A STUDY TO EVALUATE THE EFFECT OF ADDING CLONIDINE TO ROPIVACAINE FOR AXILLARY PLEXUS BLOCKADE

Aims and objectives- The present study was undertaken to evaluate the effect of adding Clonidine to Ropivacaine for axillary plexus blockade. Material and methods- A total of 60 adult patients having physical status grade I or II according to American Society of Anaesthesiologists ( ASA ) undergoing hand or forearm surgery under axillary plexus blockade using nerve stimulator were included in the study. Patients were randomly allocated to one of the two groups. Each group consisted of 30 patients. Group 1 patients received 35 ml of Ropivacaine 0.5 % + 1 ml of normal saline.Group 2 patients received 35 ml of Ropivacaine + 1 ml of clonidine ( 150 µg). Sensory block, motor block and sedation were assessed every 5 minutes for 30 minutes. Postoperatively assessment was done every 15 minutes till complete regression of sensory and motor block. Results- Mean sensory onset time in patients of group 1 was 26.48 ± 7.88 min and in patients of group 2 was 26.55 ± 8.06 min, which was insignificant statistically. Patients of group 1 had a mean motor onset time 35.51 ± 10.4 min and patients of group 2 had a mean motor onset time 37.06 ± 14.19min, the difference being statistically comparable. Mean duration of sensory block in patients of group 1 was 422 ± 163.10 min and in patients of group 2 was 438 ± 133.93 min, which was statistically comparable. Patients belonging to group 1 had a mean duration of motor block 404 ± 160.60 min and patients belonging to group 2 had a mean duration of motor block 388 ± 151.63 min, which was statistically comparable. Conclusion- Addition of Clonidine ( 150 µg) is of no benefit in the onset and duration of axillary plexus block

Anaesthetic Management of a Patient with Arthrogryposis Multiplex Congenita: A Case Report

Arthrogryposis multiplex congenita first described in 1905, is a rare congenital syndrome affecting 1 in 3000 births. It is characterized by multiple joint contractures found throughout the body and may be associated with multiple congenital anomalies like cleft palate, genitourinary defects, gastroschisis and cardiac defects. Hence appropriate evaluation should be done to rule out congenital abnormalities. Anaesthetic management may be complicated by difficult intravenous access, difficult positioning, difficult regional blockade and difficult airway. Anticipating difficulties and keeping alternate arrangements and preparation is required

Anaesthetic Management of a Patient with Arthrogryposis Multiplex Congenita: A Case Report

Arthrogryposis multiplex congenita first described in 1905, is a rare congenital syndrome affecting 1 in 3000 births. It is characterized by multiple joint contractures found throughout the body and may be associated with multiple congenital anomalies like cleft palate, genitourinary defects, gastroschisis and cardiac defects. Hence appropriate evaluation should be done to rule out congenital abnormalities. Anaesthetic management may be complicated by difficult intravenous access, difficult positioning, difficult regional blockade and difficult airway. Anticipating difficulties and keeping alternate arrangements and preparation is required

Light-emitting Diode Vein Finding Device in Facilitating Peripheral Intravenous Cannulation in Children: A Randomised Clinical Study

Introduction: Peripheral venous cannulation in the paediatric age group is always a challenging task. The transillumination technique improves the visualisation of veins. The Light Emitting Diode (LED) vein finder device is based on the side transillumination principle. Aim: To evaluate the role of transilluminating LED vein finder device (Optramed Vein-Lite), for peripheral intravenous cannulation in children with respect to ease of cannulation, time taken and number of attempts. Materials and Methods: This randomised clinical study was conducted in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2018 to January 2020. Total 130 patients, age <3 years, of either sex, and scheduled for surgery under general anaesthesia were included in the study. They were randomised into two groups. Group I (n=65), where venous cannulation was done using a transilluminating LED vein finder device, and group II (n=65) where venous cannulation was done after visualising and palpating the vein manually (conventional technique). Both the groups were compared with respect to the Difficult Intravenous Access (DIVA) score, number of attempts, ease of intravenous (i.v.) cannulation (cannulation on first or second attempt as ‘easy’, more than two attempts as ‘difficult’ cannulation) and time required for intravenous cannulation. The qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: The mean age of the population in group I was 17±13 months, and in group II was 15±23 months (p-value=0.5427). There was a significant variation with respect to the number of attempts; the first attempt success was 90.7% in group I vs. 63% in group II (p-value=0.0014). In group I, cannulation was easy in 95% of patients, while in group II, only 76.9% of patients had easy cannulation (p-value=0.0018). Time taken for intravenous cannulation in group I was 19.385±6.2015 sec and in group II was 22.886±11.6716 sec (p-value=0.0346). Conclusion: Transillumination is a useful technique to improve the success rate of peripheral venous cannulation in infants and children

A comparative study to evaluate ultrasound-guided transversus abdominis plane block versus ilioinguinal iliohypogastric nerve block for post-operative analgesia in adult patients undergoing inguinal hernia repair

Background and Aims: Both transversus abdominis plane (TAP) block and combined ilioinguinal-iliohypogastric (IIN/IHN) blocks are used routinely under ultrasound (USG) guidance for postoperative pain relief in patients undergoing inguinal hernia surgery. This study compares USG guided TAP Vs IIN/IHN block for post-operative analgesic efficacy in adults undergoing inguinal hernia surgery. Methods: Sixty adults aged 18 to 60 with American Society of Anesthesiologsts' grade I or II were included. After general anaesthesia, patients in Group I received USG guided unilateral TAP block using 0.75% ropivacaine 3 mg/kg (maximum 25 mL) and those in Group II received IIN/IHN block using 10 mL 0.75% ropivacaine. Postoperative rescue analgesia was with tramadol (intravenous) IV ± diclofenac IV in the first 4 h followed by oral diclofenac subsequently. Total analgesic consumption in the first 24 h was the primary objective, intraoperative haemodynamics, number of attempts and time required for performing the block as well as the postoperative pain scores were also evaluated. Results: Time to first analgesic request was 319.8 ± 115.2 min in Group I and 408 ± 116.4 min in Group II (P = 0.005). Seven patients (23.33%) in Group I and two (6.67%) in Group II required tramadol in first four hours. No patient in either groups received diclofenac IV. The average dose of tablet diclofenac was 200 ± 35.96 mg in Group I and 172.5 ± 34.96 mg in Group II (P = 0. 004). Conclusion: USG guided IIN/IHN block reduces the postoperative analgesic requirement compared to USG guided TAP block

A unique method of intubating an unusual neck injury with knife-in-situ

A young male, aged 32 years, was brought to the emergency operation theatre, with a household knife-in-situ, in the neck. A detailed history revealed psychiatric illness to be the cause of this self inflicted injury. His vitals were found to be stable and he had no respiratory embarrassment and was conversing comfortably. Intubating him with a knife-in-situ was a great challenge. A simple technique using two endotracheal tubes was used which helped in securing the airway avoiding any further injury with the knife-in-situ

Transient aphonia following spinal anesthesia in a parturient: A case report

Spinal anesthesia is the preferred technique of administering anesthesia for elective cesarean section (CS). Hypotension, failed spinal anesthesia, postdural-puncture headache, cauda equina syndrome are a few complications that may occur but neurological complications particularly aphonia are quite rare. The use of lipophilic opioids as adjuvants with local anesthetics are considered as culprit but the exact mechanism remains unidentified. We report such presentation in our patient and discuss the likely cause

Per-Operative Kinking of a Reinforced Endotracheal Tube: An Unforeseen Complication

Reinforced tubes are routinely used in Oro-maxillary surgeries. In spite of its advantages, any intra-operative deformity in reinforced tubes can at times lead to occlusion of a patent airway. To change this tube intraoperatively with distorted oral anatomy could be an anaesthetic challenge

Bilateral Congenital Choanal Atresia: A Case Report

Choanal atresia is an uncommon congenital anomaly of nose caused by failure of resorption of the bucco-pharyngeal membrane during embryonic development. Bilateral choanal atresia presents with severe respiratory distress and cyanosis at birth and is alleviated by crying. Surgery is the definitive treatment. We discuss successful management of a neonate with bilateral choanal atresia