Rafat Shamim

Effect of two different doses of dexmedetomidine on stress response in laparoscopic pyeloplasty: A randomized prospective controlled study

Background: Clonidine, opioids, β-blockers, and dexmedetomidine have been tried to attenuate stress responses during laparoscopic surgery. We evaluated the efficacy of dexmedetomidine in two different doses in attenuating stress responses on patients undergoing laparoscopic pyeloplasty. Subjects and Methods: Ninety patients were assigned to one of the three groups: Group A, Group B, and Group C. Group B received dexmedetomidine 1 mcg/kg as loading dose, followed by 0.7 mcg/kg/h for maintenance; Group C received dexmedetomidine 0.7 mcg/kg as a loading dose, followed by 0.5 mcg/kg/h for maintenance. Group A received normal saline. Stress responses were assessed by the variations in heart rate (HR), mean arterial pressure (MAP), blood glucose levels, and serum cortisol levels. One-way analysis of variance test was applied. Multiple comparisons between groups were done with post hoc Bonferroni test. Results: The HR and MAP were found to be higher in Group A. The difference was statistically significant (P < 0.05) during intubation, carbon dioxide insufflation, and extubation when compared with Groups B and C. Blood glucose levels at postintubation and at extubation were higher in Group A and statistically significant (P < 0.05) when compared with Groups B and C. Serum cortisol levels at postintubation, during midsurgery, and 2 h after extubation were higher in Group A and statistically significant (P < 0.05) when compared with Groups B and C. However, HR, MAP, blood glucose levels, and serum cortisol levels were similar in dexmedetomidine groups. Conclusions: Dexmedetomidine decreases stress response and provides good condition for maintenance of anesthesia. Dexmedetomidine when used in lower dose in Group C decreases stress response comparable to higher dose in Group B.

Saviour of stylet injuries: 'Ryle's tube'

How to cite this article: Kaushal A, Bindra A, Singh S, Saeed Z. Modification of intravenous cannula for arterial line insertion: Simple yet effective technique. Indian J Anaesth 2018;62:397-9.

Unconventional Method of Repairing the Inflation Line of Ambu Laryngeal Mask Airway

The Ambu® Aura40™ reusable laryngeal mask airway (LMA) is a supraglottic airway device that features a built-in curve replicating the natural human anatomy, facilitating correct insertion. In addition, it has a reinforced tip, extra soft cuff, colour-coded pilot balloon and convenient depth marks. Although, the manufacturer’s recommendations state that it can be steam autoclaved up to 40 times for sterilisation prior to reuse, its safety regarding continuing usage is determined by its ability to pass the pre-use test rather than the specific number of times it has been used (1).

Ultrasound-guided probe-generated artifacts stimulating ventricular tachycardia: A rare phenomenon

Electrocardiographic (ECG) artifacts may arise due to interference, faulty earthing, and current leakages in biomedical equipment which might create clinical dilemmas in the perioperative settings. Piezoelectric signals generated by ultrasonography probe are another uncommon source which might be sensed by the ECG electrodes and produce tracings similar to pathological arrhythmias triggering false alarms and avoidable therapies. Anesthesiologists should be familiar with these uncommon sources which might produce these artifacts and they should be identified swiftly.

Use of malfunctioning fibre-optic bronchoscope as a rescue bougie!

We describe successful management of an anticipated difficult airway using a dysfunctional FOB with a videolaryngoscope. A 19-year-old male who had sustained burns over face, neck, chest and upper limbs 5 years back was scheduled for release of contracture over axilla and chest under general anaesthesia [Figure 1]. The patient had undergone post-burn neck contracture release and skin grafting 3 months back under general anaesthesia where FOB under spontaneous ventilation was used to secure the airway.

A 'Y'- shaped connector as an indispensable component of paediatric bronchoscopy mask: A novel innovation!

Fibre‐optic bronchoscopy (FOB) has widespread diagnostic and therapeutic role in the form of its use in difficult intubation, bronchoalveolar lavage or biopsies. FOB‐guided intubation in paediatric patients with difficult airway could be a challenge and the presence of craniofacial dysmorphisms presents additional challenges.[1,2] Although awake FOB‐guided intubation is recommended for intubation of patients with difficult airways, same may not be feasible in paediatric patients primarily because of cooperation issues.[3] Some practitioners prefer performing fibre‐optic intubation on anaesthetised and paralysed patients.[2] Smaller airways, easy airway collapsibility at end expiration and reduced functional residual capacity make them susceptible to frequent desaturation during FOB, thus requiring frequent interruptions resulting in delay and at times abandonment of procedure.

Ultrasonographic optic nerve sheath diameter measurement in overweight parturient with intracranial tumour: Guiding choice of anaesthesia.

A 26‐year‐old 36‐week primigravida with body mass index of 28.33 with intracranial space occupying lesion was planned for elective caesarean section. The patient was having frontal headache for past 1 month with left eye ptosis for last 3 weeks. Headache was associated with vomiting. There was no history of seizures. Magnetic resonance imaging (MRI) obtained 3 weeks before showed large lobulated extra‐axial mass (28 mm × 22 mm) in the left parasellar region. Lateral wall of cavernous sinus was inseparable with partial encasement of cavernous internal carotid artery. Lesion was closely abutting optic nerve near optic foramen. There was no midline shift, basal cisterns were not obliterated, ventricles were normal with no obstructions, sulci and gyri were normal, cerebral grey matter and white matter were normal and hence no signs of raised intracranial tension, with possible diagnosis of chondroid [Figure 1]. Neurosurgery along with ophthalmological evaluation was done. There was ophthalmoplegia of the left eye with palsy of cranial nerve 3rd, 4th and 6th with disc pallor; papilloedema was absent. As the pregnancy was term, elective caesarean section was planned to avoid the onset of labour and any associated elevations of blood pressure and intracranial pressure (ICP) after consultation from neurosurgeons and patient also wanted elective caesarean section.