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BACKGROUND AND AIMS: There are no surveys documenting the existing regional anaesthesia (RA) practices in our country. This nationwide survey aims to record the existing RA practices, identify any lacunae that might exist and project the future direction of evolution. METHODS: This online survey consisting of 31 questions was sent to all members of the Indian Society of Anaesthesiologists and addressed participants' demographic features, central neuraxial block and peripheral nerve block practices, drug selection, RA training and safety measures. The data were analysed using Statistical Package for the Social Sciences version 24.0. All categorical variables were expressed as frequencies and percentages. RESULTS: A total of 2141 responses were received, with participants distributed across the country. Forty-two per cent of the respondents reported that more than 60% of surgeries were performed under RA. Most of the participants use 'traditional' test dose for epidural space confirmation. Fifty participants (2.4%) use ultrasound for neuraxial space identification. Twenty per cent of the participants use a checklist for monitoring post-operative epidural analgesia. 6.7% have undergone specialised training in RA. Around 3.5% of the respondents have performed a wrong-side block. 31.4% of the respondents store intralipid in the operating room. CONCLUSION: The current survey highlights the prevailing practices, various deficiencies in monitoring and the need for RA training programmes. The data accrued can serve as a baseline for future comparison.
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Endoscopic techniques are being used extensively used in the current times for the diagnosis and treatment of numerous intracranial pathologies. Although the morbidity associated with these procedures is lower as compared to other conventional surgical modalities, neuroendoscopic techniques have its own fair share of distinct complications such as bleeding, cerebrospinal fluid leakage, and subdural hematoma. However, certain specific complication fall within the purview of the attending anesthesiologist who should remain vigilant, anticipating these problems to occur and should be well equipped to deal with such contingencies. This review attempts to sensitize the anesthesiologists regarding the well-known as well as rare complications of intracranial neuroendoscopic procedures and to familiarize them with their diverse presentations, preventive strategies, and management protocols.
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BACKGROUND AND AIM: Therapeutic use of nonopioid analgesic such as paracetamol (PCM) is an alternative to opioids, so to avoid the established side effects associated with opioids, PCM is commonly used due to its analgesic and antipyretic effects. Recently, dexmedetomidine has also emerged on the anesthesia front with a potential role of providing postoperative analgesia. The present study was conducted to compare and assess the quality and duration of analgesia with PCM and dexmedetomidine using visual analog scale (VAS). METHODS: One hundred patients between the age of 18 and 60 years of the American Society of Anesthesiologists grade I and II undergoing laparoscopic cholecystectomy surgery were randomly allocated into two groups (n = 50). Each patient received either 1 g intravenous PCM, in 100 ml solution before incision (Group I), or i.v. dexmedetomidine 1 µg/kg as bolus over 10 min followed by infusion of 0.5 µg/kg/h (Group II). Postoperatively, the following parameters were observed: quality and duration of analgesia, hemodynamic parameters, time to the first dose of rescue analgesia, sedation, and any postoperative complication or side effects. Statistical analysis was carried out using an unpaired t-test for quantitative parameters and nonparametric data using Wilcoxon signed-rank test and Mann-Whitney U-test. Qualitative data were analyzed using Chi-square or Fishers' exact test. RESULTS: Postoperative analgesic requirement significantly decreased (P = 0.001), with a lower score on VAS, better patient satisfaction scores, and Ramsay Sedation Score ranges from 3 to 5 (62%) in Group I. The incidence of nausea and vomiting, hypotension, and bradycardia was comparable in both the groups except shivering, which was found significantly less in Group II. CONCLUSION: Incorporation of dexmedetomidine as a part of multimodal analgesia provides better hemodynamic profile, analgesic, sedative, and amnesic properties along with negligible serious adverse effects.
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BACKGROUND AND AIMS: Keeping in consideration the merits of total intravenous anesthesia (TIVA), a genuine attempt was made to find the ideal drug combinations which can be used in general anesthesia. This study was conducted to evaluate and compare two drug combinations of TIVA using propofol-ketamine and propofol-fentanyl and to study the induction, maintenance and recovery characteristics following anesthesia with these techniques. SETTINGS AND DESIGN: A case control study was conducted, which included 100 patients, in the department of Anaesthesiology and Intensive care, Government Medical College and Hospital, Patiala. PATIENTS AND METHODS: A hundred patients between the ages of 20 and 50 years of either gender were divided into two groups of 50 each, and they underwent elective surgery of approximately 1 h duration. Group I received propofol-ketamine while group II received propofol-fentanyl for induction and maintenance of anesthesia. All the results were tabulated and analyzed statistically with student's unpaired t-test and chi-square test. RESULTS: Propofol-fentanyl combination produced a significantly greater fall in pulse rate (PR; 9.28% versus 0.23%) and in both systolic (7.94% versus 0.12%) and diastolic blood pressures (BP; 8.10% versus 0.35%) as compared to propofol-ketamine during induction of anesthesia. Propofol-ketamine combination produced stable hemodynamics during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II. Mean time to protrusion of tongue and lifting of head was shorter in group I. CONCLUSIONS: Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anesthesia with only a few untoward side effects and only minor hemodynamic effects.
