Comparison of crystalloid and colloid preload on maternal hemodynamics in elective caesarean section under spinal anaesthesia

Background: Hypotension after spinal anaesthesia for caesarean section remains a common and potentially serious complication. Crystalloids are commonly used to counteract this adverse effect. Colloid solutions, such as albumin, hydroxylethyl starch (HES) and gelatin is effective alternatives. The main objective was to study to compare the effect of crystalloid and colloid preloading in elective caesarean section.Methods: It was a randomized controlled study conducted at North Bengal Medical College under Department of Anesthesiology in collaboration with Department of Gynaecology and Obstetrics from July 2011 to June 2012. Eighty patients were randomly allocated to two equal groups of 40 each in group 1 (Patients with Ringer’s lactate) and group 2 (Patients with hydroxylethyl starch) before performing spinal anaesthesia.Results: In the present study, the incidence of hypotension was more in Ringer’s lactate group than hydroxylethyl starch group. The fall of systolic blood pressure, mean blood pressure were higher in Ringer’s lactate group (group 1) than 6% hydroxylethyl starch group (group 2). The changes in heart rate, SpO2 and respiratory rate were clinically insignificant in both groups. Also, the time intervals from induction to reach block height upto T5, incision-delivery were similar for group 1 and group 2. Also, there was no clinical difference in neonatal outcome as measured by Apgar scores at 1 minute and 5 minutes between group 1 and group 2.Conclusions: The preloading with 6% hydroxyethyl starch in elective caesarean section was able to prevent the maternal hypotension better than preloading with Ringer’s lactate solution without any significant neonatal adverse effect.

Serum sodium and water imbalance after sellar, suprasellar, and parasellar surgeries: A prospective and observational study

Background: Sodium and water imbalance is common after sellar, suprasellar, and parasellar surgeries. A wide variation in the diagnostic criteria of diabetes insipidus (DI) has been noted in literature. A highly variable incidence of DI and hyponatraemia has been reported. There is paucity of Indian studies. Aims and Objectives: The study was designed to evaluate serum sodium level and water imbalance after sellar, suprasellar, and parasellar surgeries. This was evaluated in terms of occurrence of hyponatraemia and central DI on day 1 and day 7 in the post-operative period. Materials and Methods: Patients of either sex, aged from 18 to 65 years, ASA physical status I-II, GCS score ≥13, with baseline normal electrolyte level, posted for elective neurosurgical procedures for sellar, suprasellar, and parasellar tumours, were included for this study after satisfying the inclusion and exclusion criteria. A convenient sampling of 50 patients was considered for this study. The primary outcome measures were to determine the incidence of hyponatraemia and central DI. Other adverse event and any requirement of desmopressin in the post-operative period were also noted. Results: In the present study, the majority (74%) of patients were 31–50 years. Female preponderance was noted with male: female ratio as 1:1.4. Out of 50 cases 41 (82%) had transcranial surgery and 9 (18%) had transphenoidal surgery. The incidence of sodium and water disturbances (SWD) was observed in 22% (11/50) patients. Out of these 11 patients, nine developed DI and two had hyponatremia on day 1 in the post-operative period. Both the abnormalities were found to recover on day 7. Only 1 patient (2%) required desmopressin. Conclusion: The incidence of SWD after sellar, suprasellar, and parasellar surgeries was found to be common (22%). The hyponatraemia and DI responded to the therapy and were transient in nature

Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy

Background: Nowadays, anesthesiologists are evaluating several analgesic adjuncts to minimize opioid use during craniotomy. Some studies have evaluated the analgesic-sparing effect of intravenous infusion of dexmedetomidine and lidocaine on intraoperative hemodynamics and post-operative analgesia. There is a paucity of studies focussing on the intraoperative analgesic requirement. Aims and Objectives: The present study compared dexmedetomidine and lidocaine infusion primarily for their effects on intraoperative fentanyl requirements during craniotomy. Materials and Methods: This study was done on 70 patients aged 18–80 years, the American Society of Anesthesiologists physical status I–II, having Glasgow Coma Scale 15, undergoing craniotomies. Patients were randomly allocated to receive either dexmedetomidine (group A, n=35) at a dose of 0.6 mcg/kg bolus over 10 min followed by 0.6 mcg/kg/h infusion or lidocaine (group B, n=35) at a dose of 1.5 mg/kg bolus over 10 min, followed by 1.5 mg/kg/h infusion till the end of skin suture, respectively. Study drugs were started 10 min before the start of surgery. Intraoperative total fentanyl and propofol consumption, intraoperative hemodynamics, recovery from hypnosis, and time to extubation were recorded. Results: The use of dexmedetomidine resulted in considerably less total fentanyl requirement (245.1 vs. 300.7 mcg, P<0.0001) and total propofol requirement (172.7 vs. 236.7 mg, P<0.0001) compared with lidocaine. Comparatively better hemodynamics were observed with the use of dexmedetomidine at all the points of observation. Conclusion: Dexmedetomidine as an analgesic adjunct can be a better alternative to lidocaine in terms of reduced fentanyl consumption, reduced propofol use and favorable hemodynamics, and early recovery from anesthesia

Sample size calculation: Basic principles

Addressing a sample size is a practical issue that has to be solved during planning and designing stage of the study. The aim of any clinical research is to detect the actual difference between two groups (power) and to provide an estimate of the difference with a reasonable accuracy (precision). Hence, researchers should do a priori estimate of sample size well ahead, before conducting the study. Post hoc sample size computation is not encouraged conventionally. Adequate sample size minimizes the random error or in other words, lessens something happening by chance. Too small a sample may fail to answer the research question and can be of questionable validity or provide an imprecise answer while too large a sample may answer the question but is resource-intensive and also may be unethical. More transparency in the calculation of sample size is required so that it can be justified and replicated while reporting

Scientific misconducts and authorship conflicts: Indian perspective

This article is a narrative review about how appropriate authorship can be achieved, a brief mention about various scientific misconducts, the reason and consequences of such misconducts and finally, the policies to be adopted by the aspiring authors to avert these problems. The literature search was performed in the Google and PubMed using ′scientific misconduct′, ′honorary/ghost authorship′, ′publish-or-perish′, ′plagiarism′ and other related key words and phrases. More than 300 free full-text articles published from 1990 to 2015 were retrieved and studied. Many consensus views have been presented regarding what constitutes authorship, the authorship order and different scientific misconducts. The conflicts about authorship issues related to publication of dissertation, the area of the grey zone have been discussed. Suggestions from different authorities about improving the existing inappropriate authorship issues have been included

Nasogastric tube insertion in anaesthetised, intubated adult patients: A comparison between three techniques

Background and Aims: The existence of several methods for proper placement of nasogastric tube (NGT) and introduction of various novel methods day-by-day indicates that no method is perfect or universally accepted. However, the quest for the best is still on. Application of cold in various forms to stiffen the NGT has been tested inconsistently over the last three decades. In the recent past, frozen NGT has been compared only with conventional methods. Hence, the present study was designed to evaluate the efficacy of the frozen technique in comparison with conventional and reverse Sellick's manoeuvre. Methods: A total of 195 adult patients undergoing abdominal surgeries in anaesthetised and intubated state requiring NGT insertion were allocated to three groups to have their NGT placement using either the conventional method (Group A) or using frozen NGT (Group B) or applying reverse Sellick's manoeuvre (Group C). The number of successful placements of NGT within two attempts, procedure time, and incidences of adverse events were noted. Results: The highest success rate regarding the successful placement of NGT was observed using reverse Sellick's manoeuvre (95.2%), closely followed by the frozen NGT technique (84.6%) in comparison with conventional method (69.2%). The procedure time was the least with reverse Sellick's manoeuvre (31.5 ± 9.5 s) compared with conventional (42.2 ± 21.4 s) and frozen technique (42.1 ± 13.2 s). Conclusion: Nasogastric tube insertion using reverse Sellick's manoeuvre shows the highest success rate and having the least adverse events among the compared three methods in anaesthetised, intubated adult patients

Comparison of crystalloid and colloid preload on maternal hemodynamics in elective caesarean section under spinal anaesthesia

Background: Hypotension after spinal anaesthesia for caesarean section remains a common and potentially serious complication. Crystalloids are commonly used to counteract this adverse effect. Colloid solutions, such as albumin, hydroxylethyl starch (HES) and gelatin is effective alternatives. The main objective was to study to compare the effect of crystalloid and colloid preloading in elective caesarean section.Methods: It was a randomized controlled study conducted at North Bengal Medical College under Department of Anesthesiology in collaboration with Department of Gynaecology and Obstetrics from July 2011 to June 2012. Eighty patients were randomly allocated to two equal groups of 40 each in group 1 (Patients with Ringer’s lactate) and group 2 (Patients with hydroxylethyl starch) before performing spinal anaesthesia.Results: In the present study, the incidence of hypotension was more in Ringer’s lactate group than hydroxylethyl starch group. The fall of systolic blood pressure, mean blood pressure were higher in Ringer’s lactate group (group 1) than 6% hydroxylethyl starch group (group 2). The changes in heart rate, SpO2 and respiratory rate were clinically insignificant in both groups. Also, the time intervals from induction to reach block height upto T5, incision-delivery were similar for group 1 and group 2. Also, there was no clinical difference in neonatal outcome as measured by Apgar scores at 1 minute and 5 minutes between group 1 and group 2.Conclusions: The preloading with 6% hydroxyethyl starch in elective caesarean section was able to prevent the maternal hypotension better than preloading with Ringer’s lactate solution without any significant neonatal adverse effect.

A comparative study of infusions of phenylephrine, ephedrine and phenylephrine plus ephedrine on maternal haemodynamics in elective caesarean section

Introduction: This randomized double blind study was started with an objective of management of spinal anaesthesia-induced hypotension in elective caesarean section by combining two commonly used vasopressors - ephedrine and phenylephrine in half of their usual doses with an expectation of reducing their foetomaternal side effects. Methods: One hundred and thirty two patients were randomized into three groups to receive either 100 mg/ml phenylephrine (group-P, n=31) or 3 mg/ml ephedrine (group-E, n=33) or 50 mg phenylephrine plus 1.5 mg ephedrine/ml (group-PE, n=29). Immediately after spinal injection the study solution was started prophylactically in every patient at the rate of 40 ml/h. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP). Results: Mean fall of SBP was significantly more in group-E than group-P (P=0.009) and group-PE (P=0.013). This was not significantly different when compared between group-P and group-PE (P=0.9). Episodes of hypotension and tachycardia were more in group-E than the other two groups. Statistically significant tachycardia was seen in Group-E than that in other two groups. Incidence of bradycardia and hypertension did not differ significantly among the groups. Maternal nausea and Apgar score were also comparable in three groups. Conclusion: Current study claims that prophylactic phenylephrine 100 mg/ml is a better choice than ephedrine (3 mg/ml) or 50 mcg phenylephrine plus 1.5 mg ephedrine/ml in prevention of spinal anaesthesia-induced hypotension in elective caesarean section. Combination of two drugs in half the usual dose has no added advantage over phenylephrine, but this is better than ephedrine alone