Publications by authors named "Anju Grewal"

33 Publications

A comparative study of desflurane versus sevoflurane in obese patients: Effect on recovery profile.

J Anaesthesiol Clin Pharmacol 2020 Oct-Dec;36(4):541-545. Epub 2021 Jan 18.

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Anesthesia in obese patients is difficult due to associated comorbidities and altered physiology. Desflurane and sevoflurane have a low fat-blood solubility coefficient and are better suited in these patients to achieve a rapid emergence. We studied BIS guided drug titration to compare the postoperative recovery characteristics and cognitive function of desflurane versus sevoflurane in obese patients undergoing laparoscopic abdominal surgeries.

Material And Methods: After institutional ethics committee approval and written informed consent, sixty obese patients (BMI ≥30 kg/m) were randomized to receive either BIS guided desflurane or sevoflurane. Recovery was assessed by time taken for eye opening on verbal command, sustained head lift for 5 s, and extubation and orientation to time, place, and person after discontinuation of volatile anesthetic agent. For cognitive function, time taken to complete Mini mental state examination (MMSE) score to baseline was compared in both study groups.

Results: Difference of time taken for eye opening on verbal command, sustained head lift for 5 s, and extubation and orientation to time, place, and person was not significant between both anesthetic groups. Patients in sevoflurane group took significantly (-value = 0.001) less time (40.07 ± 13 min) to achieve preoperative MMSE score than desflurane group (51.2 ± 11.7 min).

Conclusion: Both desflurane and sevoflurane have similar recovery profile in obese patients when anesthetic concentration is carefully titrated. Reversal of cognitive function is significantly earlier in obese patients anesthetized with sevoflurane.
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http://dx.doi.org/10.4103/joacp.JOACP_307_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022057PMC
January 2021

A rational approach to manage surgical procedures in COVID Era - A perspective based on experience in a private referral hospital.

J Anaesthesiol Clin Pharmacol 2020 Jul-Sep;36(3):325-330. Epub 2020 Sep 15.

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: COVID-19 disease has imposed challenges in caring for non-Covid elective surgical patients. As elective surgeries become essential, we propose to evaluate our approach and outcomes of surgical procedures performed during the initial period of COVID-19 pandemic so as to provide a road-map for safer approach.

Material And Methods: We retrospectively evaluated outcomes in patients who underwent essential elective and emergency surgeries during the 5-week period between April 18, 2020 and May 28, 2020. All patients were screened at the front desk on their arrival to identify possible exposure to SARS- CoV-2. Nasopharyngeal swab of patients requiring hospital admission was tested for COVID-19 by quantitative RT-PCR. Patients needing essential elective surgery were taken up for surgery if they tested negative for COVID-19. Emergency procedures were undertaken in a demarcated theatre for COVID after taking level-3 protection without delay. The clinical data was reviewed and analysed.

Results: A total of 764 surgical procedures were conducted, of which 70.7% were elective essential surgeries, with 95.4% of these patients being discharged in stable healthy condition. Approximately 23% of the elective and 26% of the emergency surgeries was categorised in the surgical difficulty category III and majority of these were performed under general anesthesia. Postoperative mortality was 1.04%, but the overall mortality rate was approximately 2.5%. Only two patients (0.3%) tested positive for COVID-19 in our series.

Conclusion: A robust preoperative screening and testing can enable safe scheduling of essential elective surgeries.
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http://dx.doi.org/10.4103/joacp.JOACP_420_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812968PMC
September 2020

Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial.

Indian J Anaesth 2020 Aug 15;64(Suppl 3):S175-S179. Epub 2020 Aug 15.

Department of Urology, Father Muller's Medical College and Hospital, Mangalore, Karnataka, India.

Background And Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed.

Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows.

Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C.

Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.
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http://dx.doi.org/10.4103/ija.IJA_264_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641052PMC
August 2020

Management of pregnant laboring women during COVID-19 pandemic.

J Anaesthesiol Clin Pharmacol 2020 Aug 31;36(Suppl 1):S91-S96. Epub 2020 Jul 31.

Department of Anesthesiology, Pain medicine and Critical Care, All India Institute of Medica Sciences, New Delhi, India.

Since its first outbreak in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has become a global public health threat. In the midst of this rapidly evolving pandemic condition, the unique needs of pregnant women should be kept in mind while making treatment policies and preparing response plans. Management of COVID-19 parturients requires a multidisciplinary approach consisting of a team of anesthesiologists, obstetricians, neonatologists, nursing staff, critical care experts, infectious disease, and infection control experts. Labor rooms as well as operating rooms should be in a separate wing isolated from the main wing of the hospital. In the operating room, dedicated equipment and drugs for both neuraxial labor analgesia and cesarean delivery, as well as personal protective equipment, should be readily available. The entire staff must be specifically trained in the procedures of donning, doffing, and in the standard latest guidelines for disposal of biomedical waste of such areas. All protocols for the management of both COVID-19 suspects as well as confirmed patients should be in place. Further, simulation-based rehearsal of the procedures commonly carried out in the labor room and the operation theaters should be ensured.
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http://dx.doi.org/10.4103/joacp.JOACP_258_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573984PMC
August 2020

Sign language in anesthesiology in times of novel corona virus pandemic.

J Anaesthesiol Clin Pharmacol 2020 Aug 17;36(Suppl 1):S81-S82. Epub 2020 Aug 17.

Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/joacp.JOACP_322_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573999PMC
August 2020

Live in fear or make our lives better?

J Anaesthesiol Clin Pharmacol 2020 Aug 31;36(Suppl 1):S2-S4. Epub 2020 Jul 31.

Department of Anesthesia and Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/joacp.JOACP_288_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574015PMC
August 2020

Air embolism following hysteroscopy.

J Anaesthesiol Clin Pharmacol 2019 Jul-Sep;35(3):416-417

Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/joacp.JOACP_143_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748010PMC
September 2019

Evaluation of airway care score as a criterion for extubation in patients admitted in neurosurgery intensive care unit.

J Anaesthesiol Clin Pharmacol 2019 Jan-Mar;35(1):85-91

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Early extubation in neurocritical patients has several potential benefits. Glasgow Coma Scale (GCS) is a crude measure of neurologic function in these patients and a low GCS score does not necessarily mean contraindication for extubation. Data on patients with neurosurgical or neurological pathology undergoing early extubation utilizing the airway score criteria is limited. Hence, this study was conceived to assess the usefulness of modified airway care score (ACS) as a criterion for successful extubation of neurocritical patients whilst comparing various outcomes.

Material And Methods: One hundred and twenty four patient who underwent endotracheal intubation in the neurocritical care unit were enrolled in this prospective observational study over a period of 12 months. Patients were randomly enrolled into either the study group patients (S), who were extubated immediately after a successful spontaneous breathing trial (SBT) and an ACS ≤7 or into the control group (N), wherein patients were extubated/tracheostomized at discretion of the attending neurointensivist. Both groups were observed for comparison of preset outcomes and analyzed statistically.

Results: Patients of study group experienced a statistically significant shorter extubation delay (3.28 h vs 25.41 h) compared to the control group. Successful extubation rate was significantly higher and reintubation rate was significantly lower in study group (6.6% vs 29.3%). Incidence of nosocomial pneumonia, duration of ICU stay and overall duration of mechanical ventilation were significantly lower in the study group. ACS and GCS had a negative correlation at the time of extubation.

Conclusion: ACS can be used as a criterion for successful early extubation of neurocritical patients.
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http://dx.doi.org/10.4103/joacp.JOACP_362_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495608PMC
May 2019

Epidural Analgesia during Labor: Attitudes among Expectant Mothers and Their Care Providers.

Anesth Essays Res 2018 Apr-Jun;12(2):501-505

Department of Anaesthesia, Postgraduate Institute of Medical Sciences, Chandigarh, India.

Introduction: Varying levels of knowledge and attitudes among parturients and physicians toward epidural analgesia result in its low utilization. We aimed to assess the knowledge, attitude, and practice of parturients, obstetricians, and anesthesiologists regarding epidural labor analgesia.

Methodology: We surveyed obstetricians, anesthesiologists, and parturients availing care and later delivered at our hospital from July 1, 2017, to December 31, 2017. Knowledge, attitude, and practice regarding epidural analgesia were collected using a semi-structured predesigned questionnaire. Data were described as frequencies and analyzed for association between parity and various beliefs and attitudes using Chi-square or Fisher's exact test.

Results: About 33% of the parturients knew that delivery is possible without labor pains, but only 18% were satisfied with the procedure. Timely epidural anesthesia could not be availed by 83% of the parturients due to unavailability of service. Among the obstetricians, 64% preferred epidural analgesia and thought that epidural analgesia prolongs the duration of labor, and 55% thought that it would increase the incidence of lower uterine segment cesarean section (LUSCS). In our survey, 48% of all anesthesiologists thought that epidural analgesia would lead to an increase in the incidence of instrumental delivery, 52% required intravenous analgesics with epidural, and 63% thought that it would not increase the incidence of LUSCS. Fear of labor and delivery pain, knowledge status, unwillingness and demand for epidural analgesia, satisfaction level, and reasons for not undergoing the procedure were significantly associated with the gravid status.

Conclusion: Wide gap between desire for labor analgesia and its availability exists. A collaborative approach between anesthesiologists and obstetricians is required to disseminate correct information regarding epidural analgesia.
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http://dx.doi.org/10.4103/aer.AER_48_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020570PMC
July 2018

Formulation of a multivariate predictive model for difficult intubation: A double blinded prospective study.

J Anaesthesiol Clin Pharmacol 2018 Jan-Mar;34(1):62-67

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Various models were devised for prediction of difficult intubation but have low positive predictive value, sensitivity and specificity. We aimed to predict difficult intubation from various airway predictive indices, in isolation and combination, and to formulate a multivariate model that can aid in accurate prediction of difficult intubation.

Material And Methods: A prospective double blinded study was conducted on 500 adult patients scheduled for elective surgery under general anaesthesia. Preoperatively, they were assessed for airway screening tests. After standardized induction of anaesthesia, laryngoscopic view was classified according to the Modified Cormack and Lehane (MCL) classification. Variables' association with intubation findings was evaluated using Chi-square statistic. Stepwise logistic regression identified the multivariate independent predictors of difficult intubation and combinations were made using forward selection process. 8 models were formulated and a receiver-operating characteristic (ROC) curve worked out for them. Sensitivity and specificity analysis validated the final model.

Results: Age, sex, weight, BMI, snoring, obstructive sleep apnea (OSA), diabetes, hypertension, upper lip bite test (ULBT), Mallampati grade (MPS), thyromental distance (TMD), sternomental distance (SMD), neck movements (NM), neck circumference (NC) and inter-incisor gap (IIG) had significant correlation with difficult intubation. Based upon sensitivity and specificity analysis, model comprising of MPS, NM, NC and SMD was found to be most accurate. It had highest sensitivity 80%, specificity 87% and area under curve 0.90, thus validating the model.

Conclusions: Our study found that a combination of MPS, SMD, NM and NC permits reliable, accurate and quick preoperative prediction of difficult intubation.
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http://dx.doi.org/10.4103/joacp.JOACP_230_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885451PMC
April 2018

Stay calm and register your trial… its time.

J Anaesthesiol Clin Pharmacol 2017 Jul-Sep;33(3):287-288

Department of Anaesthesia and Critical Care, Dayanand Medical College, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/joacp.JOACP_185_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672533PMC
November 2017

A randomized comparative study assessing efficacy of pain versus comfort scores.

Saudi J Anaesth 2017 Oct-Dec;11(4):396-401

Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Context: Use of language with negative emotional content is likely to increase patient's pain and anxiety.

Aims: We designed a single-blinded randomized study to compare pain scores with comfort scores and to determine whether the technique of pain assessment affects patient's perceptions and experience.

Subjects And Methods: After cesarean section, 180 women were randomized before postanaesthesia interview into two groups. Group P women were asked to rate their pain on a 0-10-point verbal numerical rating scale (VNRS) for pain while Group C women were asked to rate their comfort on a 0-10-point VNRS for comfort. All women were asked whether the surgical wound was associated with injury or healing. The primary outcomes were to compare the incidence of reported pain and to assess pain severity as measured by a 0-10-point VNRS for pain compared with an equivalent inverted VNRS for comfort. The secondary outcomes were whether the wound was associated with injury or healing.

Statistical Analysis Used: Data were analyzed using Student's -test and nonparametric Mann-Whitney U-test, performed at a significance level of α =0.05.

Results: In Group P, 62 women (68.9%) reported pain compared with only 49 women (54.4%) in Group C ( < 0.05). There were no significant differences between groups for VNRS at rest and on movement. In Group P, thirty women (33.33%) reported sensations as injury compared with only 11 women (12.22%) in Group C ( < 0.001).

Conclusions: Assessment of pain using positive word like comfort decreases its incidence with no effect on its severity when measured by comfort score and also affects patient's postsurgical perceptions.
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http://dx.doi.org/10.4103/sja.SJA_256_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637414PMC
October 2017

Vibration sensation as an indicator of surgical anesthesia following brachial plexus block.

Saudi J Anaesth 2016 Oct-Dec;10(4):432-435

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Local anesthetic instillation in close vicinity to nerves anywhere in body blocks sensations in the same order as in central neuraxial blockade. The main purpose of this study was to evaluate the efficacy of vibration sense as criteria to determine the onset of surgical anesthesia following brachial plexus block and its correlation with loss of sensory and motor power.

Materials And Methods: This prospective study included fifty patients of American Society of Anaesthesiologist physical status I and II, aged between 18 and 45 years, undergoing elective upper limb surgery under brachial plexus block by supraclavicular approach. The baseline values of vibration sense perception using 128 Hz Rydel-Seiffer tuning fork, motor power using formal motor power of wrist flexion and wrist extension, and sensory score by pinprick method were recorded preoperatively and every 5 min after giving block till the onset of complete surgical anesthesia.

Results: The mean ± standard deviation of time (in minutes) for sensory, motor, and vibration block was 13.33 ± 3.26, 21.10 ± 3.26, and 25.50 ± 2.02, respectively ( < 0.05). Although all the patients achieved complete sensory and motor block after 25 min, 14% of the patients still had vibration sensations intact and 100% of the patients achieved complete sensory, motor, and vibration block after 30 min.

Conclusions: Vibration sense serves as a reliable indicator for the onset of surgical anesthesia following brachial plexus block. Vibration sense testing with 128 Hz Rydel-Seiffer tuning fork along with motor power assessment should be used as an objective tool to assess the onset of surgical anesthesia following brachial plexus block.
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http://dx.doi.org/10.4103/1658-354X.179114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044729PMC
November 2016

Literature search for research planning and identification of research problem.

Indian J Anaesth 2016 Sep;60(9):635-639

Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.

Literature search is a key step in performing good authentic research. It helps in formulating a research question and planning the study. The available published data are enormous; therefore, choosing the appropriate articles relevant to your study in question is an art. It can be time-consuming, tiring and can lead to disinterest or even abandonment of search in between if not carried out in a step-wise manner. Various databases are available for performing literature search. This article primarily stresses on how to formulate a research question, the various types and sources for literature search, which will help make your search specific and time-saving.
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http://dx.doi.org/10.4103/0019-5049.190618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037943PMC
September 2016

A comparative study on postoperative pain relief in laparoscopic cholecystectomy: Intraperitoneal bupivacaine versus combination of bupivacaine and buprenorphine.

Anesth Essays Res 2016 Jan-Apr;10(1):23-8

Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Context: To assess the analgesic efficacy of the combination of bupivacaine and buprenorphine in alleviating postoperative pain following laparoscopic cholecystectomy.

Aims: Laparoscopic cholecystectomy is comparatively advantageous as it offers less pain in the postoperative period and requires a shorter hospital stay. There are only a few studies performed to evaluate the analgesic efficacy of intraperitoneal instillation of buprenorphine and bupivacaine during laparoscopic cholecystectomy.

Settings And Design: The present research is a randomized, double-blind controlled study conducted in the Department of Anaesthesiology, Dayanand Medical College and Hospital Ludhiana, Punjab after formal ethical approval from Hospital's Ethics Committee.

Subjects And Methods: This study analyzed 90 adults admitted for elective laparoscopic cholecystectomy. After the procedure, subjects were divided into three equal groups to conduct the study. Three Groups A, B, and C had intraperitoneal instillation of the 25 ml of physiological saline (0.9% normal saline), 0.25% of bupivacaine, 0.25% bupivacaine, and 0.3 mg buprenorphine, respectively. Necessary vitals were monitored and recorded. Visual analog scale (VAS) and verbal rating scale (VRS) scores were recorded and analyzed systematically.

Statistical Analysis Used: All observations were analyzed using analysis of variance and Student's t-test.

Results: The mean pain scores were highest in Group A compared to Group B and Group C. Mean VAS and VRS scores were highest in Group C comparatively and lowest in Group A.

Conclusion: Combination of buprenorphine and bupivacaine intraperitoneally is comparatively more effective in relieving postoperative pain in comparison to intraperitoneal instillation of bupivacaine alone for postoperative pain management after laparoscopic cholecystectomy.
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http://dx.doi.org/10.4103/0259-1162.164731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767078PMC
March 2016

Evaluation of Cardiopulmonary Resuscitation (CPR) for Patient Outcomes and their Predictors.

J Clin Diagn Res 2016 Jan 1;10(1):UC01-4. Epub 2016 Jan 1.

PG Resident, Department of Anaesthesiology and Resuscitation, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .

Introduction: Cardiac arrest continues to be a common cause of in-hospital deaths. Even small improvements in survival can translate into thousands of lives saved every year.

Aim: The aim of our prospective observational study was to elicit the outcomes and predictors of in-hospital cardiopulmonary resuscitation among adult patients.

Settings And Design: All in-hospital adult patients (age >14) who suffered cardiac arrest & were attended by a Code Blue Team between 1(st) January 2012 & 30(th) April 2013 were part of the study.

Materials And Methods: The cardiopulmonary resuscitation (CPR) was assessed in terms of: Response time, Presenting initial rhythm, Time to first defibrillation, Duration of CPR and Outcome (Return of spontaneous circulation (ROSC), Glasgow outcome scale (GOS) at discharge).

Statistical Analysis: Age, GOS and mean response time were analysed using t-test and ANOVA. Logistic regression was applied to determine the significance of the various factors in determining mortality.

Results: ROSC was achieved in 44% of a total of 127 patients included in our study. Asystole/Pulseless electrical activity (PEA) was the most common presenting rhythm (87.5%). The survival to discharge was seen in 7.1% patients of whom only 3.9% patients had good neurological outcome. Regression and survival analysis depicted achievement of ROSC during CPR, absence of co-morbidities and shorter response time of code blue team as predictors of good outcome.

Conclusion: We found poor outcome of CPR after in-hospital cardiac arrest. This was mainly attributed to an initial presenting rhythm of Asystole/PEA in most cases and delayed response times.
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http://dx.doi.org/10.7860/JCDR/2016/14773.7012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740678PMC
January 2016

Effect of clonidine and/or fentanyl in combination with intrathecal bupivacaine for lower limb surgery.

J Anaesthesiol Clin Pharmacol 2015 Oct-Dec;31(4):485-90

Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: Various adjuncts to local anesthetics have been used with the purpose of improving the quality of subarachnoid block. This randomized double-blind study was conducted to evaluate the efficacy of adding clonidine to bupivacaine and bupivacaine-fentanyl combination.

Material And Methods: A total of 100 patients scheduled for surgery under spinal anesthesia were randomly allocated into four groups (n = 25 each) to receive intrathecal bupivacaine 7.5 mg plus normal saline 0.5 ml (group BS), intrathecal bupivacaine 7.5 mg, and fentanyl 25 μg (group BF), intrathecal bupivacaine 7.5 mg and clonidine 75 μg (group BC), intrathecal bupivacaine 7.5 mg, clonidine 37.5 μg, and fentanyl 12.5 μg (group BCF). The time of onset and duration of sensory block, highest dermatome level of sensory block, time of onset of motor block, time to complete motor block recovery and duration of spinal anesthesia, intraoperative and postoperative hemodynamics and side effects if any were recorded. VAS, total number of patients who were administered supplemental analgesic in each group and the total amount of supplemental analgesic administered in the next 24 h was quantified and documented in all the groups.

Results: The time of onset of sensory block (min) in groups BS, BC, BCF, and BF was 10.80 ± 2.26, 10.20 ± 1.00, 10.00 ± 0.00, and 13.80 ± 2.61 respectively, thus onset of sensory block was significantly earlier in groups BC and BCF. Similarly, onset of motor block was also quicker in groups BC and BCF. Time of requirement of supplemental analgesia was 135.20 ± 12.70 min, 199.2 ± 21.92 min, 209.80 ± 26.32 min, and 208.00 ± 26.58 min in groups BS, BF, BC, and BCF respectively. Intraoperative and postoperative changes in heart rate, mean arterial blood pressure, oxygen saturation, and respiratory rate were comparable. Sedation scores were significantly higher in group BC. Pruritus was only observed in groups BF and BCF. Mean nausea vomiting scores were comparable in all groups.

Conclusion: We conclude that the addition of clonidine in doses of 75 μg and 37.5 μg to low-dose bupivacaine and bupivacaine-fentanyl prolongs the sensory and motor block while increasing the duration of postoperative analgesia without significant side-effects.
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http://dx.doi.org/10.4103/0970-9185.169069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676237PMC
December 2015

A Randomized Double Blinded Comparison of Epidural Infusion of Bupivacaine, Ropivacaine, Bupivacaine-Fentanyl, Ropivacaine-Fentanyl for Postoperative Pain Relief in Lower Limb Surgeries.

J Clin Diagn Res 2015 Sep 1;9(9):UC19-23. Epub 2015 Sep 1.

PG Resident, Department of Anaesthesia, Dayanand Medical College & Hospital , Ludhiana, India .

Background: Continuous epidural infusion of Bupivacaine and Ropivacaine with or without the addition of Fentanyl has been evaluated by various researchers for effective postoperative pain relief. Studies however, depict significant variability in their results with regard to analgesic efficacy and adverse effects like hypotension, motor blockade etc.

Aim: To comparatively evaluate postoperative analgesic efficacy, motor sparing effect, postoperative haemodynamic variations and total postoperative analgesic consumption in first 24 hours.

Materials And Methods: A randomised double blind study was conducted on 100 adult, ASA grade I and II patients, of either sex who had undergone elective lower limb surgery under spinal anaesthesia. According to the group allocated, patients were started on epidural infusion after completion of surgery. Group I (0.2% Ropivacaine), Group II (0.1% Ropivacaine + 2μg/ml Fentanyl), Group III (0.2% Bupivacaine), Group IV (0.1% Bupivacaine + 2μg/ml Fentanyl) at the rate of 6 ml/hour. VAS scores, epidural consumption, supplemental epidural boluses, rescue analgesics, haemodynamics, motor block, sensory block regression, sedation, nausea and pruritis were recorded by a blinded observer for 24 hours.

Results: The haemodynamic parameters were stable in all the groups. Side effects including the motor block were negligible and comparable in all groups. Group I patients had significantly lower VAS scores, mean total epidural consumption, supplemental epidural bolus requirement and rescue analgesic requirement among all groups.

Conclusion: It can be concluded that epidural analgesia using Ropivacaine 0.2% infusion is more effective than other study groups when used for postoperative pain relief in lower limb surgeries.
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http://dx.doi.org/10.7860/JCDR/2015/15157.6459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606313PMC
September 2015

Bilateral Infraorbital Nerve Block Versus Intravenous Pentazocine: A Comparative Study on Post-operative Pain Relief Following Cleft Lip Surgery.

J Clin Diagn Res 2015 May 1;9(5):UC04-6. Epub 2015 May 1.

Professor, Department of Anaesthesia, Dayanand Medical College and Hospital , Ludhiana, Punjab, India .

Background And Objectives: Infra orbital nerve block is utilized for postoperative pain control in children undergoing cleft lip repair. This study was conducted to compare the effectiveness, advantages and disadvantages of infra orbital nerve block and opioids for postoperative pain relief following cheiloplasty.

Materials And Methods: Sixty paediatric patients aged 3 months - 13 years undergoing cheiloplasty were selected by simple random sampling and were divided into two groups. All the children received standardized premedication with midazolam, were operated upon under general anaesthesia and the block was performed at the end of surgery before reversal. Group B patients were administered bilateral infra orbital nerve block with 0.25% Bupivacaine (upto 2 mg/kg). Group O patients received Pentazocine 0.5 mg / kg IV. Postoperatively, the heart rate and respiratory rates were recorded every 15 minutes for the first 60 minutes, half hourly till 4 hours and then at 12 and 24 hours. Behavioural assessment for pain / discomfort was done at intervals of ½, 1, 2, 3, 4, 12 and 24 hours. Need for supplementary analgesics and duration between the administration of block/opioid and the first dose of supplementary analgesics were noted. Side effects such as nausea and vomiting, pruritus, respiratory depression and bradycardia during each of these periods were noted.

Results: Both the groups were comparable for age, sex, weight and operative time with no statistical difference. The mean duration of analgesia for infra orbital nerve block was 357.5 minutes i.e. 5 hours 58 minutes and that for opioid was 231 minutes i.e. 3 hours 51 minutes which was significantly lower than the hours of analgesia provided by the block. Further, at the 4th hour, 76.6% of the patients in Group O required supplementary analgesics, in contrast to only 16.6% in Group B. The incidence of nausea and vomiting and pruritus was also higher in Group O.

Conclusion: The results indicate that bilateral infra orbital nerve block provides effective analgesia in the postoperative period, lasting for 6 hours in comparison to 3½ - 4 hours following the administration of intravenous Pentazocine, with no major untoward effects.
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http://dx.doi.org/10.7860/JCDR/2015/11953.5984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484127PMC
May 2015

Vistas for the future.

Authors:
Anju Grewal

J Anaesthesiol Clin Pharmacol 2015 Jan-Mar;31(1):4-5

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/0970-9185.150514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353151PMC
March 2015

[Not Available].

Braz J Anesthesiol 2014 May-Jun;64(3):216-8. Epub 2014 May 1.

Departamento de Anestesiologia, Dayanand Medical College & Hospital, Ludhiana, Punjab, Índia.

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http://dx.doi.org/10.1016/j.bjan.2013.08.005DOI Listing
August 2015

Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block.

J Clin Diagn Res 2014 Jun 20;8(6):GC01-5. Epub 2014 Jun 20.

Professor, Department of Anaesthesia, DMCH, Dayanand-Medical-College-Hospital- , Ludhiana, India .

Background: Spinal anaesthesia is the primary anaesthetic technique for many types of surgeries. Adjuncts to the local anaesthetics (LA) used in spinal anaesthesia can exhibit undesirable side-effects like respiratory depression, urinary retention, pruritis, haemodynamic instability and nausea and vomiting, limiting their use. Magnesium when used in therapeutic doses avoids all of these side-effects.

Materials And Methods: We conducted a randomized double blind study on 90 patients, 30 in each group, scheduled for orthopaedic lower limb surgery under subarachnoid block. Group I: received bupivacaine (0.5%), 12.5 mg + 0.5 ml of preservative free 0.9% normal saline, Group II received bupivacaine (0.5%), 12.5 mg + 0.2 ml (50 mg) of preservative free 25 % magnesium sulphate + 0.3 ml of preservative free 0.9% normal saline Group III: received bupivacaine (0.5%) 12.5 mg + 0.3 ml (75 mg) of 25 % magnesium sulphate + 0.2 ml of preservative free 0.9% normal saline for subarachnoid block. The onset and duration of sensory block, the highest dermatomal level of sensory block, motor block, time to complete motor block recovery and duration of spinal anaesthesia were recorded.

Statistical Analysis: ANOVA was applied to determine the significance of difference between different groups. If p-value was significant then Turkey's Post Hoc Multicomparison test was applied. Values of p<0.05 were considered to be statistically significant.

Results: The time of maximum sensory block, time of onset of motor block, duration of sensory block, duration of motor block and time of analgesia request were prolonged in patients given magnesium 50mg and 75mg along with local anaesthetic intrathecally.

Conclusion: N-methyl-D-aspartate (NMDA) receptor antagonist, magnesium when administered intrathecally along with local anaesthetics prolongs the duration of spinal analgesia without adverse effects.
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http://dx.doi.org/10.7860/JCDR/2014/8295.4510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129284PMC
June 2014

Palatoplasty in a patient with Seckel syndrome: an anesthetic challenge.

Braz J Anesthesiol 2014 May-Jun;64(3):216-8. Epub 2013 Nov 6.

Department of Anesthesiology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.1016/j.bjane.2013.08.005DOI Listing
April 2015

Fatal mediastinal hematoma following right internal jugular vein cannulation.

J Anaesthesiol Clin Pharmacol 2014 Apr;30(2):290-1

Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/0970-9185.130119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009664PMC
April 2014

Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy.

J Anaesthesiol Clin Pharmacol 2014 Jan;30(1):46-52

Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use.

Materials And Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml) was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml) was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU) and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests.

Results: Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg) as compared to group II (24.80 ± 6.009 mg). Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P < 0.001). Group I patients were discharged earlier from PACU as compared to group II (P < 0.001) though time of discharge from hospital was similar in both the groups. There were no major adverse effects except pruritis, which was observed in 30.6% patients in group I and 37.3% in group II (statistically insignificant (P > 0.01)).

Conclusion: Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.
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http://dx.doi.org/10.4103/0970-9185.125703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927292PMC
January 2014

Hemodynamic responses with different dose of ketamine and propofol in day care gynecological surgeries.

J Clin Diagn Res 2013 Nov 10;7(11):2548-50. Epub 2013 Nov 10.

Assistant Professor, Department of Surgery, Dayanand Medical College and Hospital , Ludhiana, India .

Background: Day care gynaecological surgeries mandate use of hemodynamically stable combination of commonly used intravenous agents, propofol & ketamine. Hence we proposed to evaluate the hemodynamic profile of different dose combination of propofol & ketamine as induction agents in ambulatory gynecological surgeries.

Material & Methods: Thirty adult patients scheduled for day care gynecological surgeries were randomly divided into five Groups. Group I received inj. propofol 2mg/kg i.v + inj. Normal saline (NS); Group II received ketamine 2mg/kg i.v + inj. NS; Group III was given inj. Propofol 2mg/kg i.v followed by inj. Ketamine 1 mg/kg i.v.; Group IV received inj. Ketamine 2 mg/kg i.v followed by inj. propofol 1 mg/kg i.v; Group V received combination of inj. Propofol 1 mg/kg i.v and inj. Ketamine 1 mg/kg i.v. After administration of the drug, non invasive systolic, diastolic and mean arterial pressures, heart rate, respiratory rate, arterial oxygen saturation and ECG were recorded every minute for five minutes.

Results: Statistically significant hemodynamic alterations were observed in Group I & II, with Group I having the highest incidence of apnea (23.3%). No significant changes in hemodynamics were seen in Group V.

Conclusion: We conclude that the combination of 1mg Propofol and 1mg ketamine produced better hemodynamic stability in comparison to other Groups.
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http://dx.doi.org/10.7860/JCDR/2013/6860.3607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879860PMC
November 2013

A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study.

J Anaesthesiol Clin Pharmacol 2013 Oct;29(4):496-502

Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. Dexmedetomidine, the highly selective 2 adrenergic agonist is a new neuraxial adjuvant gaining popularity.

Settings And Design: The study was conducted in prospective, double blind manner. It included 120 American Society of Anesthesiology (ASA) class I and II patients undergoing lower limb surgery under spinal anesthesia after approval from hospital ethics committee with written and informed consent of patients.

Materials And Methods: The patients were randomly allocated into four groups (30 patients each). Group BS received 12.5 mg hyperbaric bupivacaine with normal saline, group BF received 12.5 mg bupivacaine with 25 g fentanyl, group BC received 12.5 mg of bupivacaine supplemented 30 g clonidine, and group BD received 12.5 mg bupivacaine plus 5 g dexmedetomidine. The onset time to reach peak sensory and motor level, the regression time of sensory and motor block, hemodynamic changes, and side effects were recorded.

Results: Patients in Group BD had significantly longer sensory and motor block times than patients in Groups BC, BF, and BS with Groups BC and BF having comparable duration of sensory and motor block. The mean time of two segment sensory block regression was 147 ± 21 min in Group BD, 117 ± 22 in Group BC, 119 ± 23 in Group BF, and 102 ± 17 in Group BS (P > 0.0001). The regression time of motor block to reach modified Bromage zero (0) was 275 ± 25, 199 ± 26, 196 ± 27, 161 ± 20 in Group BD, BC, BF, and BS, respectively (P > 0.0001). The onset times to reach T8 dermatome and modified Bromage 3 motor block were not significantly different between the groups. Dexmedetomidine group showed significantly less and delayed requirement of rescue analgesic.

Conclusions: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand of rescue analgesics in 24 h as compared to clonidine, fentanyl, or lone bupivacaine.
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http://dx.doi.org/10.4103/0970-9185.119151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819844PMC
October 2013

Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy.

J Anaesthesiol Clin Pharmacol 2013 Oct;29(4):478-84

Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity.

Materials And Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h.

Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations.

Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.
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http://dx.doi.org/10.4103/0970-9185.119141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819841PMC
October 2013

Regional anesthesia in patients with pregnancy induced hypertension.

J Anaesthesiol Clin Pharmacol 2013 Oct;29(4):435-44

Department of Anesthesia, Toronto Western Hospital, University Health Network, McL 2 405, Toronto, ON, M5T 2S8, Canada.

Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.
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http://dx.doi.org/10.4103/0970-9185.119108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819834PMC
October 2013

Palatoplasty in a patient with Seckel syndrome.

Ann Maxillofac Surg 2012 Jan;2(1):63-5

Department of Plastic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

We report a rare case of a patient of Seckel syndrome having cleft palate born to nonconsanguineous married parents. This 8-year-old male child underwent successful palatoplasty under general anesthesia. Till date there are approximately 60 cases of Seckel syndrome reported in the literature. The syndrome which has autosomal recessive inheritance is characterized by Intra Uterine Growth Retardation, microcephaly, dwarfism, and bird-like face. The associated features of the syndrome and technical details of surgery and anesthesia are discussed.
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http://dx.doi.org/10.4103/2231-0746.95324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591075PMC
January 2012