Anaesthesiology Clinical Pharmacology,Truview evo2 and Macintosh laryngoscope for ease of orotracheal intubation in children,I-gel is comparable to endotracheal intubation in terms of adequacy of ventilation. The increase in peak airway pressures is less with I-gel. In addition, postoperative complications are fewer with I-gel,oral dexmedetomidine and oral midazolam as premedicants in children,ropivacaine with ultrasound-guided ISB with multiple injection technique, without clinical deterioration in block onset and duration of analgesia,

Medication errors: They continue Rashmi Salhotra, Asha Tyagi Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):1-2

Anesthetic implications in hyperthermic intraperitoneal chemotherapy Nishkarsh Gupta, Vinod Kumar, Rakesh Garg, Sachidanand Jee Bharti, Seema Mishra, Sushma Bhatnagar Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):3-11 Patients with peritoneal carcinomatosis were considered incurable with dismal survival rates till hyperthermic intraperitoneal chemotherapy after optimal cytoreductive surgery evolved. Perioperative management for these procedures is complex and involves an optimal cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy. In this article we highlight the perioperative concerns in these patients including anesthetic challenges, such as optimal fluid management, maintaining blood pressure, control of body temperature, coagulation and electrolyte derangement and renal toxicity of chemotherapeutic drugs. We have also discussed the postoperative problems and their management.

Monitoring cerebral vasospasm: How much can we rely on transcranial Doppler Navneh Samagh, Hemant Bhagat, Kiran Jangra Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):12-18 Cerebral vasospasm leading to delayed cerebral ischaemia is one of the major concerns following subarachnoid haemorrhage (SAH). Various modalities are present for evaluation and detection of cerebral vasospasm that occurs following SAH. They include transcranial Doppler (TCD), computed tomographic angiography (CTA), computed tomographic (CT) perfusion and digital subtraction angiography (DSA). The recent guidelines have advocated the use of TCD and have described it as a reasonable technique for monitoring the development of vasospasm. This review describes the functioning of TCD, the cerebral haemodynamic changes during vasospasm and TCD-based detection of vasospasm. The review shall highlight as to how the TCD derived values are relevant in the settings of neurocritical care. The data in the review have been consolidated based on our search of literature from year 1981 till 2016 using various data base.

Maternal anesthesia for EXIT procedure: A systematic review of literature Kamal Kumar, Cristiana Miron, Sudha Indu Singh Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):19-24 The ex utero intrapartum treatment (EXIT) procedure is performed in cases of fetal congenital malformation. The anesthetic management is much more challenging and involves providing profound uterine relaxation, maintenance of Uteroplacental blood flow and fetal anesthesia. The aim of the article is to review the literature and compare the efficacy of both the anesthetic techniques with respect to maternal and fetal outcomes. The literature source for this review was obtained via PubMed, Medline, Google scholar and Cochrane database of systematic reviews until January 2017. In our literature review we found that both GA and Regional anesthesia were successfully described for EXIT procedure but GA was performed in the majority of cases.Consideration for anesthetic technique should be done on a case-by-case basis.

Comparative evaluation of Truview evo2 and Macintosh laryngoscope for ease of orotracheal intubation in children – A prospective randomized controlled trial Neha Pangasa, Jaspal Singh Dali, Kavita Rani Sharma, Mona Arya, Anant Vikram Pachisia Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):25-29 Background and Aims: Truview evo2 has been found to improve the glottic view when compared with the Miller blade in pediatric population. However, there is limited literature comparing it with Macintosh laryngoscope in children. We thus aimed to assess and compare Truview evo2 with the Macintosh laryngoscope for orotracheal intubation in children with regards to time to intubate, laryngoscopic view, ease of intubation, and associated hemodynamic changes. Material and Methods: Fifty ASA I-II children aged 2–8 years for elective surgery requiring general anesthesia with orotracheal intubation participated in this prospective randomized-controlled study. They were randomly allocated to two groups. In group-M (N = 25), laryngoscopy and intubation were performed using Macintosh laryngoscope, and in group-T (N = 25), Truview evo2 laryngoscope was used. Modified Cormack–Lehane grade, time to intubation, intubation difficulty score (IDS), and hemodynamic changes were compared between the groups. Data were analyzed using SPSS statistical software version 17 and P value <0.05 was considered statistically significant. Results: CL grade 1 was found in a larger number of patients of group-T (P = 0.003) and CL grades2a and 2b were found in a larger number of patients of group-M (P = 0.023 and P = 0.037, respectively). The mean time to intubation was significantly longer in group-T (19.0 ± 3.4 seconds) than in group-M (13.1 ± 2.1 seconds), P = 0.00. The over all IDS was lower in group-T than group M [i.e. median (IQR): 0 (0-0) vs 1 (0-2), respectively]. Heart rate, systolic and diastolic blood pressure, and oxygen saturation were comparable between the groups at all times. Conclusion: Truview evo2 provides better laryngeal view and has a lesser IDS, but takes longer for intubation, when compared to the Macintosh laryngoscope in children.

Comparative evaluation of I-gel vs. endotracheal intubation for adequacy of ventilation in pediatric patients undergoing laparoscopic surgeries Megha Kohli, Sonia Wadhawan, Poonam Bhadoria, Simmi K Ratan Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):30-35 Background and Aims: The use of newer supraglottic devices has been extended to laparoscopic procedures. We conducted this study to compare and evaluate the efficacy of these two devices in pediatric laparoscopic surgeries. Material and Methods: Eighty children, 2–8 years of age, scheduled for elective short laparoscopic procedures were randomly allocated to the I-gel or endotracheal tube (ETT) group. Standard anesthesia protocol was followed for inhalational induction. I-gel or ETT was inserted according to the manufacturer's recommendations. Ventilation was set with tidal volume 10 ml/kg and a respiratory rate of 16/min. Carboperitoneum was achieved up to an intra-abdominal pressure of 12 mmHg. Statistical Analysis: The primary outcome variable was adequacy of ventilation (peak airway pressure, end-tidal CO2, minute ventilation, and SPO2). These variables were recorded after securing airway, after carboperitoneum and desufflation of the peritoneal cavity. The oropharyngeal leak pressures were also noted. Statistical analysis was done using SPSS software version 17.0. P <0.05 was considered statistically significant. Results: No significant difference was observed in the heart rate or mean arterial pressure. There was a significant increase in the PECO2and peak airway pressure after creation of carboperitoneum. There was significant increase in minute ventilation in both groups after creation of carboperitoneum. Conclusion: To conclude, I-gel is comparable to endotracheal intubation in terms of adequacy of ventilation. The increase in peak airway pressures is less with I-gel. In addition, postoperative complications are fewer with I-gel.

A comparison of oral dexmedetomidine and oral midazolam as premedicants in children Binu Sajid, Taznim Mohamed, M Jumaila Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):36-40 Background and Aim: Midazolam has been the most popular oral premedicant in children despite its side effects. Dexmedetomidine with its favorable clinical profile is a suitable alternative, but with limited research. The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam as oral premedicants in children. Material and Methods: Eighty children of the American Society of Anesthesiologist physical status I scheduled for elective herniotomy were included in this prospective randomized double-blind study. Patients were randomly assigned to receive either dexmedetomidine 4 μg/kg (Group A, n = 40) or midazolam 0.5 mg/kg (Group B, n= 40) orally 40 min before induction. Pre-operative sedation, response to parental separation and venepuncture, emergence agitation, recovery nurse satisfaction, and side effects were compared between the two groups. Quantitative data were compared using unpaired Student's t-test and categorical variables with Chi-square test. Results: Pre-operative sedation and response to parental separation and venepuncture were similar between the two groups. Group A had a significantly lower incidence and severity of emergence agitation (P = 0.000). Recovery nurse satisfaction was significantly higher in Group A (P = 0.002). However, incidence of hypotension and bradycardia was found to be more in Group A (P = 0.04). Conclusion: Premedication with oral dexmedetomidine is as effective as oral midazolam in providing sedation and anxiolysis in children. Dexmedetomidine in addition reduces the incidence and severity of emergence agitation.

The estimation of minimum effective volume of 0.5% ropivacaine in ultrasound-guided interscalene brachial plexus nerve block: A clinical trial Kailash Mittal, Sarita Janweja, Prateek , Pushpender Sangwan, Deepa Agarwal, Himani Tak Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):41-46 Background and Aims: Interscalene brachial plexus block (ISB) is the most commonly used mode of anesthesia for upper limb surgeries. Higher volume of local anesthetic used in ISB is associated with increased incidence of side effects, particularly phrenic nerve palsy. The aim of this study was to determine the minimum effective volume of 0.5% ropivacaine in 90% patients (MEV90) in ISB. Material and Methods: With target of 45 successful cases, phase 1 clinical trial was conducted based on the principles of biased coin design up-and-down method. After obtaining Ethical Committee's approval and patient's consent, patients with American Society of Anesthesiologist physical status (ASA PS) I and II, aged 18–60 years of either sex, undergoing upper arm surgery were recruited into the study until 45 successful cases. A 7 ml of 0.5% ropivacaine was used as starting dose, with patients receiving a higher or lower dose depending on previous patient's response. R package, SPSS 23, and Microsoft Excel were used for statistical analysis. Results: MEV90 of 0.5% ropivacaine for ISB was determined as 8.64 ml [confidence interval (CI) 95%, 8.28–9.02 ml]. Time for onset of sensory block and motor block was 5 min (5–15 min) and 10 min (5–20 min), respectively, while duration of analgesia was observed as 8.2 (4.8–12.5) h. Conclusions: This study observes that surgical anesthesia can be accomplished with 8.64 ml (95% CI: 8.28–9.02 ml) of 0.5% ropivacaine with ultrasound-guided ISB with multiple injection technique, without clinical deterioration in block onset and duration of analgesia.

Challenges to implement minimum effective volume in regional anesthesia Sudhakar Subramani, Shuchita Garg Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):47-48

Effect of intrathecal catheterisation on incidence of postdural puncture headache after accidental dural puncture in non-obstetric patients Prateek Ahuja, Ranju Singh, Aruna Jain Journal of Anaesthesiology Clinical Pharmacology 2019 35(1):49-52 Background and Aims: After accidental dural puncture (ADP) with large bore epidural needles, postdural puncture headache (PDPH) develops in 16%–86% of patients, which is unpleasant and interferes with activities of daily life of the patient.Hence we aimed to assess the effect of intrathecal catheter insertion after ADP with 18G Tuohy needle on incidence of PDPH. Material and Methods: In all, 173 patients after ADP were enrolled and divided into two groups according to the choice of treating anesthesiologist. Group IC included 74 patients who had intrathecal catheter placed in subarachnoid space. In group NIC, which included 99 patients, one of the following was done: epidural catheter was cited in a different intervertebral space, or the procedure was abandoned and general anesthesia was administered or single-shot spinal anesthesia was administered through the Tuohy needle itself. The catheters were left in situ for 36–48 h. Patients were monitored for the next 7 days after ADP for the incidence of PDPH, its severity and requirement of analgesics, and duration of catheter in situ from the time of ADP. Results: The incidence of PDPH in group IC was 36% in comparison to 59% in group NIC (P = 0.001). The severity of PDPH and requirement of analgesics was significantly less in group IC. Conclusion: Insertion of intrathecal catheter at the site of ADP significantly reduces the incidence and severity of PDPH.