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Background and Aims: There is limited literature wherein the hypotensive drugs have been compared to know the cerebral effects by monitoring regional cerebral oxygen saturation (rScO2). This study aimed to compare the effects of dexmedetomidine and nitroglycerin on rScO2 during controlled hypotensive anaesthesia using near-infrared spectroscopy (NIRS). The primary objective was to evaluate the non-inferiority of dexmedetomidine versus nitroglycerin in the occurrence of cerebral desaturation events (CDEs) during hypotensive anaesthesia. Methods: Adult patients scheduled to undergo head and neck surgery under general anaesthesia randomised to receive either dexmedetomidine or nitroglycerin infusion for controlled hypotensive anaesthesia. Cerebral oximetry was monitored with NIRS, and data regarding CDEs, bilateral rScO2, and peri-operative haemodynamics were collected. Continuous data were analysed using unpaired Student's t-tests except for intra-group analyses, which were analysed using paired t-tests. Categorical data were analysed using the Chi-square test. For comparison of time to CDEs, Kaplan–Meier survival analysis with log-rank test was performed. Results: Of the 82 patients in both groups, CDEs were observed in 15 patients each. A decrease from baseline by 20% was observed in three patients: one in Group N and two in Group D. Statistically, there was an equal risk of getting CDEs in the groups. The time to CDE was comparable (P > 0.05). The difference in heart rate was statistically significant (P < 0.001). Conclusion: Dexmedetomidine is non-inferior to nitroglycerin in terms of the occurrence of cerebral desaturation events when used for controlled hypotensive anaesthesia in head and neck surgeries.

Byline: J. Rao, Swati. Chhabra, Sadik. Mohammed, Pradeep. Bhatia, Shilpa. Goyal, Rakesh. Kumar Background and Aims: There is limited literature wherein the hypotensive drugs have been compared to know the [...]

Background and Aims: Modified radical mastectomy (MRM) is associated with significant postoperative pain for which many blocks including thoracic paravertebral (TPV) block are being used. Erector spinae plane (ESP) block is a recently described technique. We planned to compare the efficacy and safety of ultrasound-guided continuous ESP and TPV blocks for postoperative analgaesia following MRM. Methods: Sixty-six patients belonging to American Society of Anaesthesiologists physical status I and II, aged 25–85 years, undergoing MRM were enrolled and randomly allocated into two groups. Ipsilateral block was given preoperatively at T3 or T4 level with 20 ml of 0.5% ropivacaine and 50 μg fentanyl. Infusion of 0.5% and 0.2% ropivacaine with fentanyl 2 μg/ml at a rate of 5 ml/hr was continued during intraoperative and postoperative period, respectively. Pain was assessed using visual analogue scale (VAS) till 24 hours. Block performance time, time to first rescue analgaesia, total amount of rescue analgaesic consumed, the incidence of procedure-related and postoperative complications, failure rate and patient satisfaction score were also recorded. Data collected were analysed using the Chi-square test or Student's t-test with the help of SPSS 22.0. Results: Demographics, baseline vitals, VAS scores both at rest and on movement, block performance time, time to first rescue analgaesia, the total amount of rescue analgaesia and patient satisfaction score were comparable in both groups (P value > 0.05). No complications were observed in either group. Conclusion: In patients undergoing MRM, continuous catheter technique ESP block is as efficacious and safe as TPV block for providing prolonged postoperative analgaesia.

Byline: Lovepriya. Sharma, Pradeep. Bhatia, Sadik. Mohammed, Priyanka. Sethi, Swati. Chhabra, Mritunjay. Kumar Background and Aims: Modified radical mastectomy (MRM) is associated with significant postoperative pain for which many blocks [...]

Background and Aims: Inferior vena cava (IVC) diameter and its respiratory variability have been shown to predict post-induction hypotension with high specificity in a mixed population of patients. We assessed whether these parameters could be as reliable in healthy adult patients as in a mixed patient population. Methods: In the present prospective observational study, 110 patients of either sex, aged between 18 and 50 years, belonging to American Society of Anesthesiologists class I and II, fasted as per the institutional protocol and scheduled for elective surgery under general anaesthesia were enroled. Prior to induction, ultrasound examination of IVC was done and variation in IVC diameter with respiration was assessed. Maximum and minimum IVC diameters [(dIVCmax) and (dIVCmin), respectively] over a single respiratory cycle were measured and collapsibility index (CI) was calculated. Vitals were recorded just before induction and at every minute after induction for 10 min. Episodes of hypotension (mean arterial pressure [MAP] 30% from baseline) during the observation period were recorded. The receiver operating characteristic (ROC) curve was constructed for determining optimum cut-off with sensitivity and specificity of IVC diameters and CI for development of hypotension. Results: IVC was not visualised in 22 patients. Out of the remaining 88 patients, 17 (19.3%) patients developed hypotension after induction. The dIVCmax, dIVCmin and CI were comparable between patients who developed and who did not develop hypotension. The area under curve of ROC for CI, dIVCmax and dIVCmin was 0.51, 0.55 and 0.52, respectively, with optimum cut-off value of 0.46, 1.42 and 0.73, respectively. Conclusion: Ultrasound-derived IVC parameters demonstrate poor diagnostic accuracy for prediction of hypotension after induction in healthy adult patients.

Byline: Swati. Chhabra, Lovepriya. Sharma, Sadik. Mohammed, Darshana. Rathod Sir, Patients with Andy Gump deformity have the appearance of absent chin due to an anterior mandibular defect with an extremely [...]

Background and Aims: Nasal surgery under desflurane anaesthesia is more prone to develop emergence agitation (EA). The present study aimed to evaluate the efficacy of dexmedetomidine for prevention of EA. Methods: A total of 72 patients were randomised to group C and group D. Group C patients received placebo while group D patients received dexmedetomidine 1.0 μg/kg bolus followed by 0.4 μg/kg/h after induction of anesthesia. End tidal desflurane was adjusted to keep the bispectral index (BIS) 45–55. Study drug was stopped at extubation. EA was evaluated from extubation till the patient was shifted to postanaesthesia care unit (PACU). Primary outcome was incidence of EA. Secondary outcome measures were requirement of desflurane, haemodynamic stability, and recovery after anaesthesia. The results were analyzed using SPSS version 21. Results: Infusion of dexmedetomidine significantly reduced the incidence of EA (Group C 52.8%; Group D 5.6%) by 89.5% (P = 0.00001). The endtidal desflurane concentration was significantly lower and there was an average 28.87% reduction in requirement of desflurane in group D compared to group C (P < 0.001). The mean heart rate was significantly higher in Group C (P < 0.001). In group C time to extubation, time to achieve BIS 90 and time to response on verbal command was significantly lesser compared to group D (P < 0.0001). Conclusion: Dexmedetomidine significantly reduced the incidence of EA and requirement of desflurane in patients undergoing nasal surgery. However, it was associated with delayed extubation, residual sedation, and prolonged PACU stay.

Byline: Swati. Chhabra, Sadik. Mohammed Sir, We read with great interest the article 'All India Difficult Airway Association guidelines in practice--A survey' by Kaniyil et al .[1] We congratulate the [...]

Byline: Sadik. Mohammed, Rashmi. Syal, Pradeep. Bhatia, Swati. Chhabra, Ravindra. Chouhan, Manoj. Kamal Background and Aims: Inferior vena cava (IVC) diameter and its respiratory variability have been shown to predict [...]

Background and Aims: Although volume controlled ventilation (VCV) has been the traditional mode of ventilation in robotic surgery, recently pressure controlled ventilation (PCV) has been used more frequently. However, evidence on whether PCV is superior to VCV is still lacking. We intended to compare the effects of VCV and PCV on respiratory mechanics and haemodynamic in patients undergoing robotic surgeries in steep Trendelenburg position. Methods: This prospective, randomized trial was conducted on sixty patients between 20 and 70 years belonging to the American Society of Anesthesiologist Physical Status I–II. Patients were randomly assigned to VCV group (n = 30), where VCV mode was maintained through anaesthesia, or the PCV group (n = 30), where ventilation mode was changed to PCV after the establishment of 40° Trendelenburg position and pneumoperitoneum. Respiratory (peak and mean airway pressure [APpeak, APmean], dynamic lung compliance [Cdyn] and arterial blood gas analysis) and haemodynamics variables (heart rate, mean blood pressure [MBP] central venous pressure) were measured at baseline (T1), post-Trendelenburg position at 60 min (T2), 120 min (T3) and after resuming supine position (T4). Results: Demographic profile, haemodynamic variables, oxygen saturation and minute ventilation (MV) were comparable between two groups. Despite similar values of APmean,APpeakwas significantly higher in VCV group at T2 and T3 as compared to PCV group (P < 0.001). Cdynand PaCO2were also better in PCV group than in VCV group (P < 0.001 and 0.045, respectively). Conclusion: PCV should be preferred in robotic pelvic surgeries as it offers lower airway pressures, greater Cdynand a better-preserved ventilation-perfusion matching for the same levels of MV.

Background and Aims: Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous (IV) and caudal route on post-operative analgesia in paediatric inguinal herniotomy patients. Methods: One hundred and five paediatric patients undergoing inguinal herniotomy were included and divided into three groups. Each patient received a single caudal dose of ropivacaine 0.15%, 1.5 mL/kg combined with either corresponding volume of normal saline (Group 1) or caudal dexamethasone 0.1 mg/kg (Group 2) or IV dexamethasone 0.5 mg/kg (Group 3). Baseline, intra- and post-operative haemodynamic parameters, pain scores, time to rescue analgesia, total analgesic consumption and adverse effects were evaluated for 24 h after surgery. Unpaired Student′s t-test and analysis of variance were applied for quantitative data and Chi-square test for qualitative data. Time to first analgesic administration was analysed by Kaplan-Meier survival analysis and log-rank test. Results: Duration of analgesia was significantly longer (P < 0.001), and total consumption of analgesics was significantly lower (P < 0.001) in Group II and III compared to Group I. The incidence of nausea and vomiting was higher in Group I (31.4%) compared to Group II and III (8.6%). Conclusions: Addition of dexamethasone both caudally or intravenously as an adjuvant to caudal 0.15% ropivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia with the significant advantage of caudal over IV route.

Background: Traditionally, midazolam has been used for providing conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP). Recently, dexmedetomidine has been tried, but very little evidence exists to support its use. Objective: The primary objective was to compare haemodynamic, respiratory and recovery profile of both drugs. Secondary objective was to compare the degree of comfort experienced by patients and the usefulness of the drug to endoscopist. Study Design: Open-label Randomised Controlled Trial. Methods: Subjects between 18 and 60 years of age with American Society of Anaesthesiologist Grade I-II requiring ERCP were enrolled in two groups (30 each). Both groups received fentanyl 1 μg/kg IV at the beginning of ERCP. Group M received IV midazolam (0.04 mg/kg) and additional 0.5 mg doses until Ramsay Sedation Scale (RSS) score reached 3-4. Group D received dexmedetomidine at loading dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/h infusion until RSS reached 3-4. The vital parameters (heart rate (HR), blood pressure (BP), respiration rate, SpO 2 ), time to achieve RSS 3-4 and facial pain score (FPS) were compared during and after the procedure. In the recovery room, time to reach modified Aldrete score (MAS) 9-10 and patient and surgeon′s satisfaction scores was also recorded and compared. Any complication during or after the procedure were also noted. Results: In Group D, patients had lower HR and FPS at 5, 10 and 15 min following the initiation of sedation (P

Byline: Swati. Chhabra, Pradeep. Bhatia, Sadik. Mohammed, Rakesh. Kumar Sir, Documentation of anaesthesia care is important for ensuring continuity of care, audit, quality improvement and medicolegal issues. We report a [...]

Byline: Akaansha. Garg, Manoj. Kamal, Sadik. Mohammed, Geeta. Singariya, Dilip. Chouhan, Ghanshyam. Biyani Background and Aims: Nasal surgery under desflurane anaesthesia is more prone to develop emergence agitation (EA). The [...]

Byline: Sadik. Mohammed, Sunit. Gupta, Pradeep. Bhatia, Swati. Chhabra, Priyanka. Sethi, Ravindra. Chouhan Sir, Mucopolysaccharidoses (MPS) are lysosomal storage disorders caused by the deficiency of enzymes required for the stepwise [...]

Byline: Rishabh. Jaju, Pooja. Jaju, Mamta. Dubey, Sadik. Mohammad, A. Bhargava Background and Aims: Although volume controlled ventilation (VCV) has been the traditional mode of ventilation in robotic surgery, recently [...]

Byline: Pooja. Bihani, Deepak. Choudhary, Pradeep. Bhatia, Sadik. Mohammed Sir, Modern anaesthesia workstation uses advanced electronic and software technologies to provide low-flow anaesthesia which requires monitoring of oxygen (O [sub]2 [...]

Byline: Bharath. Srinivasan, Rakesh. Karnawat, Sadik. Mohammed, Bharat. Chaudhary, Anil. Ratnawat, Sunil. Kothari Background and Aims: Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this [...]

The article discusses the research design justification for different regional blocks following modified radical mastectomy. The authors explain that the selection of the non-inferiority margin is based on statistical reasoning and clinical judgment. They also discuss the use of visual analog scores (VAS) to measure post-operative pain and the importance of continuous block techniques to prevent breakthrough pain. The authors address concerns raised by other researchers regarding multi-modal analgesic regimens and the use of tramadol as a rescue analgesic. Overall, the article provides insights into the design and implementation of regional blocks for post-operative pain management. [Extracted from the article]

Byline: Rakesh. Kumar, Sadik. Mohammed, Ghansham. Biyani, Rakesh. Karnawat Sir, A sternal cleft is a rare congenital anomaly resulting from the failure of fusion of lateral sternal bars during the [...]

Byline: Chhavi. Sawhney, Ghansham. Biyani, Sadik. Mohammed, Pallavi. Shende Introduction Bone cysts are rare but a definite cause for pathological fractures, and hydatid cyst should be considered as one of [...]

Byline: Sadik. Mohammed, Rakesh. Karnawat, P. Bhatia, Ghansham. Biyani Sir, Pregnancy-associated acute myocardial infarction (AMI) is rare, but is associated with high morbidity and mortality. The estimated incidence of AMI [...]

Byline: Priyanka. Sethi, Sadik. Mohammed, Pradeep. Bhatia, Neeraj. Gupta Background: Traditionally, midazolam has been used for providing conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP). Recently, dexmedetomidine has been tried, but [...]

Byline: Ghansham. Biyani, Sadik. Mohammed, Pradeep. Bhatia Sir, We read with interest the case report 'Tramadol- induced respiratory depression in a morbidly obese patient with normal renal function' by Thrivikrama [...]