Introduction: Dexmedetomidine, an α2 adrenergic receptor agonist has been used as a safe adjuvant... more Introduction: Dexmedetomidine, an α2 adrenergic receptor agonist has been used as a safe adjuvant in diverse clinical applications. It is increasingly being used nowadays for regional anaesthesia. Different doses of dexmedetomidine have been added perineurally. The present study has been undertaken to investigate the optimal dose of perineural dexmedetomidine with bupivacaine in ultrasound guided Infraclavicular brachial plexus block in patients undergoing below elbow surgeries. Methods: Sixty patients of ASA grade I or II were divided into two groups of 30 each. Patients in group I received dexmedetomidine 0.25mcg/kg + bupivacaine 0.5% (20ml) and patients in group II received dexmedetomidine 0.5mcg/kg + bupivacaine0.5% (20ml) in ultrasound guided infraclavicular block. The following parameters were assessed: the duration of sensory and motor block, onset of block and postoperative duration of analgesia. Also patients were evaluated for haemodynamic effects and side effects if any. Results: In both the groups all parameters were comparable i.e. statistically insignificant. Onset of sensory block (12.6 ± 2.32 vs 11.69 ± 2.108 mins, p=0.112), onset of motor block (14.96 ± 1.266 vs 14.5 ± 1.52mins, p=0.164), duration of sensory block (6.01 ± 0.969 vs 6.44 ± 1.685hrs, p=0.194), duration of motor block (5.933 ± 1.406 vs 6.423 ± 1.568 hrs, p=0.186) and duration of analgesia (7.533 ± 1.217 vs 8.017 ± 1.429 hrs, p=0.129). There were no significant haemodynamic effects or side effects. Conclusion: 0.25μg/kg dose of dexmedetomidine is optimal, safe and effective dose as an adjuvant to 0.5% bupivacaine for ultrasound guided infraclavicular block in terms of sensory and motor onset of nerve block and duration of analgesia with minimal incidence of side effects.
Background: Ropivacaine is considered to have better safety profile and differential block compar... more Background: Ropivacaine is considered to have better safety profile and differential block compared to Bupivacaine. Ropivacaine in Labor Epidural Analgesia can be useful in providing good pain relief with better maternal satisfaction due to less motor blockade. Materials & Method: This pilot study was conducted in 30 consenting nulliparous primigravida and Epidural labor analgesia was given by 0.15 % Ropivacaine with fentanyl. Our primary objective is to assess the analgesic efficacy using VAS score and degree of motor blockade of Epidural 0.15% Ropivacaine with fentanyl in nulliparous parturient undergoing labour epidural analgesia. Our secondary objective was the obstetric outcome in terms of rate of normal, instrumental vaginal or caesarean delivery, any side effects like nausea, vomiting, hypotension, maternal satisfaction score and the neonatal outcome. Observations and Results: Effective Ambulatory Labor Analgesia was observed in all 30 parturient with no failure rate. VAS score was highly statically significant (p < 0.001) between pre-bolus and post-infusion. None of the parturient required rescue analgesia or complained of VAS > 3 throughout the study. We found no significant motor blockade in our study. All Parturient were pain free, ambulatory with no motor blockade. Maternal Satisfaction score was excellent in 86.66% of parturient with no parturient complained of poor pain relief. Conclusion: In our pilot study we conclude that 0.15% Ropivacaine provide excellent walking epidural labor analgesia with no motor blockade resulting in good maternal satisfaction and neonate outcome.
Background Xanthochromia is the yellowish discoloration of cerebrospinal fluid associated with se... more Background Xanthochromia is the yellowish discoloration of cerebrospinal fluid associated with serious conditions like subarachnoid haemorrhage and spinal cord tumour which raises concerns regarding safety when presented during spinal anaesthesia. There is limited literature regarding the clinical implications of spinal anaesthesia in xanthochromia. Case presentation We report a case of a 31-year-old male patient with an incidental finding of xanthochromia cerebrospinal fluid during spinal anaesthesia. The patient with a history of fall was posted for lower limb orthopaedic surgery under subarachnoid block. In the process of administering the block, the pale yellow coloured cerebrospinal fluid was encountered. Conclusion We conclude that proceeding with spinal anaesthesia in xanthochromia should be at the discretion of the anaesthesiologist and further investigations for the diagnosis can be considered for the management in such cases.
Klippel Feil syndrome (KFS) is a rare autosomal genetic disorder comprising of classical triad of... more Klippel Feil syndrome (KFS) is a rare autosomal genetic disorder comprising of classical triad of short neck, low hairline, and limited neck mobility. Parturient with KFS syndrome presents with difficult airway and needs individualized consideration for Anaesthesia. Management with Regional Anaesthesia has its pros and cons and can be considered in parturient with KFS as General Anaesthesia in pregnancy poses increased risk of aspiration, difficult mask ventilation and endotracheal intubation. We present a case of a 25-yr old parturient G3A2 with 34+4 weeks of gestation with KFS syndrome posted for emergency caesarean section managed successfully under spinal anaesthesia.
Morbidly obese parturient requires specialized anesthetic care for safe labour and delivery. Regi... more Morbidly obese parturient requires specialized anesthetic care for safe labour and delivery. Regional anesthesia is considered safer than general anesthesia for cesarean section in super morbid obese parturient. We present this case to discuss anesthetic challenges associated with regional anesthesia and our approach in successful management of cesarean section in super morbid obese parturient. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Ankylosing spondylitis poses several anesthetic challenges ranging from difficult airway to diffi... more Ankylosing spondylitis poses several anesthetic challenges ranging from difficult airway to difficult neuraxial blockade. Limited cervical spine mobility, restricted opening of the temporomandibular joint, and cardiorespiratory compromise makes neuraxial anesthesia the preferred technique in these patients. However due to the ossification of the interspinous ligament and ligamentum flavum, and also syndesmophytes between adjacent vertebrae, neuraxial anesthesia poses its own set of challenges. We present a series of 3 cases in which a preoperative lumbosacral X-ray spine and fluoroscopic guidance in the operation theater allowed for an easy and more effective technique for neuraxial anesthesia in ankylosing spondylitis patients posted for transurethral resection of prostate. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and ... more Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and challenging case for anaesthesiologists. A 6-year-old girl with PRS along with bilateral progressive TMJ ankylosis was scheduled for gap arthroplasty. Her mouth opening was &lt;1 finger. Securing the airway in a syndromic child with mandibular hypoplasia was challenging. We performed an asleep fibreoptic bronchoscope (FOB)-guided nasotracheal intubation while retaining spontaneous breathing. Managing a difficult paediatric airway needs expertise. We believe that with the use of FOB, difficult airways can be successfully and safely managed.
Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and ... more Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and challenging case for anaesthesiologists. A 6-year-old girl with PRS along with bilateral progressive TMJ ankylosis was scheduled for gap arthroplasty. Her mouth opening was <1 finger. Securing the airway in a syndromic child with mandibular hypoplasia was challenging. We performed an asleep fibreoptic bronchoscope (FOB)-guided nasotracheal intubation while retaining spontaneous breathing. Managing a difficult paediatric airway needs expertise. We believe that with the use of FOB, difficult airways can be successfully and safely managed.
Ropivacaine is preferred over racemic bupivacaine for postoperative analgesia as it is less cardi... more Ropivacaine is preferred over racemic bupivacaine for postoperative analgesia as it is less cardiotoxic and has high selectivity for sensory fibers. We aim to compare postoperative epidural analgesia using 0.2% bupivacaine and 0.2% ropivacaine in major lower limb orthopedic surgery. In a prospective, randomized, double-blind study, 100 patients, aged 18-70 years, undergoing elective major lower limb orthopedic surgery under spinal anesthesia, were randomly allocated to receive either 7 ml ropivacaine 0.2% (Group R) or 7 ml bupivacaine 0.2% (Group B) for postoperative analgesia through a lumbar epidural catheter. The onset and duration of epidural analgesia, total epidural dose requirement, mean number of epidural topup, rescue analgesia, incidence of motor blockade, and adverse effects were recorded. No differences were noted in demographic data and hemodynamic variables in either group. The onset time of epidural analgesia was 10.46 min ± 0.68 (Group B) and 10.52 min ± 0.71 (Group R). The duration of analgesia was 253.10 ± 17.46 min (Group B) and 251.80 ± 15.77 min (Group R). The total analgesic dose requirement was 78.40 mg ± 6.93 in Group B while in Group R, it was 78.96 mg ± 6.79. Epidural topup requirement and the need for rescue analgesia were similar in both the groups. Motor blockade, hypotension, and nausea were noted more in Group B compared to Group R. In patients undergoing major lower limb orthopedic surgery under subarachnoid block, epidural ropivacaine 0.2% produces effective postoperative analgesia similar to bupivacaine 0.2% with a distinct sensory-motor dissociation resulting in analgesia without motor blockade.
Introduction: Dexmedetomidine, an α2 adrenergic receptor agonist has been used as a safe adjuvant... more Introduction: Dexmedetomidine, an α2 adrenergic receptor agonist has been used as a safe adjuvant in diverse clinical applications. It is increasingly being used nowadays for regional anaesthesia. Different doses of dexmedetomidine have been added perineurally. The present study has been undertaken to investigate the optimal dose of perineural dexmedetomidine with bupivacaine in ultrasound guided Infraclavicular brachial plexus block in patients undergoing below elbow surgeries. Methods: Sixty patients of ASA grade I or II were divided into two groups of 30 each. Patients in group I received dexmedetomidine 0.25mcg/kg + bupivacaine 0.5% (20ml) and patients in group II received dexmedetomidine 0.5mcg/kg + bupivacaine0.5% (20ml) in ultrasound guided infraclavicular block. The following parameters were assessed: the duration of sensory and motor block, onset of block and postoperative duration of analgesia. Also patients were evaluated for haemodynamic effects and side effects if any. Results: In both the groups all parameters were comparable i.e. statistically insignificant. Onset of sensory block (12.6 ± 2.32 vs 11.69 ± 2.108 mins, p=0.112), onset of motor block (14.96 ± 1.266 vs 14.5 ± 1.52mins, p=0.164), duration of sensory block (6.01 ± 0.969 vs 6.44 ± 1.685hrs, p=0.194), duration of motor block (5.933 ± 1.406 vs 6.423 ± 1.568 hrs, p=0.186) and duration of analgesia (7.533 ± 1.217 vs 8.017 ± 1.429 hrs, p=0.129). There were no significant haemodynamic effects or side effects. Conclusion: 0.25μg/kg dose of dexmedetomidine is optimal, safe and effective dose as an adjuvant to 0.5% bupivacaine for ultrasound guided infraclavicular block in terms of sensory and motor onset of nerve block and duration of analgesia with minimal incidence of side effects.
Background: Ropivacaine is considered to have better safety profile and differential block compar... more Background: Ropivacaine is considered to have better safety profile and differential block compared to Bupivacaine. Ropivacaine in Labor Epidural Analgesia can be useful in providing good pain relief with better maternal satisfaction due to less motor blockade. Materials & Method: This pilot study was conducted in 30 consenting nulliparous primigravida and Epidural labor analgesia was given by 0.15 % Ropivacaine with fentanyl. Our primary objective is to assess the analgesic efficacy using VAS score and degree of motor blockade of Epidural 0.15% Ropivacaine with fentanyl in nulliparous parturient undergoing labour epidural analgesia. Our secondary objective was the obstetric outcome in terms of rate of normal, instrumental vaginal or caesarean delivery, any side effects like nausea, vomiting, hypotension, maternal satisfaction score and the neonatal outcome. Observations and Results: Effective Ambulatory Labor Analgesia was observed in all 30 parturient with no failure rate. VAS score was highly statically significant (p < 0.001) between pre-bolus and post-infusion. None of the parturient required rescue analgesia or complained of VAS > 3 throughout the study. We found no significant motor blockade in our study. All Parturient were pain free, ambulatory with no motor blockade. Maternal Satisfaction score was excellent in 86.66% of parturient with no parturient complained of poor pain relief. Conclusion: In our pilot study we conclude that 0.15% Ropivacaine provide excellent walking epidural labor analgesia with no motor blockade resulting in good maternal satisfaction and neonate outcome.
Background Xanthochromia is the yellowish discoloration of cerebrospinal fluid associated with se... more Background Xanthochromia is the yellowish discoloration of cerebrospinal fluid associated with serious conditions like subarachnoid haemorrhage and spinal cord tumour which raises concerns regarding safety when presented during spinal anaesthesia. There is limited literature regarding the clinical implications of spinal anaesthesia in xanthochromia. Case presentation We report a case of a 31-year-old male patient with an incidental finding of xanthochromia cerebrospinal fluid during spinal anaesthesia. The patient with a history of fall was posted for lower limb orthopaedic surgery under subarachnoid block. In the process of administering the block, the pale yellow coloured cerebrospinal fluid was encountered. Conclusion We conclude that proceeding with spinal anaesthesia in xanthochromia should be at the discretion of the anaesthesiologist and further investigations for the diagnosis can be considered for the management in such cases.
Klippel Feil syndrome (KFS) is a rare autosomal genetic disorder comprising of classical triad of... more Klippel Feil syndrome (KFS) is a rare autosomal genetic disorder comprising of classical triad of short neck, low hairline, and limited neck mobility. Parturient with KFS syndrome presents with difficult airway and needs individualized consideration for Anaesthesia. Management with Regional Anaesthesia has its pros and cons and can be considered in parturient with KFS as General Anaesthesia in pregnancy poses increased risk of aspiration, difficult mask ventilation and endotracheal intubation. We present a case of a 25-yr old parturient G3A2 with 34+4 weeks of gestation with KFS syndrome posted for emergency caesarean section managed successfully under spinal anaesthesia.
Morbidly obese parturient requires specialized anesthetic care for safe labour and delivery. Regi... more Morbidly obese parturient requires specialized anesthetic care for safe labour and delivery. Regional anesthesia is considered safer than general anesthesia for cesarean section in super morbid obese parturient. We present this case to discuss anesthetic challenges associated with regional anesthesia and our approach in successful management of cesarean section in super morbid obese parturient. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Ankylosing spondylitis poses several anesthetic challenges ranging from difficult airway to diffi... more Ankylosing spondylitis poses several anesthetic challenges ranging from difficult airway to difficult neuraxial blockade. Limited cervical spine mobility, restricted opening of the temporomandibular joint, and cardiorespiratory compromise makes neuraxial anesthesia the preferred technique in these patients. However due to the ossification of the interspinous ligament and ligamentum flavum, and also syndesmophytes between adjacent vertebrae, neuraxial anesthesia poses its own set of challenges. We present a series of 3 cases in which a preoperative lumbosacral X-ray spine and fluoroscopic guidance in the operation theater allowed for an easy and more effective technique for neuraxial anesthesia in ankylosing spondylitis patients posted for transurethral resection of prostate. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and ... more Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and challenging case for anaesthesiologists. A 6-year-old girl with PRS along with bilateral progressive TMJ ankylosis was scheduled for gap arthroplasty. Her mouth opening was &lt;1 finger. Securing the airway in a syndromic child with mandibular hypoplasia was challenging. We performed an asleep fibreoptic bronchoscope (FOB)-guided nasotracheal intubation while retaining spontaneous breathing. Managing a difficult paediatric airway needs expertise. We believe that with the use of FOB, difficult airways can be successfully and safely managed.
Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and ... more Pierre Robin sequence (PRS) with bilateral temporomandibular joint (TMJ) ankylosis is a rare and challenging case for anaesthesiologists. A 6-year-old girl with PRS along with bilateral progressive TMJ ankylosis was scheduled for gap arthroplasty. Her mouth opening was <1 finger. Securing the airway in a syndromic child with mandibular hypoplasia was challenging. We performed an asleep fibreoptic bronchoscope (FOB)-guided nasotracheal intubation while retaining spontaneous breathing. Managing a difficult paediatric airway needs expertise. We believe that with the use of FOB, difficult airways can be successfully and safely managed.
Ropivacaine is preferred over racemic bupivacaine for postoperative analgesia as it is less cardi... more Ropivacaine is preferred over racemic bupivacaine for postoperative analgesia as it is less cardiotoxic and has high selectivity for sensory fibers. We aim to compare postoperative epidural analgesia using 0.2% bupivacaine and 0.2% ropivacaine in major lower limb orthopedic surgery. In a prospective, randomized, double-blind study, 100 patients, aged 18-70 years, undergoing elective major lower limb orthopedic surgery under spinal anesthesia, were randomly allocated to receive either 7 ml ropivacaine 0.2% (Group R) or 7 ml bupivacaine 0.2% (Group B) for postoperative analgesia through a lumbar epidural catheter. The onset and duration of epidural analgesia, total epidural dose requirement, mean number of epidural topup, rescue analgesia, incidence of motor blockade, and adverse effects were recorded. No differences were noted in demographic data and hemodynamic variables in either group. The onset time of epidural analgesia was 10.46 min ± 0.68 (Group B) and 10.52 min ± 0.71 (Group R). The duration of analgesia was 253.10 ± 17.46 min (Group B) and 251.80 ± 15.77 min (Group R). The total analgesic dose requirement was 78.40 mg ± 6.93 in Group B while in Group R, it was 78.96 mg ± 6.79. Epidural topup requirement and the need for rescue analgesia were similar in both the groups. Motor blockade, hypotension, and nausea were noted more in Group B compared to Group R. In patients undergoing major lower limb orthopedic surgery under subarachnoid block, epidural ropivacaine 0.2% produces effective postoperative analgesia similar to bupivacaine 0.2% with a distinct sensory-motor dissociation resulting in analgesia without motor blockade.
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increasingly being used nowadays for regional anaesthesia. Different doses of dexmedetomidine have been added perineurally. The present
study has been undertaken to investigate the optimal dose of perineural dexmedetomidine with bupivacaine in ultrasound guided Infraclavicular
brachial plexus block in patients undergoing below elbow surgeries. Methods: Sixty patients of ASA grade I or II were divided into two groups
of 30 each. Patients in group I received dexmedetomidine 0.25mcg/kg + bupivacaine 0.5% (20ml) and patients in group II received
dexmedetomidine 0.5mcg/kg + bupivacaine0.5% (20ml) in ultrasound guided infraclavicular block. The following parameters were assessed:
the duration of sensory and motor block, onset of block and postoperative duration of analgesia. Also patients were evaluated for
haemodynamic effects and side effects if any. Results: In both the groups all parameters were comparable i.e. statistically insignificant.
Onset of sensory block (12.6 ± 2.32 vs 11.69 ± 2.108 mins, p=0.112), onset of motor block (14.96 ± 1.266 vs 14.5 ± 1.52mins, p=0.164),
duration of sensory block (6.01 ± 0.969 vs 6.44 ± 1.685hrs, p=0.194), duration of motor block (5.933 ± 1.406 vs 6.423 ± 1.568 hrs,
p=0.186) and duration of analgesia (7.533 ± 1.217 vs 8.017 ± 1.429 hrs, p=0.129). There were no significant haemodynamic effects or side
effects. Conclusion: 0.25μg/kg dose of dexmedetomidine is optimal, safe and effective dose as an adjuvant to 0.5% bupivacaine for
ultrasound guided infraclavicular block in terms of sensory and motor onset of nerve block and duration of analgesia with minimal incidence
of side effects.
increasingly being used nowadays for regional anaesthesia. Different doses of dexmedetomidine have been added perineurally. The present
study has been undertaken to investigate the optimal dose of perineural dexmedetomidine with bupivacaine in ultrasound guided Infraclavicular
brachial plexus block in patients undergoing below elbow surgeries. Methods: Sixty patients of ASA grade I or II were divided into two groups
of 30 each. Patients in group I received dexmedetomidine 0.25mcg/kg + bupivacaine 0.5% (20ml) and patients in group II received
dexmedetomidine 0.5mcg/kg + bupivacaine0.5% (20ml) in ultrasound guided infraclavicular block. The following parameters were assessed:
the duration of sensory and motor block, onset of block and postoperative duration of analgesia. Also patients were evaluated for
haemodynamic effects and side effects if any. Results: In both the groups all parameters were comparable i.e. statistically insignificant.
Onset of sensory block (12.6 ± 2.32 vs 11.69 ± 2.108 mins, p=0.112), onset of motor block (14.96 ± 1.266 vs 14.5 ± 1.52mins, p=0.164),
duration of sensory block (6.01 ± 0.969 vs 6.44 ± 1.685hrs, p=0.194), duration of motor block (5.933 ± 1.406 vs 6.423 ± 1.568 hrs,
p=0.186) and duration of analgesia (7.533 ± 1.217 vs 8.017 ± 1.429 hrs, p=0.129). There were no significant haemodynamic effects or side
effects. Conclusion: 0.25μg/kg dose of dexmedetomidine is optimal, safe and effective dose as an adjuvant to 0.5% bupivacaine for
ultrasound guided infraclavicular block in terms of sensory and motor onset of nerve block and duration of analgesia with minimal incidence
of side effects.