International Journal of Medical Anesthesiology

Journal Information
ISSN / EISSN : 2664-3766 / 2664-3774
Published by: Comprehensive Publications (10.33545)
Total articles ≅ 310
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Latest articles in this journal

Raghu Sp, Peram Srividya
International Journal of Medical Anesthesiology, Volume 4, pp 21-23; https://doi.org/10.33545/26643766.2021.v4.i4a.317

Abstract:
The most common discomforts that were faced by the patients of SMES under local anesthesia were noise during surgery and anxiety, followed by dizziness, backache, claustrophobia and ear ache. To reduce these discomforts, careful patient selection, adequate preparation for anesthesia, and appropriate sedation are necessary. All patients were randomly divided into two groups. Two 50-ml syringes, labelled as loading and maintenance were given for each patient. Group D patients had dexmedetomidine 1 μg/kg and Group MF had midazolam 0.05 mg/kg plus fentanyl 1.5 μg/kg in their respective loading syringes diluted up to 30 ml of normal saline. Group D 1μg/ml of dexmedetomidine and Group MF had normal saline in their respective maintenance syringes. Rescue infiltration was required in 8 patients in group D and 20 patients in group MF. Rescue sedation, infiltration & analgesia, were statistically significant between group D and group MF.
Sagar Gavale, Noopur Singh, Bhausaheb Pawar
International Journal of Medical Anesthesiology, Volume 4, pp 16-20; https://doi.org/10.33545/26643766.2021.v4.i4a.316

Abstract:
Objectives1. To assess the degree of cardiovascular responses to laryngoscopy and endotracheal intubation in controlled hypertensive patients with standard induction techniques. 2. To assess the effectiveness of nebulised lignocaine in attenuating these pressor responses. Methodology: Total 60 patients aged between 18-65 years k/c/o hypertension taking some antihypertensive medications scheduled for elective surgical procedures belonging to ASA class II under GA were included in our study. The study population was randomly divided into two groups with 30 patients in each group using computer generated randomized table. Group A (n=30): received 8 ml of 4% lignocaine nebulization 10 min prior to induction.Group B (n=30): received intravenous lignocaine 2% 1.5 mg/kg 90 seconds prior to induction. Result: The study revealed that there is significant difference between (p value < 0.05) the two groups during laryngoscopy and endotracheal intubation with respect to heart rate, systolic, diastolic and mean arterial BP. Conclusion: Study concludes that both nebulized and intravenous lignocaine are effective in attenuating pressor response but nebulized lignocaine gave slightly better results than intravenous lignocaine in attenuating pressor response to laryngoscopy and endotracheal intubation without any significant side effects in controlled hypertensive patients.
Richa Gupta, Mittal Patel, Harsha Patel
International Journal of Medical Anesthesiology, Volume 4, pp 05-08; https://doi.org/10.33545/26643766.2021.v4.i4a.313

Abstract:
Background and Aim: Sevoflurane and Desflurane are the inhalation anaesthetic agents are the most frequently used drugs for giving general anaesthesia to the patients. The purpose of this study was to evaluate desflurane and compare it with sevoflurane in terms of intraoperative haemodynamic stability and any other side effects noted in elective laparoscopic surgeries. Methods: A prospective randomized controlled study was conducted over 60 ASA I-III patients posted for laparoscopic surgeries. Basal HR, SBP, DBP, Oxygen saturation were noted. Patients were pre-medicated and induced and were maintained on inhalation agents according to the group allocated. Haemodynamic parameters were recorded at 1, 5, 10 minutes after intubation and then every 15 minutes throughout the operative period. After extubation, patients were monitored and treated for complications such as hypo/ hypertension, tachy/bradycardia. Incidence of cough, nausea, vomiting, sore throat, laryngospasm, blood on device, lip and dental trauma were noted. Haemodynamic parameters and side effects were compared amongst both groups. Results: We observed no statistically significant difference in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure between the groups at any time interval (p>0.05). All the patients were observed for side effects and adverse effects during perioperative period. None of the patients in either group had side effects like hypotension, bradycardia, nausea, vomiting, arrhythmias, shivering, cough, sore throat. Conclusion: Desflurane and sevoflurane when compared as a maintainance agent during laparoscopic surgery were comparable with respect to intraoperative haemodynamics parameters and perioperative complications.
Shylaja D, Mohana Priya, Lakshmi
International Journal of Medical Anesthesiology, Volume 4, pp 24-26; https://doi.org/10.33545/26643766.2021.v4.i4a.318

Abstract:
Anteromedial sub costosternal defects, also referred as Morgagni diaphragmatic hernia, is the potentially life-threatening herniation of the abdominal contents into the thorax. Being only a small fraction of all types of congenital diaphragmatic hernias, precise diagnosis of Morgagni Hernia is often deferred, owing to the nonspecific associated respiratory and gastrointestinal symptoms. Once recognized, the primary management for both symptomatic and asymptomatic cases are surgical repair as there is increased risk of strangulation of hernia contents. Various abdominal and thoracic surgical repair approaches have been described. Cardiopulmonary compromise due to the hernial content’s mass effect on heart, lungs, and risk of strangulation poses a great challenge to anaesthesiologists. This case highlights the key feature of the effective anaesthetic management of adult-onset Morgagni hernia posted for laparoscopic repair.
Noopur Singh, Lisha Jain, Ayesha Naikwade
International Journal of Medical Anesthesiology, Volume 4, pp 12-15; https://doi.org/10.33545/26643766.2021.v4.i4a.315

Abstract:
Background: The ideal anesthetic technique for laparoscopic surgery should maintain stable cardiovascular and respiratory functions, provide rapid postoperative recovery, lead to minimal postoperative nausea and vomiting and provide good postoperative pain relief for early mobility. Administering subarachnoid blocks before general anesthesia in laparoscopic surgeries offer the benefits of good surgery field, hemodynamic stability and reduced requirement of general anesthesia. When subarachnoid block is utilised for short duration laparoscopic surgeries, sympathectomy counteracts the increased systemic vascular resistance (due to pneumoperitoneum) and it contracts the bowel, thereby giving a better field to the surgeon. Methodology: In this study, 60 patients, aged 18-60 years belonging to ASA class I and II were taken and randomly allocated in 2 groups of 30 each. Group A (30 patients) given intrathecal 1% 2- chloroprocaine 30mg(3ml) combined with General anesthesia and Group B (30 patients) given intrathecal 0.5% bupivacaine 15mg (3ml) combined with General anesthesia. Result: The study revealed there is significant difference (p value 0.05) between both the groups with respect to hemodynamic parameters. Conclusion: Recovery from sensory motor blockade was faster with 1% 2-chloroprocaine thereby enabling surgeons to perform short duration laparoscopic surgeries on a day-care basis and hence minimising hospital stay. We recommend conjunction of two anesthesia techniques in patients undergoing short duration laparoscopic surgeries.
Varun R Chelani, Anuj Kapoor, Neeraj Gupta, Prakash Doodhya
International Journal of Medical Anesthesiology, Volume 4, pp 09-11; https://doi.org/10.33545/26643766.2021.v4.i4a.314

Abstract:
Osteogenesis imperfecta (OI) is a rare genetically inherited disorder of connective tissue, resulting in anatomic and physiological abnormalities which pose unusual challenges for the anaesthesiologists during any form of anaesthesia. We present the anaesthetic management of a 48-year-old dwarf male with OI, who underwent craniotomy and excision of a skull-based meningioma SOL with midline shift at our institute. After a successful surgery under general anaesthesia, patient was shifted to ICU on mechanical ventilator for post-op care.
Rakhi Gupta, Nishat Nasar
International Journal of Medical Anesthesiology, Volume 4, pp 34-36; https://doi.org/10.33545/26643766.2021.v4.i4a.321

Abstract:
Background: Pregnant women experience severe labor pain which is the leading cause of stress and anxiety. The present study compared 0.1% ropivacaine and 0.1% levobupivacaine with 2 µg/ml fentanyl as a patient controlled epidural analgesia. Materials and Methods: 30 labouring parturients were divided into 2 groups of 15 each. Group I patients received 0.1% ropivacaine with 2 µg/ml fentanyl and group II patients received 0.1% levobupivacaine with 2 µg/ml fentanyl as epidural solutions via PCEA pump infusions. Results: Mode of delivery found to be caesarean seen in 5 in group I and 7 in group II, instrument‑assisted vaginal delivery seen 8 in group I and 6 in group II and normal vaginal delivery seen 7 in group I and 7 in group II. The difference was non- significant (P> 0.05). Demand boluses per hour was 0.08 in group I and 0.36 in group II, mean total number of manual rescue boluses was 1.02 in group I and 0.61 in group II and first requirement of manual rescue bolus was 3.10 in group I and 2.60 in group II. The difference was significant (P< 0.05). Conclusion: Both bupivacaine and ropivacaine produced equivalent analgesia with fentanyl for labor.
Polapally Venu, R Gopinath
International Journal of Medical Anesthesiology, Volume 4, pp 65-70; https://doi.org/10.33545/26643766.2021.v4.i4b.323

Abstract:
Aim: To compare the efficacy of and safety of dexmeditomidine versus nitroglycerine during hypotensive anaesthesia induced by either drug in adult patients posted for elective spine surgeries. Material and Methods: This was a prospective, randomized, and double blinded clinical comparative study conducted in the Department of Anaesthesiology, ESIC Medical College, Sanath Nagar, Hyderabad, Telangana, India for the period of 1 year. 100 participants belonging to ASA class I or II between 20 and 55 years of age scheduled for elective spine surgeries were include in this study. The study drug dexmeditomidine was given to group DX in the dose of 1 micro gram/kg body weight in a 600 seconds infusion before induction diluted to 10 ml with normal saline followed by maintenance dose at infusion rate of 0.2- 0.7 microgm/kg. The group NG received 10 ml plain normal saline over 600 seconds before induction followed by maintenance dose of nitroglycerine at an infusion rate of 0.5-10 microgm/kg/min. different parameter were compared in both the groups.
Rakhi Gupta, Nishat Nasar
International Journal of Medical Anesthesiology, Volume 4, pp 30-33; https://doi.org/10.33545/26643766.2021.v4.i4a.320

Abstract:
Background: (ESPB) Erector spinae plane block is an interfascial plane block that effectively bonds a local anesthetic deep into the erector spinae muscle that lies contiguous to transverse processes. The present study was conducted to assess the outcome of dexmedetomidine and dexamethasone as an adjuvant for the erector spinae plane block (ESPB) to control postoperative pain after lumbar spine surgery. Materials and Methods: 60 patients selected for undergoing lumbar spine surgery were grouped into 3 groups of 20 each. Group I patients received 0.375% ropivacaine 20 mL group II patients received 0.375% ropivacaine 20 mL with 8 mg dexamethasone and group III patients received 0.375% ropivacaine 20 mL with 1 µg/kg dexmedetomidine deep to the erector spinae muscle. Postoperative tramadol consumption, amount of rescue analgesia use, post-surgical hospital stay and (PONV) postoperative nausea and vomiting were noted. Results: The demographic data and intraoperative opioid requirement was comparable in all groups. Postoperative tramadol consumption and rescue analgesic need was significantly less in group III as compared to group II and I. Postoperative stay in hospital was 6.1 days in 6.2 days in group II and 4.6 days in group III and the difference was significant. Conclusion: Dexmedetomidine is found to be better than dexamethasone as an adjuvant to ropivacaine in erector spinae plane block in lumbar spine surgery.
Pranav A Sheth, Hetal Hathiwala, Divyang Shah
International Journal of Medical Anesthesiology, Volume 4, pp 76-80; https://doi.org/10.33545/26643766.2021.v4.i4b.326

Abstract:
Introduction: Direct laryngoscopy and intubation are noxious stimuli and are associated with transient, unpredictable and variable hemodynamic changes. Dexmedetomidine has the potential to produce bradycardia and hypotension when administered as a bolus; in a way to solve this problem, nebulization route chosen. Nebulized dexmedetomidine has a bioavailability of 65%. Nebulized drug preferred over intranasal administration to avoids adverse effects. Aim and Objectives: The aim of this study to evaluate the role of nebulized dexmedetomidine as a premedication in attenuating the stress response to laryngoscopy and intubation along with any adverse effects of drug. Materials and Methods: 50 patients of ASA grade I and II elective surgery undergoing general anesthesia were randomly divided in two groups N and D, who received nebulized normal saline(5ml) and nebulized dexmedetomidine (1ug/kg diluted in 5ml NS) respectively with a nebulizer face mask for 10 min before induction of anesthesia in sitting position.Result: Following laryngoscopy and intubation, stress response markedly increased in the group N where stress response markedly decreases in group D.Conclusions: Nebulized dexmedetomidine effectively blunts the stress response to laryngoscopy and intubation with no adverse effects.
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