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  Most popular articles (Since May 02, 2016)

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Hybrid operating room: Clinical applications
Ajmer Singh
July-December 2016, 17(2):35-36
  932 104 -
On starting a new medical journal: Problems, challenges, and remedies
Anjan Trikha
January-June 2016, 17(1):3-5
  801 143 -
Combined spinal–epidural anesthesia for an elderly patient with proportionate dwarfism for laparotomy
Teena Bansal, Rajmala Jaiswal, Arnab Banerjee
January-June 2016, 17(1):14-16
Anesthesia in a dwarf patient may be challenging as various anatomical anomalies make both general and regional anesthesia difficult. These patients may have atlantoaxial instability, potential for airway obstruction, and associated respiratory problems that may pose problems for general anesthesia. Spinal stenosis, osteophytes, short pedicles, or a small epidural space could complicate regional anesthesia in dwarfs which could lead to difficulties in locating the epidural space and increase the risk of dural puncture. Spinal stenosis may impair cerebrospinal fluid flow such that identification of dural puncture is difficult. This elderly dwarf patient had history of bronchial asthma with restriction of neck extension, managed successfully using combined spinal–epidural anesthesia.
  796 138 -
Anesthetic management of lower segment cesarean section with postpartum hemorrhage in two patients with tetralogy of Fallot
Jayashree Patki, Nareshkumar Reddy
January-June 2016, 17(1):10-13
Pregnant patient with heart disease is a unique challenge to the obstetrician and anesthesiologist, and requires a thorough understanding of the impact of pregnancy on the haemodynamic response in view of existing cardiac lesion. Among the congenital heart diseases causing right to left shunt, Tetralogy of Fallot (TOF) is commonest congenital heart disease. Symptoms of TOF may get worsened during pregnancy and if neglected, it causes significant morbidity and mortality to the patient as well as to fetus. Uncorrecrected TOF parturient posted for LSCS poses an unique challenge to the anesthesiologist. We present 2 case reports of patients of TOF with BT shunt who underwent caesarean section under general anaesthesia. Both the patients had post partum hemorrhage (PPH) which was treated successfully without further complications
  704 135 -
The journal in a new avatar
Pradeep Kumar Bhatia
January-June 2016, 17(1):1-2
  672 156 -
Clinical pearls of anesthesia for radio-guided, robot-assisted retroauricular parathyroidectomy
Soumi Pathak, Itee Chowdhury, Nitesh Goel, Col A. K. Bhargava
January-June 2016, 17(1):6-9
Robot assisted transaxillary and retroauricular parathyroidectomy provides a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Robotic surgery requires innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel. Anaesthesiologists should become familiar with these changes by learning the basic features of robotic surgical systems to provide good anaesthetic care.
  664 124 -
Posterior reversible encephalopathy syndrome: An atypical postpartum complication
Debashish Paul, Sachin Narayan Kulkarni, Mili Das Choudhury, GD Maity
January-June 2016, 17(1):17-20
Posterior reversible encephalopathy syndrome (PRES) is presented by headache, altered mental status, blurring of vision, vomiting and seizure in conjunction with radiological finding of posterior cerebral white matter edema. Data suggest that most cases occur in young middle-aged with marked female preponderance, hypertension being the most common cause. In this case, it was diagnosed in a normotensive patient in the postnatal period that underwent cesarean section. The initial symptoms had misled toward a diagnosis of postdural puncture headache. Symptomatic treatment was started immediately in the ICU. This is an interesting case as the patient was a normotensive one without any other contributory factors and there was unanticipated delay in diagnosing the case until the time we could get a magnetic resonance imaging report.
  552 71 -
Preoperative anxiety-an important but neglected issue: A narrative review
Teena Bansal, Akanksha Joon
July-December 2016, 17(2):37-42
Anxiety is an emotional state characterized by apprehension and fear resulting from the anticipation of a threatening event. The incidence of preoperative anxiety ranges from 11% to 80% in adult patients and also varies among different surgical groups. Preoperative anxiety may lead to various problems and a wide range of physiological and psychological responses. A variety of objective and subjective methods are available for measuring preoperative anxiety. Every patient scheduled for surgery should be assessed for the presence of anxiety in their routine preoperative anesthesia assessment, and counseling should be done by anesthesiologist in patients with a high level of anxiety. Surgery information reduces anxiety in the preoperative period.
  481 87 -
Accuracy of tension and saturation-based oxygen indices in the assessment of disease severity and its progress in adults with acute respiratory distress syndrome
Ghada F El-Baradey, Nagat S El-Shmaa
July-December 2016, 17(2):43-47
Objective: The goal of this study was to assess the reliability of different tension and saturation-based oxygen indices with traditional oxygenation index (OI) in the assessment of disease severity and its progress in adult patients with acute respiratory distress syndrome (ARDS) when compared to the standard arterial oxygen tension (PaO2)/inspired fraction of oxygen (FiO2) (PF) ratio included in the Berlin definition of ARDS; the primary objective was assessed by the correlation of different OIs to the standard PF index. Design: This was a prospective, observational study. Setting: This study was carried out in Intensive Care Unit (ICU) in a university hospital. Patients and Methods: Sixty adult patients with different grades of ARDS severity according to Berlin definition were enrolled in this study. Measurements: The following indices were measured: (1) PF, (2) OI = FiO2 × mean airway pressure [MAP] × 100/PaO2 , (3) oxygen saturation index (OSI) = FiO2 × MAP × 100/oxygen saturation by pulse oximeter. The primary outcome measurement was the correlation of different OIs to the standard PF index. The secondary outcome measurements were sensitivity and specificity of each index. Results: There were a strong significant negative correlation between OI and OSI with the PF (r = −0.9 and −0.91, respectively) and a significant positive correlation between OI and OSI (r = 0.93). Total mortality rate was 36% (22 patients). The PF, OI, and OSI were sensitive and specific (sensitivity: 0.63, 0.77, and 0.81, respectively, and specificity: 0.76, 0.86, and 0.78, respectively). Conclusion: OSI can be used as a noninvasive index for the assessment of ARDS severity in adults as it correlates significantly with PF ratio and OI with high sensitivity and specificity to predict ICU mortality.
  460 75 -
Takayasu's arteritis: An anesthetic challenge
Geetanjali S Verma
July-December 2016, 17(2):52-54
Takayasu's arteritis (TA) is found commonly in young women presenting for cesarean section. A 24-year-old woman with a history of cerebrovascular disease and known case of Type I TA was managed successfully without perioperative complications under general anesthesia.
  436 82 -
Anesthetic management of a child with autistic spectrum disorder and homocysteinemia
Deepak Choudhary, Ghansham Biyani, Pradeep Kumar Bhatia, Nikhil Kothari
January-June 2016, 17(1):29-31
Autistic spectrum disorder (ASD) is a developmental disability of the central nervous system with rapid worsening. A subset of patients also has mitochondrial dysfunction leading to increased sensitivity to various anesthetic agents. Rarely, gene mutation in these patients results in homocysteinemia which causes higher incidences of thromboembolism, hypoglycemia, and seizures. Anesthetic management of ASD with homocysteinemia and refractory seizures has not been previously reported.
  416 62 -
Severe intraoperative hypercarbia undetected by continuous end-tidal CO2 monitoring in a chronic smoker undergoing one-lung ventilation
Shagun Bhatia Shah, Binod Kumar Naithani, Vani Bhageria, Ajay Kumar Bhargava
January-June 2016, 17(1):21-24
One-lung ventilation is known to alter the physiology and result in a discrepancy between end-tidal CO2 (ETCO2) and arterial blood CO2partial pressure despite protective mechanisms like hypoxic pulmonary vasoconstriction. Shunts in an emphysematous patient, lateral positioning and capnothorax may aggravate the discrepancy. We present here an incredible discrepancy of 40 mmHg which led us to question the very utility of ETCO2monitoring in this subset of patients and consider alternative techniques.
  384 68 -
“Zero” diastolic blood pressure
Deepak Choudhary, Om Prakash Suthar, Pradeep Kumar Bhatia, Ghansham Biyani
January-June 2016, 17(1):32-33
  307 112 -
Central neuraxial blockade in chronic immune thrombocytopenic purpura: Platelet count or function and the concept of rebalanced hemostasis
Tasneem Dhansura, Nabila Shaikh, Tarana Shaikh, Mohtasib Madaoo
July-December 2016, 17(2):48-51
Anesthetic management of patients having immune thrombocytopenic purpura (ITP) remains a challenge for the anesthesiologist. Surgeries such as knee arthroplasty are associated with significant bleeding. Neuraxial anesthesia is often preferred for knee arthroplasty. However, in patients with bleeding diathesis such as ITP, neuraxial anesthetic management remains controversial as there are no specific guidelines, and there is a risk of spinal hematoma. There are numerous case reports of safe regional anesthesia administered in parturients suffering from thrombocytopenia, but no explanation has been given. A new emerging concept of "rebalanced hemostasis" is now being used to explain the discrepancies observed in the laboratory reports versus the actual bleeding. In our case report, we have reviewed the literature and described the anesthetic management of a patient having chronic ITP and chronic obstructive pulmonary disease undergoing knee arthroplasty under neuraxial technique.
  338 75 -
Anesthetic concern during cesarean delivery in patient with ruptured cerebral arteriovenous malformation
Rakesh Karnawat, Sadik Mohammed, Snehil Gupta, Naveen Paliwal, Meenal Agarwal
January-June 2016, 17(1):25-28
Vascular malformations of the brain are a rare cause of intracranial hemorrhage during pregnancy. The presentation of arteriovenous malformations during pregnancy is usually a result of hemorrhage following rupture. Once hemorrhage occurs, it accounts for 5–12% of all the maternal deaths and remains the third most common nonobstetric cause of maternal morbidity. Successful anesthetic management during cesarean delivery requires close monitoring to address both the varying maternal and fetal needs. The fundamental aims are to maintain oxygenation and stable systemic, cerebral, and placental hemodynamics and to avoid increase in intracranial pressure.
  340 68 -
Ondansetron-induced atrial fibrillation?
Abhijit S Nair, Veena G Enagandula, MS Shyam Prasad, Basanth Kumar Rayani
July-December 2016, 17(2):55-57
Drug-induced dysrhythmias are frequently encountered with several drugs that are routinely used in the practice of medicine. However, it is difficult to predict in which group of patients the rhythm disturbances can happen. The clinician should try to identify the cause of the new onset rhythm disturbance (electrolyte imbalance, ongoing cardiac insult, hypoxia, hemodynamic disturbance, cerebrovascular event, etc.). Once a drug is suspected, it should be documented on medical case record and everyone involved in the patients care should be informed.
  301 41 -
A child of Williams-Beuren syndrome for inguinal hernia repair: Perioperative management concerns
Sangeeta Deka, Jyotirmoy Das, Sangeeta Khanna, Yatin Mehta, Meera Luthra
July-December 2016, 17(2):62-64
Williams-Beuren syndrome, commonly known as Williams syndrome (WS), is a multi-organ disorder. The principal anomalies of the syndrome are developmental delay, unusual craniofacial dysmorphic features, and cardiovascular anomalies such as valvular or supravalvular aortic stenosis, pulmonary artery stenosis, and coronary insufficiency. Sudden cardiac death during minor procedures even in the absence of gross cardiovascular pathology is the most dreaded complication in these patients. A 7-year-old child with WS was posted for left-sided inguinal hernia repair under general anesthesia. Our article describes the uneventful perioperative course of the patient and highlights the concerns and complications that may be an integral part with the syndrome.
  295 25 -
Incidental laryngeal web: Look before you leap
Kirti Kamal, Pooja Bihani Jaju, Rishabh Jaju, Bharat Paliwal
July-December 2016, 17(2):68-69
  235 30 -
Entropy-guided use of a unique cocktail in awake craniotomy
Itee Chowdhury, Soumi Pathak, AK Bhargava, Shagun Bhatia
July-December 2016, 17(2):58-61
The major benefit of awake craniotomy is to enable a tailored resection that can theoretically maximize the extent of the tumor resection and can minimize the neurological damages. There is still no consensus as to the best anesthetic technique. We describe here a case report where a combination of propofol infusion and dexmedetomidine along with intermittent doses of fentanyl, and fentanyl patch was used with entropy monitoring to assess the depth of sedation in a patient for awake craniotomy.
  213 25 -
Is it time for yet another new safety feature in workstations?
Bharat Paliwal, Pradeep Bhatia, Shilpi Verma, Manoj Kamal
July-December 2016, 17(2):66-67
  193 25 -
Armored tubes: An unusual chink in armor!
Shagun Bhatia Shah, Ajay Kumar Bhargava, Priyanka Goyal
July-December 2016, 17(2):65-66
  102 28 -