbered Opaque Sealed Envelope technique, namely Group Dx and Dm (n = 80). Group Dx received iv dexamethasone 0.1 mg/kg whereas Group Dm received iv dexmedetomidine 1 μg/kg. Incidence of shivering and shivering score were the primary outcomes and the secondary outcomes were sedation score, level of blockade, duration of surgery, axillary temperature, adverse effects, Apgar score, and hemodynamic parameters. Results: Incidence of shivering was significantly low in dexmedetomidine compared to dexamethasone (13.75% vs. 31.25%; P = 0.00468). Group Dx also had comparatively higher shivering score. Overall incidence of sedation was higher in Group Dm compared to Group Dx (15% vs. 3.75%; P = 0.0022). Five parturients in Group Dm (6.25%) had bradycardia compared to none in Group Dx. Respiratory rate, oxygen saturation, and Apgar score were statistically comparable between the 2 Groups. Conclusion: iv dexmedetomidine is more effective in preventing PSS compared to dexamethasone. Additional sedation with dexmedetomidine aids more comfort to the parturients.
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Compliance of hand hygiene practices in operating rooms by care workers: A preliminary observational study p. 9
Mahima Lakhanpal, Ritesh Kumar, Rajiv Chawla, Debpriya Sarkar, Isha Yadav
Context: Hand hygiene is the most important measure to prevent healthcare-associated infections. As part of a major global effort to improve hand hygiene in health care, the SAVE LIVES: Clean Your Hands annual global campaign was launched by the World Health Organization (WHO) in 2009. The “My 5 Moments for Hand Hygiene” approach by the WHO defines the key moments when health-care workers should perform hand hygiene. Aims: This is a preliminary observational study to monitor the level of adherence to hand hygiene practice by health-care workers (HCWs) in an operating room. Materials and Methods: This study was conducted in the surgery operation theater (OT) of our hospital. Direct observation of various personnel working in the OT was done by a single-trained observer. The time of observation was taken from the transfer of the patient on the OT table to the draping of the patient by the surgeon. The hand hygiene opportunities (HHO) as stated by WHO My 5 moments of hand hygiene were noted. Results and Conclusion: A total of 524 HHO were observed among health-care workers, among which 301 were missed and 223 were utilized. Out of the opportunities used were moments 3 and 4, which are primarily for the personal protection of Healthcare workers. Overall compliance of hand hygiene is very low among health-care professionals in the OT. There is an urgent need to educate the health-care personnel about “5 moments of hand hygiene” and ensure strict compliance to ensure patient's safety.
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Impact of the COVID-19 pandemic on general surgical practice – An observational cross-sectional study p. 12
Sumedha Suresh, Bhavna Gupta, Ajit Kumar, Jharana Mohanta, Ruby Perween, Abhishek Kumar Singh
Introduction: The study aimed to study the impact of the COVID-19 pandemic on surgical practice in a tertiary care setup in India and the future implications of the pandemic. Methodology: This observational cross-sectional study was conducted at a tertiary-care hospital. The case series consisted of a snapshot search of all operating theatre activity at AIIMS, Rishikesh between the 1st of March 2020, and 31st August 2020. Observations: A total of 790 patients were operated on in the first 6 months of the covid era while 5308 patients had undergone surgery in the 6 months preceding the onset of covid-19. In the precovid era, 73.71% of the cases were performed under General Anaesthesia while 62.6% of the cases were performed under general anaesthesia in the covid era. 18.83% of the cases in precovid era were performed under spinal anaesthesia and 3.5% under combined spinal and epidural anaesthesia in the precovid era. Conclusion: This study has shown the extent to which general surgical practice was affected during the covid pandemic. With the lessons learnt during this period, we can implement a more robust plan in the eventuality of another pandemic and be more thoroughly prepared the next time around.
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Evaluation of the effect of saline flush on the time of onset and duration of action following bolus dose of rocuronium p. 17
Vineet Manchanda, Kirti N Saxena, Bharti Wadhwa
Background: Circulatory factors modify the onset time of neuromuscular-blocking drugs. Therefore, we hypothesized that a bolus of saline flush immediately after rocuronium administration would shorten the onset time without influencing the duration of the rocuronium effect. Methods: A total of 84 patients were randomly allocated to either the control or saline flush group. Anesthesia was induced with propofol and fentanyl and maintained with isoflurane <1% and all patients received 0.6 mg/kg rocuronium in 10 mL of normal saline. In the saline flush group, 20 mL normal saline was immediately infused after rocuronium administration. Neuromuscular blockade was assessed using TOF-WATCH device at the adductor pollicis muscle using stimulation of ulnar nerve. The neuromuscular indices recorded were latent onset time, onset time, and clinical duration of bolus dose of rocuronium. Results: The measured latent onset time and onset time were significantly shorter within the saline flush group than the control group (P < 0.001). In addition, the clinical duration was significantly prolonged within the saline flush group (P < 0.001). Conclusion: A 20-mL saline flush administered immediately after slow intravenous 0.6 mg/kg rocuronium shortens the onset time and prolongs the clinical duration of neuromuscular blockade.
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Anesthetic considerations in COVID-19 patients undergoing tracheostomy: A case series p. 22
Riniki Sarma, Kiran Mahendru, Anuja Pandit
Being an aerosol-generating procedure (AGP), tracheostomy for patients infected with severe acute respiratory syndrome-coronavirus-2 poses a great risk of infection for health-care workers. We present a series of four COVID-19-infected cases who underwent surgical tracheostomy and discuss the anesthetic concerns regarding the same.
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Opsoclonus-myoclonus syndrome in a COVID-19-positive pregnant patient – A rare case report p. 25
Aanchal Kakkar, Priyanka Singh, MD Kaur, Amit Kumar
In the present time of severe acute respiratory syndrome coronavirus-2 pandemic, there are various systemic complications reported as its sequelae. We hereby report a rare presentation of opsoclonus-myoclonus syndrome as a neurological complication in a COVID-19-positive pregnant patient posted for emergency cesarean section.
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Anesthetic challenges in an infant with multiple structural airway anomalies p. 27
Preeti Goyal Varshney, Maitree Pandey, Garima Daga
Airway anomalies such as laryngomalacia, laryngeal webs, micrognathia, and retrognathia cause respiratory distress in infants and pose a significant challenge in anesthetic management. We report the case of a 2-month-old infant with laryngomalacia on continuous positive airway pressure support since birth, posted for laryngeal surgery, who was found to have micro-retrognathia during pre anaesthesia checkup. Securing the airway and preventing hypoxia were the main challenges in this child. Adequate measures were taken for continuous oxygenation during induction of anesthesia. The child underwent supraglottoplasty with an uneventful intraoperative course. However, the airway obstruction persisted in the postoperative period requiring a surgical tracheostomy. The child subsequently underwent mandibular distraction surgery after 1 month and was discharged with a tracheostomy tube. Although various anesthetic options have been described to manage the difficult pediatric airway, the anesthetic technique should be customized to ensure airway patency and oxygenation in the perioperative period as illustrated in this case report.
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Dexmedetomidine and emergency front of neck access for acute stridor in advanced laryngeal carcinoma: Anesthetic challenges p. 30
Neelakshi Koul, Uma Hariharan, Amit Kumar, Nidhi Yadav, Vijay Kumar Nagpal
Supraglottic airway obstruction due to airway malignancy resulting in respiratory distress is a medical emergency requiring urgent re-establishment of airway patency, with tracheostomy to alleviate the stridor and threat to life. We report a 61-year-old male patient who presented with acute stridor, dyspnea, and a left-sided metastatic neck mass to the emergency room. The patient was rushed to the operation theater for emergency tracheostomy under monitored anesthesia care. We hereby discuss a successful surgical cricothyroidotomy, post failed emergency tracheostomy under dexmedetomidine infusion.
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A rare case of congenital methemoglobinemia with severe mitral stenosis: An anesthetic and surgical challenge p. 33
Mahima Lakhanpal, Ritesh Kumar, Debpriya Sarkar, Vasundhera Tyagi
Methaemoglobinemia is a condition that occurs when red blood cell contains higher than 1% methaemoglobin (MHb). It can be congenital or acquired. The condition is generally asymptomatic until the serum MHb level reaches as high as 40%. Dyspnea, acidosis, cardiac dysrhythmias, heart failure, seizures, and coma may occur at levels exceeding 45%, and a high mortality rate is seen with levels above 70%. We report a rare association of a case of rheumatic heart disease with severe mitral stenosis with congenital methemoglobinemia diagnosed incidentally during mitral valve replacement procedure under cardiopulmonary bypass.
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An unusual case report of trepopnea in a patient with unilateral diaphragmatic palsy p. 36
Divya Gupta, Sukhyanti Kerai
Trepopnea, a rare form of dyspnoea observed in lateral decubitus position is a crucial clue towards diagnosis. It indicates either cardiac or respiratory pathology that may warrant immediate attention. Usually, it has been reported the patient with congestive cardiac failure or diseased left lung who prefers the right lateral decubitus position. Only in a few cases with the unilateral lung disease it has been described. We present one such case report of trepopnea in a patient recovering from pneumonia was observed having trepopnea, which was later confirmed due to unilateral diaphragmatic palsy.
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Subarachnoid block in a parturient with ventriculoperitoneal shunt in situ: A case report and review p. 39
Bharti Wadhwa, Gurleen Kaur Oberoi, Mousumi Saha, Kirti N Saxena
While it is now conclusively established that subarachnoid block (SAB) for cesarean section has distinct advantages, its administration in a parturient with a ventriculoperitoneal (VP) shunt in situ has been controversial. Over the years, experience with regional anesthesia techniques for labor and operative delivery in patients with VP shunt is accumulating, and various workers have reported safe outcomes with successful administration. In the absence of clinical evidence pointing to significant risks and complications, neuraxial anesthesia may be a safe and suitable alternative alternative to general anesthesia for Cesarean delivery in parturients with VP shunt, provided due considerations are followed. The indications for SAB in a parturient with VP shunt should be based on obstetrics considerations and neurological status.
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An uncommon site of breathing circuit leak: Crack-ing the code!! p. 42
Akhilesh Pahade, Ashita Mowar, Vishwadeep Singh, Geeta Karki
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A perplexing event of propellant masquerading as anesthetic vapors p. 44
Anupama Nayar, HT Prashant, Sukhyanti Kerai, Kirti N Saxena
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Early extubation to preventive noninvasive ventilation in coronavirus disease-2019 patient: A promising approach! p. 46
Jyotsna Agarwal, Pratibha Panjiar, Samiksha Khanuja, Sana Yasmin Hussain
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A case of left ventricular apical thrombus extending into left ventricular outflow tract and role of intraoperative transesophageal echocardiography p. 50
Guriqbal Singh, Ramesh Patel
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