Sandhya Yaddanapudi

A randomized study of surgical site infiltration with bupivacaine or ketamine for pain relief in children following cleft palate repair

Wound infiltration with ketamine reduces postoperative pain after tonsillectomy by NMDA receptor blockade and local anesthetic effect.

A randomized trial of propofol consumption and recovery profile with BIS-guided anesthesia compared to standard practice in children

Aim:  To evaluate the impact of bispectral index (BIS) monitoring on the consumption of propofol and recovery from anesthesia compared to the standard clinical practice in children.

Intensive care unit-acquired infections in a tertiary care hospital: An epidemiologic survey and influence on patient outcomes.

BACKGROUND AND OBJECTIVE Nosocomial infections are common in intensive care units (ICUs), but the pattern of infections and the distribution of microorganisms vary. We studied the ICU-acquired infections and their effect on patient outcomes in our ICU. METHODS Patients admitted to our ICU for >48 hours were studied prospectively over a year. Infections were diagnosed based on Centers for Disease Control and Prevention guidelines. Antibiotics were administered based on culture and sensitivity. Univariate and multivariate logistic regressions were carried out to determine the factors associated with infection. RESULTS One hundred ninety-eight patients were studied. The crude infection rate was 50% with ventilator-associated pneumonia (40%) and bloodstream infection (21%) being the most common. Acinetobacter calcoaceticus-baumannii complex, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most common microorganisms. More than 90% of patients received antibiotics, the most common being β lactam-β lactamase inhibitors, aminoglycosides, fluoroquinolones, and carbapenems. Thirty-five percent of staphylococci were methicillin-resistant, 50% of Enterococcus strains were vancomycin-resistant, and 68% of Acinetobacter calcoaceticus-baumannii complex, 47% of Pseudomonas strains, and 35% of Klebsiella strains were multidrug-resistant. A longer duration of ventilation was associated with infection. The overall ICU mortality rate was 24% and was similar in patients with or without infection. CONCLUSIONS The incidence of infection and the multidrug resistance in the ICU was high. Infection was associated with duration of ventilation but not mortality.

Insertion of laryngeal mask airway does not increase the intraocular pressure in children with glaucoma

Objectives: It is hypothesized that in children with glaucoma, the insertion of laryngeal mask airway (LMA) will cause lesser rise in intraocular pressure (IOP) than tracheal tube (TT).

Indications for blood and blood product transfusion

Transfusion of blood products carries certain inherent risks and hence it should be undertaken only if it improves patient outcome. A review of the literature was carried out to find the indications and effects of transfusion on morbidity and mortality of patients. There is high-quality evidence showing that restrictive blood transfusion with a transfusion trigger of haemoglobin of 7-8 g/dl or the presence of symptoms of anaemia is safe and not associated with increased mortality compared with liberal transfusion. Thus, restrictive strategy is strongly recommended in surgical and critically ill-patients. There is moderate evidence for the use of plasma and platelet transfusion in patients receiving massive blood transfusion. There is not enough evidence to support the use of plasma, platelets and cryoprecipitate in any other clinical setting. Retrospective studies show improved survival after high plasma and platelet to red blood cell ratio of 1:1:1, but this has not been confirmed in randomised trials.

Correspondence: A randomized trial of propofol consumption and recovery profile with BIS‐guided anesthesia compared to standard practice in children

Aim: To evaluate the impact of bispectral index (BIS) monitoring on the consumption of propofol and recovery from anesthesia compared to the standard clinical practice in children. Background: Titrating propofol administration using BIS reduces its requirement and shortens the recovery from anesthesia in adults. However, there is still mixed evidence for utility of anesthesia depth monitors in reducing anesthesia requirement in children. Methods ⁄ Materials: A prospective randomized study was conducted in 50 ASA I children of 2–12 years, randomly assigned into standard practice (SP) or BIS group. After induction with propofol, anesthesia was maintained with 150 lgÆkgÆmin propofol infusion. The propofol infusion rate was altered by 20 lgÆkgÆmin to maintain the systolic blood pressure within 20% of the baseline (SP group) or BIS value between 45 and 60 (BIS group). The rate of propofol infusion was reduced by 50% about 15 min before the end of surgery. The amount of propofol used and the times from stopping the propofol infusion to eye opening, extubation, response to commands and attaining Steward score of 6 were recorded. Results: There was no evidence of a difference in the mean propofol consumption in the two groups (BIS 232.6 ± 136.7 mg, SP 250.8 ± 118.2 mg). The intraoperative hemodynamics and BIS values were similar in the two groups. There was no evidence for a difference between groups in the mean times from termination of anesthetic to eye opening, extubation, response to commands and to achieve a Steward Recovery score of 6. Conclusions: Our study showed no benefit of BIS-guided propofol administration on anesthetic consumption or recovery compared to standard anesthetic practice.

Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children

Background and Aims: It is not known whether trapezius squeeze test (TPZ) is a better clinical test than jaw thrust (JT) to assess laryngeal mask airway (LMA) insertion conditions in children under sevoflurane anesthesia. Material and Methods: After the Institutional Ethics Committee approval and written informed parental consent, 124 American Society of Anesthesiologists I and II children of 2–8 years of age undergoing minor surgical procedures were randomized into TPZ and JT groups. The children were induced with 8% sevoflurane in oxygen at a fresh gas flow of 4 L/min. TPZ or JT was performed after 1 min of start of sevoflurane and then every 20 s till the test was negative, when end-tidal (ET) sevoflurane concentration was noted. Classic LMA of requisite size was inserted by a blinded anesthetist and conditions at the insertion of LMA, insertion time, and the number of attempts of LMA insertion were recorded. Results: The mean LMA insertion time was significantly longer (P < 0.001) for TPZ (145 ± 28.7 sec) compared to JT group (111.8 ± 31.0 sec). ET sevoflurane concentration at the time of LMA insertion was comparable in the two groups. LMA insertion conditions were similar in the two groups. There was no difference between the two groups regarding total number of attempts of LMA insertion. Heart rate (HR) decreased in both groups after LMA insertion (P < 0.001) but TPZ group had significantly lower HR compared with the JT group up to 5 min after LMA insertion (P = 0.03). Conclusion: Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

Not just a separate consent for anesthesia

1 A colleague recently commented about the practice of anesthesia consent in India: “In our country every institute has a separate consent for anesthesia.” Such a state of affairs is arguably desirable but not true. The practice of obtaining a specific consent for anesthesia separate from the consent for surgery (separate anesthesia consent) is not uniform across hospitals within this country or in others. The hospitals accredited by the National Accreditation Board for Hospitals and Healthcare Providers or those certified by the Joint Commission International, do use a separate anesthesia consent form. Most of the others probably do not.