Abha Saxena

The Assessment of Cancer Pain in North India: The Validation of the Hindi Brief Pain Inventory—BPI-H

The status of pain treatment for cancer patients in India is largely undocumented. Although many languages and dialects are spoken throughout the country, millions of persons in North India speak Hindi. This project developed and validated a Hindi version of the Brief Pain Inventory (BPI-H), a short measure of pain and pain interference that has been shown to be relatively free of cultural or linguistic influences. In the validation process, we were able to administer both the Hindi and English versions of the BPI to a sample of bilingual (Hindi and English) patients. The English and Hindi versions of the BPI were very similar in their psychometric properties, supporting the reliability and construct validity of the Hindi version. As with other language versions of the BPI, factor analysis of the BPI-H items results in severity and interference subscales. We followed the validation with an examination of the status of cancer pain management in a major northern Indian cancer center, based on 200 patients with pain who spoke only Hindi. Using a conservative measure of analgesic prescription adequacy (the Pain Management Index), three-fourths of Hindi-speaking cancer patients in this study were inadequately treated by World Health Organization (WHO) recommendations. The results of this study encourage the development of other forms of the BPI in the many languages of India, and the use of the instrument in studies of the epidemiology and treatment of cancer pain.

Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia

We prospectively studied 30 healthy female patients undergoing intracavitory brachytherapy applicator insertion for carcinoma of the cervix under spinal anaesthesia. Patients were randomly allocated to receive either intrathecal bupivacaine 10 mg alone or bupivacaine 7.5 mg combined with preservative‐free ketamine 25 mg. Spinal block onset, maximum sensory level, duration of blockade, haemodynamic variables, postoperative analgesic requirements and adverse events were recorded. Onset of sensory and motor block and duration of spinal analgesia were comparable between groups. Duration of motor blockade was shorter (p = 0.0416) and requirement for intravenous fluids in the peri‐operative period was less (p = 0.0159) in the ketamine group. Significantly more patients in the ketamine group had adverse events, such as sedation, dizziness, nystagmus, ‘strange feelings’ and postoperative nausea and vomiting. Although the addition of ketamine to spinal bupivacaine had local anaesthetic sparing effects, it did not provide extended postoperative analgesia or decrease the postoperative analgesic requirements. Moreover, the central adverse effects of ketamine limit its spinal application.

Pulmonary edema following intrauterine methylene blue injection

Methylene blue is a commonly used dye in diagnostic procedures such as fistula detection, delineation of body tissues during surgery and for checking the patency of fallopian tubes. Many such dyes interfere with accurate measurement of oxygen saturation by a pulse oximeter. We report here a case in which methylene blue not only interfered with pulse oximetery but also caused pulmonary edema in an ASA grade 1 patient.

An ayurvedic herbal compound to reduce toxicity to cancer chemotherapy: A randomized controlled trial

Background: Maharishi Amrit Kalash (MAK) is an ayurvedic compound containing many herbs rich in antioxidants. We evaluated its role in reduction of chemotherapy toxicity among women with breast cancer. Patient and Methods: We recruited 214 patients with breast carcinoma receiving cyclophosphamide, methotrexate and 5- flourouracil (CMF) or cyclophosphamide, adriamycine,& 5-flourouracil (CAF), adjuvant or neo-adjuvant chemotherapy. The toxicity of chemotherapy was assessed according to WHO criteria. Statistical analysis was carried out on Epi-info 6 and STATA-7. All patients received same antiemetic therapy with ondensetron and dexamethasone. Results: There was a significant reduction in toxicities observed in MAK group throughout chemotherapy cycles: Poor performance status was prevented by concomitant administration of MAK along with chemotherapy.(Prevented Fraction (PF)=60.6% (95% confidence interval 22.1 to 80.1 ; p value =0.005 ). Vomiting was prevented by MAK {PF=40.3%, (95% confidence interval 15.1 to 58.1; p value=0.002)}. Similarly anorexia was reduced with PF= 35.6%. (95% confidence interval 17.6 to 49.7, p value = 0.0001) in MAK group. No improvement occurred in stomatitis, diarrhea, alopecia and leucopenia. No overgrowth of tumours occurred in the group treated with Neoadjuvant chemotherapy receiving MAK. Conclusion: MAK may be used as a supplement along with chemotherapeutic drugs for reducing chemotherapy induced vomiting, anorexia and improving general well being of patients.

Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report.

A case of advanced cryptogenic fibrosing alveolitis (CFA) with multiple bullae and extensive pulmonary fibrosis, scheduled for modified radical mastectomy for carcinoma of breast, is presented. This patient had ischemic heart disease, corticosteroid-induced hypertension, diabetes mellitus, and a difficult airway. Thoracic epidural segmental anesthesia was successfully given to this patient. Preoperative problems, perioperative management, and alternative anesthetic techniques are discussed.

Propofol for pediatric radiotherapy

Objective : Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room.Methods : This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20–22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted.Result: The drug was graded on a scale of 0–10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (±SD) of all the measured parameters were calculated and compared between the two groups.Conclusion : Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was betwen 94–95%, was easily treatable with supplementation of oxygen by face mask

Oral ketamine for radiotherapy in children with cancer.

Children coming for radiotherapy under sedation usually get repeated injections, which cause distress to both the child and the parents. A prospective study was conducted to evaluate the efficacy of oral ketamine for sedation for radiotherapy (RT) in children with cancer. Ten children who received 49 sittings of RT were given 8–15 mg/kg body weight of oral ketamine. The onset time, recovery time, efficacy of sedation and incidence of abnormal movements were compared with another group of 8 children, who received intramuscular ketamine in the dose of 6 mg/kg for a total of 28 sittings of RT. Onset time and recovery time were significantly longer in oral ketamine group as compared to the intramuscular group (p<0.001). Limb movements in patients receiving oral ketamine necessitated further supplement of sedation and interruption of RT. These drawbacks discourage use of oral ketamine as a good sedative for radiotherapy treatment in paediatric oncology patients.