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Introduction: Postoperative pain is one of the common causes of increased postoperative morbidity and delayed recovery. Pain causes adverse effects such as hypertension, tachycardia, myocardial ischaemia, decreased alveolar ventilation, poor wound healing, and postoperative morbidity. Vitamin C and N-acetylcysteine (NAC), which is a novel co-analgesic, are being studied to reduce postoperative pain and opioid consumption. Aim: To study the effect of intravenous Vitamin C and NAC on postoperative surgical pain and opioid consumption after laparoscopic gynaecologic oncosurgeries. Materials and Methods: The present study was a randomised controlled study conducted at the Department of Anaesthesiology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India on 300 patients of American Society of Anaesthesiologists (ASA) physical status 1 and 2 scheduled for laparoscopic Gynaeconcology surgery after obtaining written informed consent. All the selected patients were randomly allocated into three groups. Group P was the control group in Group N patients received intravenous injections of NAC (50 mg/kg) and vitamin C infusion (50 mg/kg) in Group C. Patients were explained about the visual analogue pain scale preoperatively. In the postoperative period, VAS scores were recorded and noted along with the rescue analgesics received and side-effects. Results: Haemodynamic variables were comparable among all three groups. The number of patients who had VAS scores of more than 4 was lower in group C (Vitamin C) at various time intervals when compared to the NAC and placebo groups. It was also statistically significant at 45 minutes, 60 minutes, 90 minutes, 150 minutes, 180 minutes, 300 minutes, and 10 hours (p-value=0.014, <0.001, <0.001, <0.001, 0.003, 0.005, 0.006, respectively). Postoperative opioid consumption was significantly reduced in group C (Vitamin C) compared to the other two groups (p-value <0.001). Conclusion: Intraoperative Vitamin C usage reduced postoperative pain and fentanyl consumption in the postoperative period, and NAC can be used as a part of multimodal analgesia. [ABSTRACT FROM AUTHOR]

Background: Lung, oral, oesophageal, stomach and nasopharyngeal cancers are the most common cancers in men, whereas cancers of the breast, cervix and uterus are the most common cancers in women. Although systemic chemotherapy is the most common form of treatment for these cancers, the incidence of surgeries for the same have been on the increasing trend and therefore the need for oncoanesthesia has increased. Methodology- The study was conducted in Department of Anaesthesiology and Pain relief at Kidwai Memorial Institute of Oncology, Bangalore. duration of the study was from November 2019 to November 2021. 210 patients fulfilling the inclusion criteria were included in the study. Patients were divided into 3 groups and randomly allocated to each of them. Designated drug was administered via IV route. Oral intubation with proper cuffed endotracheal tube and its position was confirmed by bilateral five-point auscultation and was connected to volume controlled mode of mechanical ventilation. Monitoring of NIBP, continuous Ecg, Capnography and SpO2 was done. Result- In our study, there was no statistically significant difference in the mean baseline heart rates between the three groups. There is a decrease in mean heart rate after administration of study drug till the time interval before intubation when compared to the baseline heart rate. In our study, there was no statistically significant difference in the mean baseline SBP, DBP and MAP between the three groups. Conclusion-Dexmedetomidine is a better premedication when compared to lignocaine, as it completely attenuated the stress response to intubation. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and endotracheal intubation is the commonest method of securing a definitive airway for administering anaesthesia. However, it is associated with tachycardia and hypertension and an increase in intraocular pressure. Various pharmacologic and non-pharmacologic methods have been tried to limit the pressure responses and intraocular pressure changes following the insertion of endotracheal tube. One such attempt is the use of laryngeal mask airway, which has been shown to be an effective means of securing a clear airway in fasting patients for elective surgery. Its insertion requires neither the visualization of cords nor the penetration of larynx, making the placement less stimulating than tracheal tube insertion and it may provoke less sympathetic response and catecholamine release Methodology: Sixty patients, of 18-60 years of age, of either sex undergoing elective surgical procedures at Kidwai Memorial Institute of Oncology, Bangalore requiring general anaesthesia were selected randomly. The study was conducted in our institute from December 2019 to February 2021. Patients were randomly divided into 2 groups. In Group 1, appropriate size of LMA was inserted blindly without laryngoscopy using standard technique whereas in Group 2, appropriate size of endotracheal tube was used to intubate trachea under direct laryngoscopy using macintosh laryngoscope. Results: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. Conclusion: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. There was statistically significant rise in hemodynamic parameters and IOP following laryngoscopy and intubation. [ABSTRACT FROM AUTHOR]

Background: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a Sodium channel blocker attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a Calcium channel blocker attenuates hemodynamic response by blocking voltage sensitive L type channels, and inhibiting calcium entry mediated action potential in smooth and cardiac muscle. It also has peripheral vasodilation property. Esmolol, a Beta blocker attenuates hemodynamic response by blocking sympathetic nervous system. Methodology-90 patients admitted for elective surgeries posted under general anaesthesia at Kidwai memorial institute of oncology, Bangalore during the duration of December 2018 to May 2019 were included in the study. Patients were randomly divided into 3 groups of 30 each. Randomization done by computer generated table. Group A: received Inj. Diltiazem 0.1mg/kg and preservative free lignocaine 1mg/kg. Group B: received Inj. Esmolol 0.5mg/kg and lignocaine 1mg/kg. Group C: received Inj. lignocaine 1mg/kg. Hemodynamic parameters HR, SBP, DBP, MAP were recorded before extubation (pre reversal) and 1min, 2mins, 3mins, 5mins and 10mins post extubation. In this study, the dosage was fixed based on previous studies. Results-Post extubation, the decrease in mean heart rate was statistically significant in Group B in comparison with Group C (control group) from 1 min post extubation till 10 min. There was increase in heart rate in Group A compared to Group C (control group) which is not statistically significant. Also there was slight decrease in heart rate in Group B compared to Group A (both study group) which is statistically significant at all the intervals. Conclusion-Smaller doses of esmolol when combined with lignocaine gives much better results when compared to Diltiazem + Lignocaine combination and lignocaine alone. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of multimedia based educational video shown preoperatively to cancer patients posted for surgery in alleviating anxiety associated with spinal anaesthesia/sub arachnoid block. Materials and Methods: This was a randomised controlled trial conducted on a total of 200 patients posted for oncological procedure in Department of Anaesthesiology and Pain relief, Kidwai Memorial Institute of Oncology, Bengaluru, India. the total subjects included were randomised into two groups: Video group, where a short educational video depicting procedure of spinal anaesthesia was shown preoperatively to the patients and non video group (control group) where no video was shown. Anxiety using Visual Analogue Scale (VAS) and haemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Systolic blood Pressure (SBP), Diastolic blood pressure (DBP) were assessed pre and post intervention in both groups. Categorical data were compared using chi-square test. Student's unpaired t-test was used for inter-group comparison. The p-value <0.05 was considered statistically significant. Results: Out of total 200 patients (93 males and 107 females; 18-60 years of age) enrolled in the study, 100 patients were categorised in video group (41.53±11.60 years) and remaining 100 were included in non video group (42.92±11.63 years). There was no statistically significant difference in the mean anxiety score and haemodynamic parameters at the baseline for both the groups. Post intervention, the video group showed a greater reduction in anxiety than the control group (intra-group reduction: 1.84±1.20 vs 1.42±1.18), and the difference was statistically significant (p-value=0.013). Mean HR was significantly higher in the control group (84.66±13.22, 80.46±13.11 and 79.44±14.05 at 5, 10 and 15 min, respectively) when compared with the video group (81.75±11.49, 77.35±12.59 and 74.82±13.05 at 5, 10 and 15 min, respectively). Similarly, SBP, DBP & MAP were noted significantly higher in the control group compared to the video group (p-value <0.001). Conclusion: Multimedia-based educational video depicting technique of spinal anaesthesia/sub arachnoid block significantly reduces anxiety and associated haemodynamic variations. Showing short video clip about spinal anaesthesia technique is an easy way for transfer of information about anaesthesia for patients and allows time for patients to reflect on this preoperatively and thereby reduces their anxiety. [ABSTRACT FROM AUTHOR]

Introduction: From the early 1970’s, laparoscopic procedures became well established because of their advantages like excellent visualisation, improved cosmesis, reduced postoperative pain and reduced hospital stay. Despite its advantages, laparoscopic surgeries have its demerits such as pneumoperitoneum and positional changes. Alpha-2 agonists have shown promising results in attenuating the stress response in laparoscopic surgeries. Aim: To compare clonidine and dexmedetomidine in attenuating haemodynamic stress response during laparoscopic lower abdominal oncosurgeries. Materials and Methods: A randomised controlled trial was conducted at Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India, during the period of December 2018 to May 2019. Institutional Ethical Committee clearance was obtained for the trial. Total 48 patients were recruited into two groups with 24 participants in each group: A (clonidine) and B (dexmedetomidine). Both drugs were infused at a dose of 1 µg/kg for 15 minutes along with premedication before induction. Haemodynamic stress response was estimated using parameters like Heart Rate (HR), systolic and diastolic blood pressure and mean arterial pressure at induction, pneumoperitoneum and at extubation. All the data were analysed using the statistical software R (V3.6.2). Continuous data were presented in the form of Mean ± Standard Deviation (SD). The difference in mean value of the various parameters between the two groups was analysed using Student’s t-test. A p-value of <0.05 was considered to be significant. Results: Patients in both the groups were comparable with regards to demographic features. The mean age was 46.76±8.17 years, 46.24±9.70 years and weight was 55.76±7.28 and 56.08±6.06 for group A and group B, respectively. There were statistically significant differences in attenuating stress response in dexmedetomidine compared to clonidine group. Statistically significant reduction in the HR was noticed in group B as compared to group A at 12 minutes of infusion (p=0.008), at the end of infusion (p=0.008), before intubation (p=0.005), 10 minutes after intubation (p=0.008) and after pneumoperitoneum (p=0.045). Group B which was given dexmedetomidine drug compared to group A with clonidine drug showed better attenuation of the systolic blood pressure during extubation (p=0.006). Conclusion: To conclude, both clonidine and dexmedetomidine effectively attenuate the haemodynamic response in patients undergoing laparoscopic lower abdominal onco-surgeries when administered as intravenous bolus dose. In addition, the dexmedetomidine attenuates haemodynamic responses better than clonidine. [ABSTRACT FROM AUTHOR]

Teleradiology can be used to provide health care to rural populations, especially where there is a scarcity of resources, including on-site radiologists. We have established a network link between a commercial teleradiology provider in Bangalore, south India and the Ramakrishna Mission Hospital (RKMH), located over 3000 km away in the north east of India. Image files were transferred to Bangalore via an ADSL connection using secure file transfer protocol. In the 12-month period beginning in August 2007, a total of 962 studies was sent to Bangalore from the RKMH. The average turnaround time for the report to reach the hospital once the images had been received in Bangalore was six hours for non-emergency cases. For emergency cases the turnaround time was consistently below 30 minutes. Because the RKMH was a charitable institution providing rural patients with free or low-cost treatment, no charge was made for the reporting. Our experience demonstrates that remote implementation of teleradiology is possible in rural India. The service has proved valuable for the remote hospital concerned. [ABSTRACT FROM AUTHOR]