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Background: Chronic Low Back Pain (CLBP) is very common and is associated with significant patient burden, and health resource expenditure. A large proportion of CLBP patients are treated with routine analgesic medications with unsatisfactory results leading to frequent exploration of second line options including pregabalin. Therefore this study was conducted to assess the efficacy of pregabalin in decreasing CLBF and compare its different doses using visual analogue scale (VAS). Materials & Methods: A 24 weeks, prospective, non-interventional, observational study was performed on patients of either sex, aged 18 years to 60 years, belonging to ASA I, II and III categories. Patients were divided into 3 groups A, B and C according to different doses of pregabalin i.e. 75mg once per day, 75mg twice per day and 50mg twice per day respectively. Effectiveness was measured from the patient's perspective using reduction of Visual Analogue Scale (VAS) score. All the patients who enrolled in different study groups also received the following concomitant medications; Tablet Paracetamol 500 mg twice daily, Tablet Amitriptyline 10 mg once daily at bed time, Tablet Methylcobalamin 1500 mcg once daily, Capsule (Pantoprazole 40mg + Domperidone 30 mg) once daily. Choice of therapy was determined solely by the clinical judgment of the treating physician. Results: The study reflected greater reduction in VAS score of less than 5 (p <0.05) in Group B followed by Group C and A at 8th week and a score of less than 3 (p < 0.05) at 24th week of follow up. Conclusion: When used in conjunction with standard therapy, pregabalin can relieve chronic low back pain. Pregabalin dosages of 75 mg twice daily followed by 50 mg twice daily, and 75 mg once daily are the most effective. These findings support pregabalin's therapeutic effectiveness and validate its applicability in the management of patients with this difficult ailment. [ABSTRACT FROM AUTHOR]

Background:Spinal route of approach is the standard mode of regional anesthesia for conducting caesarean section is considered the standard mode of anaesthesia in caesarean section and it is considered safe, low cost with patient compliance. Spinal anesthesia induced sympathetic blockade, supine hypotension syndrome and low baseline vascular tone cause post spinal hypotension in the mothers. Perfusion index is a real time non-invasive parameter for early detection of this post spinal hypotension. Therefore the aim of this study was early prediction of anypost spinal hypotension and its degree of correlation withperfusion index. Materialsand Methods:A prospective observation study was conduct on200parturient, based on inclusion exclusion criteria devoid of any co-morbidities undergoing elective caesarean section subjected to spinal anesthesia. After routine investigations parturient were posted for elective caesarean section maintaining proper fasting guidelines. The perfusion index was measured with pulse oximeter at fixed time interval along with other vital parameters. The final data were analyzed with appropriate statistical software. Results:The parturient whose baseline finger perfusion index (P.I) is >3.5 have more chance of post spinal hypotension with a significance of p< 0.0001. Finger P.I with degree of decrease of SBP has positive correlation with highly significant value (r=0.7,p value<0.0001) whereas for MAP, it is highly significant but notpositively correlated(r=0.4, p value<0.0001). Conclusion:Finger perfusion index is an effective non- invasive predictor for the post spinal hypotension undergoing elective caesarean section. Additionally, the finger perfusion index is a reliable indicator of the extent to which systolic and mean arterial pressure decreases. [ABSTRACT FROM AUTHOR]

Context: Pain management intraoperatively and postoperatively in the pediatric age group is a matter of concern. On the one hand, children are poorer at precisely conveying the extent of pain all the while being more susceptible to pain-related complications such as laryngospasm. On the other hand, children are less suited to use of potent opioids due to associated complications which can often lead to catastrophe. Therefore, a multimodal approach is desirable to optimize pain management in children. A nerve block is a highly effective and popular modality nowadays. In this single-blinded, parallel group, monocentric, and randomized protocol study, we have compared the efficacy of pain control achieved in the use of nonsteroidal anti-inflammatory drugs as analgesic versus iliohypogastric ilioinguinal (IIIH) nerve block in herniotomy in pediatric age group. Materials and Method: The parallel-group prospective study recruited 104 participants who were randomly allocated into two groups of 52 each, such that both groups received 1 mcg/kg fentanyl and sevoflurane during induction of GA. For analgesia, Group 2 was given diclofenac suppository intraoperative after induction of GA. Group 1 was given IIIH nerve block under nerve stimulator guidance for perioperative analgesia. Both groups were studied for the following parameters which included: time to get the 1st dose of rescue analgesic, total dose of rescue analgesic, visual analog scale (VAS) score, and hemodynamic parameters. Results: We observed that Group 1 showed a statistically significant difference in the form of longer duration of analgesia after surgery (9.67 ± 1.80 h vs. 6.35 ± 0.84 h) and lower total dose of rescue analgesic requirement (69.23 ± 2 [22.77] vs. 106.23 ± 2 [21.49]) while having a better hemodynamic profile and lower cumulative VAS score (7.71 ± 1.39 vs. 12.04 ± 1.72). Conclusion: Based on the above findings, we deduce that preincisional nerve stimulator-guided IIIH block by levobupivacaine (0.25%, 0.3 ml/kg) and rectal diclofenac (2 mg/kg) is both safe approaches to provide postoperative analgesia in pediatric inguinal herniotomy under general anesthesia. However, nerve stimulator-guided IIIH nerve block by levobupivacaine is a safe and better choice as it provides more intense analgesia for a longer duration compared to diclofenac suppository in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Background and Aims: In India, the awareness about the psycho-social dimension of chronic pain is minimal among physicians and patients. The research with community-based group therapies (like mindfulness) to address the psycho-social aspects in chronic pain patients remains limited. The aim of this randomized controlled trial was to see the effects of mindfulness on pain intensity, pain catastrophizing, chronic pain acceptance, perceived stress, well-being, and mindfulness characteristics. Materials and Methods: In this two-site, parallel group, clinical trial, 170 patients attending pain outdoors of two government hospitals in West Bengal, India, were randomized to attend five weekly in-person mindfulness sessions (cases) or usual care sessions (controls) within the hospital premises. Pre-program and post-program data were collected and analyzed using statistical methods like repeated measures analysis of variance. Results: In participants of the mindfulness group, significant changes post session were noted in pain intensity [F(1,326) = 15.0122; P = 0.0001291], pain acceptance [F(1,326) = 4.5311; P = 0.03403], and perceived stress score [F(1,326) = 13.2788; P = 0.0003122] compared to pre-session. The changes in pain catastrophizing, World Health Organization well-being and Freiburg mindfulness inventory scores were non-specific. Conclusion: Mindfulness had a positive influence on pain intensity, pain acceptance, and perceived stress of Indian chronic pain patients. The effects on pain catastrophizing, mindfulness characteristics, and well-being (non-specific) were also encouraging. Further studies will be required to substantiate these results. [ABSTRACT FROM AUTHOR]

Byline: Arif. Ahmed, Raghu. Thota, Sushma. Bhatnagar, Parmanand. Jain, Raghavendra. Ramanjulu, Naveen. Salins, Aparna. Chatterjee, Dipasri. Bhattacharya The Indian Society for Study of Pain (ISSP), cancer pain Special Interest Group [...]

Byline: Arif. Ahmed, Raghu. Thota, Aparna. Chatterjee, Parmanand. Jain, Raghavendra. Ramanjulu, Sushma. Bhatnagar, Naveen. Salins, Dipasri. Bhattacharya The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group [...]

Byline: Naveen. Salins, Raghu. Thota, Sushma. Bhatnagar, Raghavendra. Ramanjulu, Arif. Ahmed, Parmanand. Jain, Aparna. Chatterjee, Dipasri. Bhattacharya The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group [...]

Byline: Raghu. Thota, Raghavendra. Ramanjulu, Arif. Ahmed, Parmanand. Jain, Naveen. Salins, Sushma. Bhatnagar, Aparna. Chatterjee, Dipasri. Bhattacharya The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group [...]

Byline: Raghavendra. Ramanjulu, Raghu. Thota, Arif. Ahmed, Parmanand. Jain, Sushma. Bhatnagar, Naveen. Salins, Aparna. Chatterjee, Dipasri. Bhattacharya The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group, [...]

Byline: Aparna. Chatterjee, Raghu. Thota, Raghavendra. Ramanjulu, Arif. Ahmed, Dipasri. Bhattacharya, Naveen. Salins, Parmanand. Jain, Sushma. Bhatnagar The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group [...]

Background: Predicting a difficult airway preoperatively overcomes the hurdles of unanticipated difficult airway management. Cormack--Lehane grading (CL Grading) best describes the view of larynx. However, direct laryngoscopy cannot be used to predict difficult airway for patients undergoing intubation for the 1st time. On the other hand, ultrasound is a safe and painless procedure. This study was done to correlate airway ultrasound findings with CL Grading by direct laryngoscopy. The patients selected were undergoing elective surgeries under general anesthesia. Aims and Objectives: The aims of the present study were to correlate the ultrasound view of the airway with the Cormack--Lehane classification by direct laryngoscopy. Materials and Methods: A group of 94 patients, aged 18--60 years, ASA I/II were selected who underwent elective surgical procedures under general anesthesia requiring intubation by direct laryngoscopy. Pre-epiglottic (PRE-E) depth and epiglottic vocal distance (E-VC) were measured along with hyomental distance ratio (HMDR) by ultrasound. The ultrasound parameters were then compared with CL Grading during laryngoscopy. Results: The PRE-E depth/epiglottic vocal cord distance correlated better than hyomental distance ratio in predicting CL Grading (P=0.000). Conclusion: The PRE-E/E-VC ratio was a better predictor of CL Grading than the HMDR. [ABSTRACT FROM AUTHOR]

Background: Smoking has various deleterious effects and peri-operative complications. Pulmonary complications following abdominal surgery are frequent and associated with increased morbidity and mortality and length of hospital stay. Aims and Objectives: Hence, this study was done to observe the incidence of various respiratory and cardiovascular complications in the perioperative period in patients undergoing elective open upper abdominal surgery under general anaesthesia among smokers versus non-smokers. The various complications which are studied are as follows - Arterial desaturation, Severe coughing, Laryngospasm, Bronchospasm, Recurrent apnea, Variations in Mean Arterial Blood Pressure and Heart rates. Materials and Methods: Male patients ASA-I, II or III, aged 20-60 years undergoing elective open upper abdominal surgery under general anaesthesia were selected. They were divided into two groups (during pre-anaesthetic checkup) - smokers (>10 cigarette/day for the past 1 year and continued smoking till admission), non-smokers (who never smoked). General anaesthesia was given according to standard protocol. Results: The smokers had higher incidence of laryngospasm as well as bronchospasm but they were not statistically significant. Smokers had low baseline SpO2; greater fall in SpO2 just after extubation, before sending to PACU and on day 1 which were statistically significant. Smokers had raised MAP just after extubation, on day 1 and day 2 which were statistically significant. Conclusion: Smokers had increased incidences of respiratory and hemodynamic complications than non-smokers. [ABSTRACT FROM AUTHOR]

Byline: Arindam. Hazra, Dipasri. Bhattacharya, Sayantan. Mukherjee, Santanu. Ghosh, Manasij. Mitra, Mohanchandra. Mandal Background and Aims: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). [...]

Byline: Sugata. Dasgupta, Shipti. Singh, Arunima. Chaudhuri, Dipasri. Bhattacharya, Sourav. Choudhury Background: Although tracheal tubes are essential devices to control and protect airway in a critical care unit (CCU), they [...]

The article focuses on the effectiveness of postextubation noninvasive ventilation (NIV) in preventing reintubation in brain-injured patients. Topics include points for clarification regarding the inclusion of surgically treated patients, the need for serial monitoring of relevant clinical parameters, and the assessment criteria for the prophylactic use of high-flow nasal oxygen and NIV, suggesting that further studies addressing these aspects can consolidate the evidence.

Background: Pain is the leading symptom of knee osteoarthritis (OA) leading to significant morbidity and decreased quality of life. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor, has been demonstrated to have a centrally acting analgesic effect. Aims and Objectives: To evaluate the efficacy and safety of two different doses of duloxetine and compare with conventional pharmacotherapy in treatment of chronic pain due to osteoarthritis of knee. Materials and Methods: Ninety patients with symptomatic knee OA were randomly divided into 3 groups to receive duloxetine 40 mg & 3g paracetamol/ day (Group A), duloxetine 20 mg & 3g paracetamol/day (Group B) and paracetamol 3gm/ day (Group C). Patients were followed up for 6 months to assess pain relief and functional improvement. Visual Analogue Scale (VAS) for assessing pain intensity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire physical function subscale for assessing physical function were used. Results: Reduction in VAS score from baseline was significantly high in groups A and B as compared to C at 1 month, 3 months and 6 months. Reduction in WOMAC score from baseline were also significantly high in groups A and B as compared to C at 1 month, 3 month and 6 months. Adverse effects in Group A were significantly high as compared to group B and C. Patients discontinuing due to adverse effects were significantly high in group A. Conclusion: Lower dose of duloxetine is associated with significant pain reduction and improved function with lesser adverse effects in patients with pain due to knee OA. [ABSTRACT FROM AUTHOR]

Background: Epidural injection of steroid and local anaesthetic is a common modality for management of radicular pain. Transforaminal approach is preferred for epidural injection in case of radiculopathy. Aims and Objectives: To compare the effect of the Kambin's triangle and subpedicular approaches of transforaminal epidural injection (TFEI) in patients of lumbar radiculopathy. Materials and Methods: Forty patients with lumbar radicular pain were enrolled and randomly assigned to each group (Group K for Kambin's triangle approach and Group S for subpedicular approach). All procedures were performed under fluroscopic guidance. The frequency of complications during the procedure and the effect of TFEI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual Analog scale (VAS). Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors and the therapeutic effect. Result: VAS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VAS between these two groups. Spinal nerve pricking occurred in one case of the subpedicular and in none of the cases of the Kambin's triangle approach (p<0.05). Conclusion: Kambin's triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). So, Kambin's triangle approach may be an alternative method for TFEI in cases where needle tip positioning in the anterior epidural space is difficult. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular stress due to reflex sympathetic over activity is a great concern during laryngoscopy and endotracheal intubation. Aims and Objectives: To compare the efficacy and safety of esmolol and verapamil for attenuation of hemodynamic effects (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) due to laryngoscopy and endotracheal intubation in elective surgical cases. Materials and Methods: A prospective, randomized, double blinded, controlled study was conducted on 60 patients divided equally into 30 each receiving esmolol (2 mg/kg body weight) and verapamil (0.1 mg/kg body weight) respectively. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were recordedat pre-operative stage, after administration of the study drugs, immediately after intubation and at 1,3,5 minutes after intubation. Data collected were statistically analyzed. Results: The mean systolic blood pressure was lower in the esmolol group at all times of estimation compared with the verapamil group and the difference was at the time of intubation (p value <0.001).The mean diastolic blood pressure was lower in the esmolol group at all times of estimation compared to the verapamil group which was not statistically significant at any time of estimation. The mean arterial pressure was significantly lower at the time of immediately after intubation (p<0.001) in esmolol as compared to verapamil group. Adverse effects in both the study groups were insignificant. Conclusion: Esmololand Verapamil can effectively attenuate the cardiovascular stress to laryngoscopy and endotracheal intubation with the former appears to be a better alternative from efficacy and safety perspectives. [ABSTRACT FROM AUTHOR]

Prevention of postoperative pain and preservation of Quadriceps muscle strength is essential for mobilization after total knee replacement (TKR) surgery. Peripheral nerve blocks are important modalities of pain management. We have compared adductor canal block (ACB) versus femoral nerve block (FNB) for assessment of the intensity of pain, duration of analgesia, consumption of tablet paracetamol as rescue analgesic, and Quadriceps range of motion following TKR. A double-blind randomized prospective study was carried out on 74 patients scheduled for TKR under spinal anesthesia. Patients were divided into two equal groups. Group ACB (n = 37) received ACB and Group FNB (n = 37) received FNB at the end of the operation. The intensity of postoperative pain was assessed by the Visual Analog Scale (VAS) score. Duration of analgesia and Quadriceps range of motion were assessed postoperatively. Group ACB showed low cumulative VAS, increased duration of analgesia, and increased Quadriceps range of motion (P ≤ 0.5) compared to Group FNB. Ultrasound-guided ACB is a better alternative to FNB for postoperative analgesia and better Quadriceps function in patients undergoing TKR under spinal anesthesia. [ABSTRACT FROM AUTHOR]

Background: Hemodynamic change takes place during procedures like laryngoscopy and endotracheal intubation due to reflex sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation before a surgery under general anesthesia. Aims and Objectives: The aim of the study was to compare the effectiveness of oral clonidine and intravenous lignocaine as premedicant to obtund the stress response due to such mandatory maneuvers. Materials and Methods: A prospective, randomized, double-blind, double dummy-controlled study was undertaken for 11 months at a tertiary care hospital in the eastern part of India. A total (n=100) patient aged 30 to 50 years of either sex with ASA I and II waiting for elective abdominal surgery were randomized into two equal groups. Group C (n=50) received (4µg/kg) of oral clonidine 90 minute before laryngoscopy and Group L (n=50) received 1.5 mg/kg lignocaine 3 minute before laryngoscopy as active drugs and appropriate placebos were administered as double dummy technique. Comparable demographic and base line parameters like heart rate, systolic blood pressure and diastolic blood pressure were recorded at various time intervals. Similar anesthesia technique applied was in both the study arm. Result: Attenuation of systolic blood pressure, diastolic blood pressure, heart rate and mean arterial pressure was statistically highly significant (p<0.0001) more in Group C as compared to Group L within first vital 10 minutes of intubation. Conclusion: Oral clonidine attenuates the stress response better than intravenous lignocaine during laryngoscopy and endotracheal intubation with minimum adverse effects. [ABSTRACT FROM AUTHOR]

Introduction: Successful airway management in patients with restricted cervical spine movement is always very challenging as there is no consensus regarding management of difficult airway in such patients with limited or no cervical spine mobility. Aim: To assess whether the King Vision® Video Laryngoscope (KVVL) provides a better view of the glottis and has higher success rate of tracheal intubation than McCoy laryngoscope in patients with simulated difficult airway. Materials and Methods: A prospective, longitudinal, comparative study was conducted with prior approval from Institutional Ethics Committee, 100 patients were divided equally (n=50) into group V {Video Laryngoscope (VL)} and group M (McCoy laryngoscope). Time required for laryngoscopy and intubation, any damage to teeth or soft tissue injury was noted and view of the glottis was graded using a modified classification reported by Cormack and Lehane. Qualitative data (sex, American Society of Anesthesiologists (ASA) physical status, Mallampati classification, Cormack and Lehane glottis view grade, number of laryngoscopic attempts, number of optimisation maneuver required etc.,) were compared between the groups. Chi-square test (χ²) and Fisher-exact test were used. Results: The success on first attempt of laryngoscopy was significantly greater (p=0.014), time taken to do the procedure of laryngoscopy (p<0.001) and duration of intubation (p<0.001) was significantly lesser in the group V patients as compared to group M. Incidence of procedural dental injury was totally absent in group V, whereas four cases were recorded in group M. Optimisation maneuver was required in 50% of the group M patients as compared to 10% of group V (p<0.001). Changes in baseline parameters like pulse, Blood Pressure (BP) was noted more in group M (p<0.01) probably owing to the greater mean duration of intubation. Conclusion: KVVL appears to possess more advantages over the McCoy laryngoscope in respect to ease of viewing glottis, reduced duration of laryngoscopy and intubation, lesser complications and haemodynamic instability. [ABSTRACT FROM AUTHOR]

Byline: Sugata. Dasgupta, Soumi. Das, Dipasri. Bhattacharya, Sonia. Agarwal Sir, A 10-year-old girl, 130 cm tall, weighing 30 kg and belonging to a low socio-economic status, was brought to the [...]

Introduction: Caesarean section is a common obstetric operation which requires adequate and safe postoperative analgesia sometimes using morphine or clonidine to provide comfort to the mother and ease in handling the new born. Aim: A randomised double-blinded study was conducted to compare the adjuvant effect of morphine and clonidine when co-administered intrathecally with 0.5% bupivacaine heavy during caesarean section. Materials and Methods: A total 90 parturient were randomly divided into three groups, during March to November 2011, receiving intrathecal 100 mcg morphine, 75 mcg clonidine and 0.5 mL normal saline along with 2.5 mL of bupivacaine respectively. The quality and duration of postoperative analgesia and any side effects were assessed at fixed time interval. APGAR score of foetuses was also done to assess their wellbeing. Statistical analysis was done using Analysis of Variance (for continuous variables like Blood Pressure, heart rate, etc.,) and chi-square test (for discrete variables like VAS score, side effects, etc.,). Results: Postoperative VAS score at different time were much lower in the morphine group as compared to clonidine group (p-value<0.001) at 2,8,24-hour interval postoperative period. The time required for 1st rescue analgesia was longer in morphine (14±7.33 hours) as compared to clonidine (7±1.02 hours) (p<0.001). The total dose of rescue analgesic required in 24 hours was less (p<0.001) in morphine (75±48.25 mg) group. Hypotension bradycardia and sedation (p-value 0.028) were more in clonidine group as compared to morphine group. Conclusion: Low dose morphine is better as an adjuvant than clonidine during spinal anaesthesia for relieving pain following caesarean section. [ABSTRACT FROM AUTHOR]

Byline: Susmita. Chakraborty, Jayanta. Chakrabarti, Dipasri. Bhattacharya The analgesic effect of the centrally acting opioid, tramadol, is well-known. It has been shown in clinical studies that using tramadol epidurally can [...]

Byline: Dipasri. Bhattacharya, B. Bhalotia, Sudev. Saha The laryngeal mask airway - LMA classic has been widely used in clinical practice. A new disposable supraglottic airway device, the soft seal [...]

Byline: Dipasri. Bhattacharya, I. Tewari, S. Chowdhuri Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block in this decade for high risk geriatric [...]

The article presents comments on the study of high-flow nasal oxygen (HFNO) versus Venturi mask oxygen therapy to prevent reintubation. Topics discussed include the use of the respiratory rate (ROX) index, the prediction of the postextubation respiratory distress during spontaneous breathing trial, and the assessment of dyspnoea among patients with rescue noninvasive ventilation (NIV). Also noted is a request for clarifications on these points.

Background and objective Postdural puncture headache (PDPH) is a very distressing symptom after spinal anesthesia. It usually resolves spontaneously but may extend the length of hospital stay. Although there are different measures to reduce the incidence, most of the times, none of them are effective. Paracetamol is commonly used for the treatment of PDPH. Pregabalin is recently being used for PDPH with effective results. In this study, our aim was to compare the respective effects of paracetamol, pregabalin, and their combination in the treatment of PDPH. Patients and methods In total, 150 patients who had undergone major gynecological surgery under spinal anesthesia and subsequently developed PDPH (diagnosed by postdural components of the pain) were randomly allocated by using computer-generated random numbers placed in sealed opaque envelopes. The patients were allocated into three equal groups (n = 50, each group) to receive orally either a single dose of 150 mg pregabalin (group 1) or 1000 mg of paracetamol (group 2) or a combined dose of paracetamol 1000 mg plus pregabalin 150 mg (group 3). All the patients received the same drug that they had originally received, if required, and were then followed up for 4 days. A patient's headache was scored using the visual analogue scale. Results Earlier relief from PDPH and favorable adverse event profile (overall and central nervous system-related) were found in for the pregabalin-paracetamol combination compared with either of the drugs being used alone (P < 0.05). Conclusion It was concluded that the pregabalin-paracetamol combination is a better option for the treatment of PDPH compared with both of the drugs when used alone. [ABSTRACT FROM AUTHOR]

Background and Objectives: Large-volume administration of 0.9% saline are known to causes hyperchloremic metabolic acidosis (HMA) due to its high chloride load. Balanced or physiological fluids with inorganic ions are not associated with the same disturbance. The purpose of this study was to see whether balanced crystalloid and colloid solutions cause less disturbances in postoperative acid base status than sodium chloride based solutions in patients undergoing elective open gastrointestinal surgery. Methodology: Study subjects were patients aged between 30-60 years, ASA grades I and II, undergoing elective open gastrointestinal surgery, were selected as per proposed sampling design and were allotted into two groups, by the help of simple randomization process. Patients in the Group B received Hartmann's solution and 6% hetastarch in balanced electrolyte and glucose solution and patients in the Group N received 0.9% sodium chloride solution and 6% hetastarch in 0.9% sodium chloride solution. Arterial blood samples were taken from both the groups of patients just prior to and 30 min after surgery. Baseline and final acid base status, heart rate, mean blood pressure, peripheral temperature, as well as urine output before, during and after surgery were recorded up to 48 hours. Prevalence of development of HMA was determined by appropriate statistical technique. Results: The mean chloride level of normal saline group postoperatively was 118.66 ± 5.75 mmol/L (Normal range: 98-106 mmol/L) whereas in balanced saline group it was 103.27 ± 2.29 mmol/L, arterial pH was 7.31 ± 0.29 and 7.4 ± 0.02 respectively. Hence the changes in chloride level as well as arterial pH were significant in normal saline group versus balanced fluid group. Conclusion: Normal saline based fluids cause significant alteration in arterial chloride and pH levels against the use of balanced fluids in gastrointestinal surgery. [ABSTRACT FROM AUTHOR]