Indian Journal of Anaesthesia

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ISSN / EISSN : 0019-5049 / 0976-2817
Published by: Wolters Kluwer - Medknow (10.4103)
Total articles ≅ 2,572
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Abinaya Ramachandran, Nagalakshmi Palanisamy, M V Vidya, Mamie Zachariah, Sagiev K George, R V Ranjan
Indian Journal of Anaesthesia, Volume 65, pp 519-524; https://doi.org/10.4103/ija.ija_168_21

Abstract:
Emergence agitation (EA) in children is one of the most common postoperative problems encountered in the recovery room. Sevoflurane has been strongly associated with EA owing to its lower solubility and rapid recovery. Dexmedetomidine has been found to reduce the incidence of EA. This study was designed to evaluate the effectiveness of dexmedetomidine in two doses in reducing EA in children. This was a prospective double-blinded randomised study done on eighty children aged 5-14 years undergoing adenotonsillectomy/tonsillectomy under sevoflurane anaesthesia. Patients in Group A (n = 40) received 0.3 μg/kg/h and patients in group B (n = 40) received 0.5 μg/kg/h infusion after a bolus dose of 0.5 μg/kg of dexmedetomidine. The primary objective was to compare two different doses of dexmedetomidine on EA in the postoperative period. The secondary objectives were to assess the pain and perioperative haemodynamics in the recovery room. The anaesthesiologist blinded to the study charted the paediatric anaesthesia emergence delirium score (PAED), perioperative haemodynamic parameters, objective pain score and rescue medications if given. The data were analysed using Student's unpaired t-test, Chi-square test, repeated measures Analysis of Variance (ANOVA) and Mann-Whitney U test wherever appropriate. The incidence of EA was comparable between both groups (P = 0.960). The haemodynamic parameters (P > 0.05) and the objective pain score (P = 0.810) also did not show a statistically significant difference. A lower dose of dexmedetomidine (0.3 μg/kg/h) is equally effective as a higher dose (0.5 μg/kg/h) after a bolus dose of 0.5 μg/kg in decreasing EA.
, Sukhminder Jit Singh Bajwa, Muralidhar Joshi, Lalit Mehdiratta, Indrani Hemantkumar, R Amutha Rani, Ta Shamshad Beegum, Surekha Shinde, Madhuri Kurdi, Amit Kohli, et al.
Indian Journal of Anaesthesia, Volume 65, pp 499-507; https://doi.org/10.4103/ija.ija_662_21

Sujitha Reddy Karri, Kavitha Jayaram, Annekiran Kumar, Padmaja Durga
Indian Journal of Anaesthesia, Volume 65, pp 539-544; https://doi.org/10.4103/ija.ija_140_21

Abstract:
The multiplicity of the mechanisms of the pain in laparoscopic cholecystectomy inclines us to the usage of multimodal analgesia. Gabapentin is known for its analgesic efficacy when given as premedication in many surgeries. N-methyl-D-aspartate (NMDA) antagonists are used for both acute and chronic pain, but the use of memantine in the perioperative period is less studied. The aim of this randomised controlled study was to subjectively and objectively compare postoperative pain relief using gabapentin, memantine and placebo as premedication. Sixty-six patients posted for laparoscopic cholecystectomy were randomised into three groups. During the preoperative assessment, the baseline threshold and tolerance values of pain were measured using an algesiometer. Patients were pre-medicated with oral gabapentin 600 mg or memantine 20 mg or placebo an hour before surgery. Following extubation, pain scores were reassessed (both subjectively and objectively) along with Ramsay sedation scores at different time intervals for 4 h postoperatively. Gabapentin group had lower Numerical Rating Scale scores at 15 min and 1 h postoperatively when compared to the other two groups. Memantine group had a longer time for the first request for rescue analgesia (50.53 min) compared to gabapentin and placebo. The objective assessment of pain with analgesiometer showed no statistical significance between the three groups for both threshold and tolerance values. Ramsay sedation scores were higher in the gabapentin group compared to the other two. Gabapentin provides better postoperative pain relief compared to memantine when given as single dose premedication for laparoscopic cholecystectomy.
, Pablo Casas Reza, Maria Gestal Vazquez, Paula Dieguez Garcia
Indian Journal of Anaesthesia, Volume 65, pp 563-564; https://doi.org/10.4103/ija.ija_146_21

, Neelam Sinha, Swastika Chakraborty, Bhupendra Singh
Indian Journal of Anaesthesia, Volume 65, pp 565-565; https://doi.org/10.4103/ija.ija_400_21

K B Swathi, , Mritunjay Kumar, Rakesh Kumar, Swati Chhabra, Pradeep Bhatia
Indian Journal of Anaesthesia, Volume 65, pp 512-518; https://doi.org/10.4103/ija.ija_64_21

Abstract:
The paravertebral block (PVB) is an effective alternative to thoracic epidural analgesia for post-operative analgesia in thoracic surgeries. Despite the use of ultrasound in PVB, the search for a safer approach continues. This study was conducted to compare the analgesic efficacy of conventional and mid-transverse process to the pleura (MTP) approach of the PVB. Forty patients aged between 18-60 years, posted for video-assisted thoracoscopic surgery, were enroled for this study. Patients were randomised into two groups using a random number table, and group allocation was done by the sealed opaque envelope method. One group received PVB by conventional approach (group CP). In contrast, patients in the other group (group MP) received PVB by the mid-transverse process to pleura (MTP) approach before induction of general anaesthesia under ultrasound guidance. The study's primary aim was to compare analgesic consumption in the first 24 hours. Secondary aims were comparing the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, haemodynamic parameters such as heart rate (HR), oxygen saturation (SpO2), and non-invasive blood pressure (NIBP), patient satisfaction scores, and complications observed. Data were analysed using Statistical Package for the Social Sciences version 23. Demographic parameters, block performance time, and dermatomal distribution were comparable in both groups. We did not find any statistical difference in the analgesic consumption in the first 24 hours (P = 0.38), VAS at rest or on movement, complication rates, and patient satisfaction scores between the groups. The MTP approach of the PVB is as effective as the conventional thoracic paravertebral approach for post-operative analgesia in video-assisted thoracoscopic surgeries.
Yi Lin Lee, Suhitharan Thangavelautham, Sudha Harikrishnan, Ranjith Karthekeyan, Harikrishnan Kothandan
Indian Journal of Anaesthesia, Volume 65, pp 525-532; https://doi.org/10.4103/ija.ija_201_21

Abstract:
Orthognathic surgeries for maxillofacial deformities are commonly performed globally and are associated with significant blood loss. This can distort the surgical field and necessitate blood transfusion with its concomitant risks. We aimed to review if invasive intraarterial (IA) line monitoring and/or hypotensive anaesthesia is required for orthognathic surgeries, and their effects on intraoperative blood loss and transfusion requirements. This was a retrospective observational study conducted in patients admitted for orthognathic surgeries in a public tertiary hospital. Anaesthetic techniques and intraoperative haemodynamics were studied for their effects on intraoperative blood loss. The data from 269 patients who underwent orthognathic-bimaxillary surgeries was analysed. Inhalational anaesthetic combined with remifentanil was administered for 86.6%, total intravenous anesthesia to 11.2% patients, while the rest received inhalational anaesthesia. Hypotensive anaesthesia was achieved in 48 subjects (17.8%) and associated with shorter duration of surgery (349 vs 378 min, P = 0.02) and a trend towards lower blood loss (874 mL vs 1000 mL, P = 0.058) but higher transfusion requirement (81.3% vs 58.8%, P = 0.004). An IA line was used in 119 patients (44.2%) and was not associated with a higher probability of achieving hypotensive anaesthesia (19.3% vs 16.7%, P = 0.06). However, less blood loss (911 vs 1029 mL, P = 0.05) occurred compared to noninvasive blood pressure monitoring. Invasive blood pressure monitoring is as effective as noninvasive methods to achieve hypotensive anaesthesia. It does not aid in achieving lower target blood pressure. There is a lack of association between a reduction in blood loss and higher blood transfusion during hypotensive anaesthesiaand thiswill require further evaluation.
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