Publications by authors named "Renu Sinha"

73 Publications

Preoperative planning for central venous cannulation in conjoint twins.

J Anaesthesiol Clin Pharmacol 2020 Oct-Dec;36(4):569-570. Epub 2021 Jan 18.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Delhi, India.

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http://dx.doi.org/10.4103/joacp.JOACP_596_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022058PMC
January 2021

Local anaesthetic systemic toxicity in paediatric patient: Tips to prevent.

Saudi J Anaesth 2020 Oct-Dec;14(4):561-562. Epub 2020 Sep 24.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/sja.SJA_233_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796731PMC
September 2020

Different standards of the variable pitch for oxygen saturation with pulse rate and heart rate monitoring: An avoidable complication.

Saudi J Anaesth 2020 Oct-Dec;14(4):559-560. Epub 2020 Sep 24.

Department of Anesthesiology, All India Institute of Medical Science, New Delhi, India.

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http://dx.doi.org/10.4103/sja.SJA_163_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796754PMC
September 2020

Persistent intraoperative arrhythmias due to cannabis: Report of two cases.

Indian J Anaesth 2020 Aug 15;64(Suppl 3):S210-S212. Epub 2020 Aug 15.

Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India.

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http://dx.doi.org/10.4103/ija.IJA_324_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641057PMC
August 2020

Endoscopy mask for safe extubation in patients with COVID-19.

J Anaesthesiol Clin Pharmacol 2020 Aug 31;36(Suppl 1):S155-S157. Epub 2020 Jul 31.

Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.

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http://dx.doi.org/10.4103/joacp.JOACP_391_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574007PMC
August 2020

Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents - A prospective controlled clinical trial.

Saudi J Anaesth 2020 Jan-Mar;14(1):15-21. Epub 2020 Jan 6.

Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.

Background: Anesthesia trainee may initially take longer time to intubate and unintentionally place the endotracheal tube (ETT) in the esophagus. The present study determined if ultrasound is the fastest method of confirmation of correct placement of ETT compared to capnography, and chest auscultation in trainees.

Methods: First year anesthesia residents performed intubation in 120 patients recruited after ethical clearance and informed consent. Time to visualize flutter in trachea, double trachea sign, time to appearance of first and sixth capnography, and time to execute chest auscultation was noted.

Results: Ultrasonography was statistically fastest method to determine endotracheal intubation (36.50 ± 15.14 seconds) vs unilateral chest auscultation (50.29 ± 15.50 seconds) vs bilateral chest auscultation (51.90 ± 15.98 seconds) vs capnography first waveform (53.57 ± 15.97 seconds) vs capnography sixth waveform (61.67 ± 15.88 seconds).

Conclusion: When teaching endotracheal intubation to novice anesthesia residents using conventional direct laryngoscopy, ultrasonography is the fastest method to confirm correct ETT placement compared to capnograph and chest auscultation. Mentor can guide trainee to direct ETT towards trachea and can promptly detect esophageal intubation by double trachea sign.
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http://dx.doi.org/10.4103/sja.SJA_180_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970360PMC
January 2020

Comparison of the C-MAC video laryngoscope size 2 Macintosh blade with size 2 C-MAC D-Blade for laryngoscopy and endotracheal intubation in children with simulated cervical spine injury: A prospective randomized crossover study.

J Anaesthesiol Clin Pharmacol 2019 Oct-Dec;35(4):509-514

Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: CMAC video laryngoscope size 2 D-Blade has been recently introduced for management of pediatric difficult airway. Our primary outcome was to compare glottic view, intubation time, and ease of intubation with the size 2 Macintosh versus D-Blade of C-MAC video laryngoscope in simulated cervical injury in children.

Material And Methods: This randomized crossover study was conducted in a tertiary care hospital of Northern India. Forty children of 4-14 years of age were enrolled in this study. After induction of anesthesia, video laryngoscopy was performed either with size 2 CMAC Macintosh (group M) or D-Blade (group D) with manual in-line stabilization. After removal of the first blade, second video laryngoscopy was performed with the alternative blade. Endotracheal intubation was done with the second laryngoscopy. Best glottic view, time for best glottic view, and difficulty in blade insertion were recorded during both the video laryngoscopies. During second video laryngoscopy, difficulty of tube insertion and time for intubation were noted.

Results: The glottic view grade was significantly better in group D compared with the group M ( = 0.0002). Insertion of D-Blade was more difficult than Macintosh blade ( = 0.0007). There was no statistical difference in terms of time for best glottic view in group M and group D (13.40 ± 4.90 vs 13.62 ± 5.60 s) and endotracheal tube insertion time (24.80 ± 7.90 vs 27.90 ± 10.90 s), respectively. Number of intubation attempts was similar in both the groups.

Conclusions: Size 2 D-Blade of C-MAC video laryngoscope provided a better glottic view in children with simulated cervical spine injury as compared with CMAC Macintosh blade. Success of intubation, intubation time, and ease of intubation were comparable with both the blades.
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http://dx.doi.org/10.4103/joacp.JOACP_106_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939578PMC
January 2020

Successful anaesthesia management of a child with hunter syndrome for adenotonsillectomy.

Intractable Rare Dis Res 2019 Nov;8(4):286-288

Department of ENT, All India Institute of Medical Sciences, New Delhi, India.

Airway management in a child with hunter syndrome is a challenge to the anesthetists. Various methods to achieve this are reported in literature. Here we describe another method in a three year old male child posted for adenotonsillectomy and myringotomy. After check videolaryngoscopy with C Mac blade size 2, vocal cords were not visible even with various monoevres. Thus a larger blade size 3 was used to place it under the epiglottis after which posterior part of vocal cords became visible and bougie guided endotracheal intubation was successful. Thus we recommend that in a child with hunter syndrome if vocal cords are not visible, a larger blade can be utilized to place under the epiglottis to visualize the vocal cords for successful endotracheal intubation.
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http://dx.doi.org/10.5582/irdr.2019.01072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929600PMC
November 2019

Effect of entropy-guided low-flow desflurane anaesthesia on laryngeal mask airway removal time in children undergoing elective ophthalmic surgery - A prospective, randomised, comparative study.

Indian J Anaesth 2019 Jun;63(6):485-490

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: In children, entropy-guided titration of isoflurane and sevoflurane leads to faster recovery after anaesthesia. However, role of entropy in recovery following desflurane anaesthesia is not known. Hence, we compared laryngeal mask airway (LMA) removal time and desflurane consumption with entropy and minimal alveolar concentration-guided titration in children given low-flow desflurane anaesthesia.

Methods: After ethics committee approval and parental consent, 80 American Society of Anesthesiologists grade I-II children, age 2-14 years, undergoing elective ophthalmic surgery were randomised into entropy and minimal alveolar concentration-guided groups. After LMA insertion, anaesthesia was maintained using oxygen, air (FiO 0.5) and desflurane using low fresh gas flow of 0.75 L/min. In the entropy-guided group, desflurane was titrated to maintain state entropy between 40 and 60. In the minimal alveolar concentration-guided group, desflurane was titrated to maintain a minimal alveolar concentration between 1 and 1.3. We recorded LMA removal time (from switching off desflurane at the end of surgery till removal of LMA), haemodynamic parameters, uptake and consumption of desflurane between the groups.

Results: LMA removal time was significantly decreased in the entropy-guided group in comparison to the minimal alveolar concentration-guided group (4.34 ± 2.03 vs 8.8 ± 2.33 min) ( < 0.0001). Consumption of desflurane was significantly less in the entropy-guided group compared with the minimal alveolar concentration-guided group (18.7 ± 5.07 vs 25.3 ± 8.11 mL) ( < 0.0001).

Conclusion: Entropy-guided low-flow desflurane anaesthesia is associated with faster LMA removal and reduced consumption of desflurane in children undergoing ophthalmic surgery.
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http://dx.doi.org/10.4103/ija.IJA_237_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6573054PMC
June 2019

Surgical outcomes of immediate sequential bilateral vitreoretinal surgery for advancing retinopathy of prematurity.

Indian J Ophthalmol 2019 06;67(6):903-907

Department of Ocular Anaesthesia, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Bilateral eye surgery in the same session may be required for advancing stage 4 retinopathy of prematurity (ROP). The purpose of this study was to evaluate the outcomes of immediate sequential bilateral vitreoretinal surgery (ISBVS) in stage 4 ROP.

Methods: In a retrospective interventional study at a tertiary care center, 60 eyes of 30 infants who underwent ISBVS for stage 4 ROP between December 2015 and May 2017 were studied. In cases with clear retrolental access, 25G or 27G lens sparing vitrectomy (LSV) was performed and in the rest 25G lensectomy with vitrectomy (LV) was performed through clear corneal entries. The final anatomical outcome measures were the status of tractional retinal detachment (TRD) and macular status.

Results: The mean gestational age was 28.4 ± 2.0 weeks and birth weight was 1214.5 ± 329.7gms. The mean postconceptional age at surgery was 40.8 ± 2.2 weeks. Stages 4a and 4b were present in 86.7% and 13.3% eyes respectively. LSV was performed in 95% eyes whereas LV was performed in the rest. None of the eyes developed lens touch, choroidal hemorrhage, postoperative hypotony, corneal decompensation, or endophthalmitis. At last follow-up (mean 45 weeks, range 20-68 weeks), macula was attached in 90% eyes with the TRD resolved completely in 61.7% eyes and significantly decreased in another 25% eyes. Sequalae included macular drag, epiretinal membrane, and progression to fibrotic stage 5 disease.

Conclusion: ISBVS is safe and effective for bilateral stage 4 ROP and should be recommended in rapidly progressive cases.
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http://dx.doi.org/10.4103/ijo.IJO_741_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552586PMC
June 2019

Evaluation of performance of C-MAC video laryngoscope Miller blade size zero for endotracheal intubation in preterm and ex-preterm infants: A retrospective analysis.

Indian J Anaesth 2019 Apr;63(4):284-288

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: The preterm and ex-preterm babies form a separate group among the paediatric population with unique airway anatomy. The utility of C-MAC Video laryngoscope (VL) for routine intubation of preterm babies has not been evaluated. The purpose of this study is to report the performance of C-MAC VL Miller blade size-0 for endotracheal intubation in preterm babies at our institute.

Methods: After Institute Ethics Committee approval, a retrospective study was designed to evaluate the performance of C-MAC VL for intubation in preterm and ex-preterm babies. The medical files, and video recordings of preterm babies up to 60 weeks of post-gestational age who had undergone surgery for retinopathy of prematurity from January 2014 to April 2016 were reviewed. All babies were intubated with C-MAC Miller blade size-0. Demographic parameters, time to best glottic view (TTGV), time to intubate (TTI), ease and number of intubation attempts were assessed. Episodes of desaturation and complications related to intubation were recorded.

Results: Data of 37 preterm and ex-preterm babies were analysed. The mean age and weight at the time of surgery were 40.5 (±4.9) weeks and 2532 (±879) grams respectively. The median TTGV and TTI were 11.0 and 22.0 seconds. A total of 32 babies (86.5%) were intubated on initial attempt and five were intubated on second attempt. Stylet was used to facilitate intubation in all infants. There was no incidence of desaturation, mucosal injury or bleeding.

Conclusion: C-MAC video laryngoscope Miller blade size 0 is suitable for endotracheal intubation in preterm and ex-preterm infants.
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http://dx.doi.org/10.4103/ija.IJA_753_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460968PMC
April 2019

Comparison of low-fresh gas flow technique to standard technique of sevoflurane induction in children-A randomized controlled trial.

Paediatr Anaesth 2019 04 24;29(4):304-309. Epub 2019 Jan 24.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background: Although sevoflurane is preferred for inhalational induction in children, financial and environmental costs remain major limitations. The aim of this study was to determine if the use of low-fresh gas flow during inhalational induction with sevoflurane could significantly reduce agent consumption, without adversely affecting induction conditions.

Methods: After institutional ethical committee approval, 50 children, aged 1-5 years, undergoing ophthalmic procedures under general anesthesia, were randomized into two groups-standard induction (Group S) and low-flow induction (Group L). A pediatric circle system with 1 L reservoir bag was primed with 8% sevoflurane in oxygen at 6 L min for 30 seconds before beginning induction. In Group S, fresh gas flow was maintained at 6 L min until the end of induction. In Group L, fresh gas flow was reduced to 1 L min after applying facemask (time = T0). In both groups, sevoflurane was reduced to 5% after loss of eyelash reflex (T1). Once adequate depth of anesthesia was achieved (regular respiration, loss of muscle tone, and absence of movement to trapezius squeeze), intravenous access was secured (T2), followed by insertion of an appropriately sized LMA-Classic™ (T3). Heart rate and endtidal sevoflurane concentration were measured at each of the above time points, and at 15 seconds following laryngeal mask airway insertion (T4). The total amount of sevoflurane consumed during induction was recorded.

Results: Sevoflurane consumption was significantly lower in Group L (4.17 ± 0.70 mL) compared to Group S (8.96 ± 1.11 mL) (mean difference 4.79 [95% CI = 4.25-5.33] mL; P < 0.001). Time to successful laryngeal mask airway insertion was similar in both groups. There were no significant differences in heart rate, incidence of reflex tachycardia, or need for rescue propofol.

Conclusion: Induction of anesthesia with sevoflurane using low-fresh gas flow is effective in reducing sevoflurane consumption, without compromising induction time and conditions.
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http://dx.doi.org/10.1111/pan.13582DOI Listing
April 2019

C-MAC D-BLADE for awake oro-tracheal intubation with minimal mouth opening - A safe alternative to fibreoptic bronchoscope.

Indian J Anaesth 2018 Nov;62(11):916-918

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ija.IJA_431_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236794PMC
November 2018

Systemic Associations of Childhood Glaucoma: A Review.

J Pediatr Ophthalmol Strabismus 2018 Nov;55(6):397-402

Purpose: To review systemic associations of childhood glaucoma.

Methods: Patients younger than 15 years and diagnosed as having glaucoma were divided into four groups: isolated primary congenital glaucoma, glaucoma with other congenital ocular anomalies, congenital glaucoma with known systemic diseases, and secondary glaucoma. Prevalence and type of systemic associations in each group were studied.

Results: A retrospective analysis of 371 patients diagnosed as having glaucoma was done. In the primary congenital glaucoma group, 13 of 218 (5.9%) patients had an associated systemic illness: congenital heart disease and global developmental delay were the most common systemic manifestations. In the congenital ocular anomalies group, 10 of 63 (15.8%) patients had an associated systemic illness. Axenfeld-Reiger syndrome, aniridia, and Peters' anomaly frequently had systemic comorbidities with congenital heart disease. In the known systemic diseases group, all 18 (100%) patients had systemic manifestations of an associated syndrome: Sturge-Weber and Down syndrome were the most frequent. In the secondary glaucoma group, 9 of 72 (12.5%) patients had systemic involvement, which was often seen as the most common cause after congenital cataract surgery. These children had congenital heart disease and global developmental delay as a consequence of congenital rubella and congenital cytomegalovirus infection.

Conclusions: The study found that 12.9% of patients with childhood glaucoma had an associated systemic abnormality. Patients with congenital glaucoma and other ocular anomalies have a three times higher risk of an underlying systemic anomaly than patients with isolated primary congenital glaucoma. A team comprising an ophthalmologist, pediatrician, and anesthesiologist is recommended to treat these cases. [J Pediatr Ophthalmol Strabismus. 2018;55(6):397-402.].
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http://dx.doi.org/10.3928/01913913-20180905-01DOI Listing
November 2018

Anaesthetic concerns in the patients with congenital erythropoietic porphyria for ocular surgery.

J Clin Anesth 2019 May 26;54:3-5. Epub 2018 Oct 26.

Dept. of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1016/j.jclinane.2018.10.010DOI Listing
May 2019

Intravenous dexmedetomidine augments the oculocardiac reflex.

J AAPOS 2019 02 22;23(1):62. Epub 2018 Sep 22.

AIIMS, New Delhi, India.

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http://dx.doi.org/10.1016/j.jaapos.2018.09.001DOI Listing
February 2019

Major leak during controlled ventilation due to faulty exhaust valve missed during pre-use machine check.

Indian J Anaesth 2018 Jul;62(7):560-562

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ija.IJA_143_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053888PMC
July 2018

Correlation between duration of preoperative fasting and emergence delirium in pediatric patients undergoing ophthalmic examination under anesthesia: A prospective observational study.

Paediatr Anaesth 2018 06 12;28(6):547-551. Epub 2018 May 12.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background: Preoperative fasting in children can cause anxiety, which may ultimately lead to postoperative emergence delirium. However, no data are available whether duration of preoperative fasting correlates with postoperative emergence delirium.

Aims: The aim of this study was to identify if there is any correlation between the duration of preoperative fasting and emergence delirium in children undergoing ophthalmic examination under anesthesia.

Methods: In this prospective observational study, 100 children between the age group 2-6 years of American Society of Anesthesiologists physical status I or II, scheduled for examination of the eye under general anesthesia with sevoflurane were recruited. Data regarding preoperative fasting was recorded and presence of emergence delirium was assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 minute interval till 30 minutes from the time of leaving the operation theater. No premedication was used in any patients but parental presence was allowed in all of them.

Results: Mean (standard deviation) duration of fasting to clear liquid was 6.3 (1.7) hrs. Twenty-four children (24%) had at least 1 recorded PAED score >10 at any time point in the postoperative period. PAED scores at 15 and 25 minutes were significantly correlated with duration of fasting (r [95% CI] = .24 [0.04, 0.41], P = .02, Pearsons's correlation and r [95% CI] = .23 [0.04, 0.41], P = .02, Pearsons's correlation, respectively). No correlation has been found between duration of fasting and blood glucose level (r [95% CI] = -.05 [-0.24, 0.15], P = .65, Pearsons's correlation) between fasting blood glucose and PAED score at any time point.

Conclusion: Increased preoperative fasting duration may be a risk factor for postoperative emergence delirium in children undergoing ophthalmic examination under general anesthesia.
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http://dx.doi.org/10.1111/pan.13381DOI Listing
June 2018

Safer methods of ophthalmic block.

Indian J Anaesth 2018 Apr;62(4):323

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ija.IJA_220_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907444PMC
April 2018

Subcutaneous emphysema - An unexpected cause for respiratory distress during vitreoretinal surgery under peribulbar block.

Indian J Anaesth 2018 Jan;62(1):79-80

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ija.IJA_606_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787897PMC
January 2018

Unfavourable outcome after uneventful anaesthesia and surgery in a child with Hurler syndrome.

Indian J Anaesth 2017 Oct;61(10):853-855

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ija.IJA_392_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664898PMC
October 2017

Pectoral nerve blocks to improve analgesia after breast cancer surgery: A prospective, randomized and controlled trial.

J Clin Anesth 2018 03 11;45:12-17. Epub 2017 Dec 11.

Department of Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Study Objective: To evaluate the analgesic efficacy of ultrasound guided combined pectoral nerve blocks I and II in patients scheduled for surgery for breast cancer.

Design: Prospective, randomized, control trial.

Setting: Operating rooms in a tertiary care hospital of Northern India.

Patients: Sixty American Society of Anesthesiologists status I to II adult women, aged 18-70years were enrolled in this study.

Interventions: Patients were randomized into two groups (30 patients in each group), PECS (P) group and control (C) group. In group P, patients received both general anesthesia and ultrasound guided combined pectoral nerve blocks (PECS I and II). In group C, patients received only general anesthesia.

Measurements: We noted pain intensity at rest and during abduction of the ipsilateral upper limb, incidence of postoperative nausea and vomiting; patient's satisfaction with postoperative analgesia and maximal painless abduction at different time intervals in both groups.

Main Results: There was significant decrease in the total amount of fentanyl requirement in the in P group {(140.66±31.80μg) and (438±71.74μg)} in comparison to C group {(218.33±23.93μg) and (609±53.00μg)} during intraoperative and post-operative period upto 24h respectively. The time to first analgesic requirement was also more in P group (44.33±17.65min) in comparison to C group (10.36±4.97min) during post-operative period. There was less limitation of shoulder movement (pain free mobilization) on the operative site at 4h and 5h after surgery in P group in comparison to C group. However there was no difference in the incidence of post-operative nausea and vomiting (22 out of 30 patients in group P and 20 out of 30 patients in group C) but patients in group P had a better satisfaction score with postoperative analgesia than C group having a p value of <0.001(Score 1; 5 VS 20; Score 2; 12 VS 9; Score 3; 13 VS 1).

Conclusions: Ultrasound guided combined pectoral nerve blocks are an effective modality of analgesia for patients undergoing breast surgeries during perioperative period.

Clinical Trial Registration: CTRI/2015/12/006457.
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http://dx.doi.org/10.1016/j.jclinane.2017.11.027DOI Listing
March 2018

Evaluation of optimum time for intravenous cannulation after sevoflurane induction of anesthesia in different pediatric age groups.

J Anaesthesiol Clin Pharmacol 2017 Jul-Sep;33(3):371-374

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: The ideal time for intravenous (IV) cannulation following inhalational induction in children is debatable. The effect of age on this time has not been studied. We evaluated the optimum time for IV cannulation after sevoflurane induction of anesthesia in different pediatric age groups.

Material And Methods: A prospective interventional study based on Dixon's sequential up and down method was conducted in children of age 1-10 years. They were grouped according to their age - Group 1: 1-3 years, Group 2: >3-7 years, and Group 3: >7-10 years. Anesthesia was induced with 8% sevoflurane in 5 L of 100% oxygen. IV cannulation was attempted at 3.5 min in the first child in each group. The time for cannulation in the next child was stepped up or down by 30 s depending on positive or negative response, respectively, in the previous child. Children were recruited till a minimum of six pairs of failure-success sequence which was obtained in each group. The mean of midpoints of the failure-success sequence was calculated to obtain the time for cannulation in 50% of the children in each group.

Results: Total number of children in Groups 1, 2, and 3 were 24, 23, and 24, respectively. The mean (95% confidence level) time for IV cannulation after sevoflurane induction in Groups 1, 2, and 3 was 53.6 (40.0-67.1), 105 (62.6-147.4), and 143.6 (108.8-178.4) s, respectively. This time was significantly shorter in Group 1 compared to those in Groups 2 and 3.

Conclusion: The optimum time for IV cannulation in 50% of the children after sevoflurane induction of anesthesia was shorter in children of age 1-3 years than in older children.
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http://dx.doi.org/10.4103/joacp.JOACP_58_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672536PMC
November 2017

Microlaryngeal endotracheal tube for lung isolation in pediatric patient with significant tracheal narrowing.

Saudi J Anaesth 2017 Oct-Dec;11(4):490-493

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

A 15-year-old boy, weighing 45 kg, 160 cm height with large anterior mediastinal mass and significant tracheal narrowing was scheduled for thoracotomy and excision of the mass. He had a history of progressive dyspnea, inability to lie supine, and a right upper hemithorax mass 13 cm × 13 cm × 11 cm as evident on a computerized tomography with significant compression of the trachea and right main stem bronchus. Inhalational induction was carried out using sevoflurane with 100% oxygen. After achieving adequate depth of anesthesia with the maintenance of spontaneous respiration with oxygen and sevoflurane (minimum alveolar concentration 1.7), left principal bronchus was intubated under fiber-optic bronchoscopy, with 5 mm cuffed microlaryngeal surgery tube. Excellent lung isolation was achieved. Selection of endotracheal tube for lung isolation and endobronchial intubation in the presence of significant tracheal narrowing are discussed.
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http://dx.doi.org/10.4103/1658-354X.215427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637430PMC
October 2017

Is perioperative administration of 5% dextrose effective in reducing the incidence of PONV in laparoscopic cholecystectomy?: A randomized control trial.

J Clin Anesth 2017 Aug 12;40:7-10. Epub 2017 Apr 12.

Department of Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Study Objective: To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy.

Design: Prospective, randomized, double-blind trial.

Setting: Operating rooms in a tertiary care hospital of Northern India.

Patients: One hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study.

Interventions: Patients were randomized into two groups [normal saline (NS) group and 5% dextrose (D) group]. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished.

Measurements: Incidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics.

Main Results: Demographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002).

Conclusions: Perioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly.
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http://dx.doi.org/10.1016/j.jclinane.2017.03.048DOI Listing
August 2017

Role of dexmedetomidine for sedation in a patient with schizophrenia for strabismus surgery.

Indian J Anaesth 2016 Nov;60(11):856-857

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/0019-5049.193688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125192PMC
November 2016

Anesthesia maintenance with 'induction dose only' sevoflurane during pediatric ophthalmic examination: comparison with standard low-flow technique through a randomized controlled trial.

Paediatr Anaesth 2017 Feb 30;27(2):162-169. Epub 2016 Nov 30.

Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.

Background: Sevoflurane is preferred for pediatric day care procedures. However, financial and environmental costs remain major limitations. Induction dose of sevoflurane could itself be sufficient for maintaining anesthesia with low fresh gas flow during short noninvasive procedures.

Methods: Fifty children, aged 1-5 years, scheduled for ophthalmic examination under anesthesia, were randomized into two groups. All children were induced with 8% sevoflurane in O : N O (40 : 60). In the Group S, anesthesia was maintained with 2% sevoflurane at 1 l·min fresh gas flow [O : N O = 50 : 50]. In Group L, the sevoflurane vaporizer was turned off and fresh gas flow was reduced to 0.5 l·min [O : N O = 50 : 50]. HR, BP, MAC, BIS, total sevoflurane consumption, ocular deviation, body movement, time to laryngeal mask airway removal (T ), and airway complications were compared between the groups. Rescue propofol bolus was used, if needed.

Results: Median duration of examination was 14 min (IQR = 9-17) in Group S and 15 min (IQR = 10-17) in Group L. Sevoflurane consumption was lower in the Group L (7 ml) compared to Group S (9 ml) [median difference = 2 ml, P < 0.001, 95% CI = 0.96-3.04]. T was lower in Group L (86 s) compared to Group S (131 s) [median difference = 45 s, P = 0.002, 95% CI = 19.85-70.15]. There was no difference in hemodynamic parameters, incidence of ocular deviation, movement or airway complications, and need for rescue propofol.

Conclusion: Induction dose of sevoflurane is, in itself, adequate for maintaining anesthesia for short noninvasive ophthalmic examinations lasting approximately 15 min. This method significantly reduces sevoflurane consumption and cost.
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http://dx.doi.org/10.1111/pan.13040DOI Listing
February 2017

Perioperative Management of Juvenile Nasopharyngeal Angiofibroma: A Retrospective Analysis of 56 Patients From a Single Tertiary Care Institute.

AANA J 2016 Oct;84(5):348-356

is the head of the Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.

The present study was undertaken with the primary aim to analyze a large number of surgically treated patients with juvenile nasopharyngeal angiofibroma (JNA) in respect to preoperative embolization, different surgical procedures, and JNA stages. Ages of the patients ranged between 8 and 31 years. Mean blood loss was 1,240 mL (range, 50-6,000 mL). Preoperative embolization was performed in 23 patients (41%). Mean blood loss in patients who underwent embolization was not significantly different from those who did not; 1,580.4 mL vs 910.4 mL. Mean blood loss in stage IIB and above was more than 1 L. Intraoperatively 15 patients (37%) required 2 U of packed red blood cells. Postoperatively only 22 patients (39%) required packed red blood cells compared with 38 (67%) intraoperatively. The trachea was kept electively intubated in 46 patients (82%). We conclude that most of the JNA surgeries do not require replacement of more than 2 U of blood intraoperatively. Only 1 intravenous line is required in stages IB and IIA because of less blood loss. Not all patients need to be kept intubated electively in the postoperative period.
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October 2016

Comparison of effects of ProSeal LMA™ laryngeal mask airway cuff inflation with air, oxygen, air:oxygen mixture and oxygen:nitrous oxide mixture in adults: A randomised, double-blind study.

Indian J Anaesth 2016 Aug;60(8):566-72

Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: Laryngeal mask airway (LMA) cuff pressure increases when the air is used for the cuff inflation during oxygen: nitrous oxide (O2:N2O) anaesthesia, which may lead to various problems. We compared the effects of different gases for ProSeal LMA™ (PLMA) cuff inflation in adult patients for various parameters.

Methods: A total of 120 patients were randomly allocated to four groups, according to composition of gases used to inflate the PLMA cuff to achieve 40 cmH2 O cuff pressure, air (Group A), 50% O2 :air (Group OA), 50% O2:N2O (Group ON) and 100% O2 (Group O). Cuff pressure, cuff volume and ventilator parameters were monitored intraoperatively. Pharyngolaryngeal parameters were assessed at 1, 2 and 24 h postoperatively. Statistical analysis was performed using ANOVA, Fisher's exact test and step-wise logistic regression.

Results: Cuff pressure significantly increased at 10, 15 and 30 min in Group A, OA and O from initial pressure. Cuff pressure decreased at 5 min in Group ON (36.6 ± 3.5 cmH2 O) (P = 0.42). PLMA cuff volume increased in Group A, OA, O, but decreased in Group ON (6.16 ± 2.8 ml [P < 0.001], 4.7 ± 3.8 ml [P < 0.001], 1.4 ± 3.19 ml [P = 0.023] and - 1.7 ± 4.9 ml [P = 0.064], respectively), from basal levels. Ventilatory parameters were comparable in all four groups. There was no significant association between sore throat and cuff pressure, with odds ratio 1.002.

Conclusion: Cuff inflation with 50% O2:N2O mixture provided more stable cuff pressure in comparison to air, O2 :air, 100% O2 during O2:N2O anaesthesia. Ventilatory parameters did not change with variation in PLMA cuff pressure. Post-operative sore throat had no correlation with cuff pressure.
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http://dx.doi.org/10.4103/0019-5049.187787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989807PMC
August 2016

Tracheo-oesophageal fistula with sub-glottic stenosis: Another option for airway management.

Indian J Anaesth 2016 Jun;60(6):447

Department of Anaesthesiology, Pain Medicine and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/0019-5049.183402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910496PMC
June 2016