The Indian Anaesthetists’ Forum

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Background: Anesthetic agents cause a dose-dependent effect on motor-evoked potentials (MEPs). We conducted a study to find whether addition of ketamine to the combination of propofol–fentanyl–dexmedetomidine has an effect on MEP monitoring and hemodynamic parameters in patients undergoing spine surgeries. Materials and Methods: Sixty patients of American Society of Anesthesiologists Grade I–III undergoing spine surgery in general anesthesia were divided into two groups,P and K randomly. Written informed consent was obtained and all the patients were blinded to the interventions. After induction, anesthesia was maintained in Group P using propofol + dexmedetomidine + fentanyl infusion, whereas in Group K, ketamine infusion was added to the above combination. After taking baseline reading of MEP, heart rate (HR), and mean arterial pressure (MAP), mean of all the other readings was calculated and percentage fall in all factors was calculated. More than 80% fall in mean MEP and more than 20% fall in mean HR and MAP were considered significant. Statistical Analysis: Analysis was done by SPSS 20.0 statistical system. Continuous normally distributed data were analyzed using Student's independent t-test. Results: In Group P, percentage fall in MEP on the right side was 46.39 ± 24.19, whereas in Group K, it was 37.98 ± 26.17. Similar results were obtained on the left side. In Group P, percentage fall in HR in Group P was 17.68 ± 7.0, on the other hand, it was 14.02 ± 7.7 in Group K. Finally, percentage fall in MAP was found to be 14.61 ± 6.37 in Group P, whereas in Group K, it was 9.51 ± 5.02. On intergroup comparison of all factors, we found that difference in percentage fall in MEP and HR was insignificant whereas it was significant in case of MAP. Conclusion: It was found that addition of ketamine in Group K led to better hemodynamics in patients undergoing spine surgery without affecting the MEP significantly.

Introduction: Preemptive N-methyl-D-aspartate (NMDA) receptor antagonist ketamine inhibits central sensitization in response to peripheral nociception. The purpose of our study was to compare efficacy of three small doses of ketamine for improving postoperative analgesia after laparoscopic surgeries. Materials and Methods: A total of 120 patients of American Society of Anesthesiologists physical status I–II undergoing laparoscopic surgeries were randomly allocated into four groups. Groups 1, 2, and 3 received intravenous ketamine in dose of 1, 0.75, and 0.5 mg/kg, respectively, and control Group 4 received isotonic saline 30 min before incision. Variations in heart rate and mean arterial pressure were noted, and response to pain at rest and at deep breathing was studied over 24 h. Fentanyl 0.5 μg/kg was used for rescue analgesia. Results: Visual analog scale score was significantly low in Groups 1, 2, and 3 as compared to control Group 4. 66.7% of patients in Group 4 required rescue analgesia at 24 h which was significantly higher (P < 0.0001) than that in Groups 1, 2, and 3 (26.67%, 20.00%, and 36.67%, respectively). Total number of analgesic doses required was only 32 in Group 3 as compared to Groups 2, 1, and 4, wherein it was 36, 40, and 78, respectively. Conclusion: Preemptive administration of ketamine decreases postoperative analgesic requirement with satisfactory hemodynamic stability and no side effects in 0.5 mg/kg dose.

Airways of postradiotherapy and postchemotherapy female oncosurgical patients on steroid therapy are devitalized and any airway handling in such patients commands caution. We report a case of a large iatrogenic tracheal rent occurring during manipulation of a flexometallic tube through a tracheostomy stoma created in a patient with postcricoid carcinoma undergoing esophagectomy and gastric pull-up surgery. The timely detection, emergent, and postoperative management strategies are discussed below.

We report a case focusing on achieving an optimum cardiac output (CO) in a patient with heart failure with severely reduced ejection fraction using EV1000 monitor to obtain various dynamic parameters such as stroke volume (SV), SV variation (SVV), systemic vascular resistance (SVR), and CO. We optimized preload by SVV-guided intraoperative goal-directed fluid transfusion and modulated SVR using multipronged anesthetic techniques to decrease afterload and increase forward flow to improve CO in a patient undergoing radical cholecystectomy with wedge liver resection.

Partial thromboplastin time, kaolin (PTTK) is a global test sensitive to low levels of all the coagulation factors, except Factor VII and Factor XIII. Patients with extensive cancer have a propensity to develop a shortened PTTK. Our breast cancer patient had a prolonged PTTK result roughly 4 times the normal values. A detailed description of the preoperative workup including the special investigations is required to ascertain the cause of the prolongation and precautions taken, leading to successful breast cancer surgery and postoperative period in this patient follows. Allowing the surgeon to operate a patient with a PTTK >120 s and simultaneously at risk of thrombosis due to lupus anticoagulant is possible with a calculated risk and thorough preoperative evaluation. Prophylactic fresh frozen plasma and deep venous thrombosis prophylaxis have an important role.

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