Risk factors affecting the length of intensive care unit stay after brain tumor surgery Selda Kayaaltı, Omer Kayaaltı The Indian Anaesthetists Forum 2019 20(2):61-69 Aims: In recent years, the number of surgical procedures performed in high-risk patients has increased, and the need for postoperative intensive care has also increased. In this study, it is aimed to identify the risk factors that can be used to estimate the need for intensive care stay of more than 1 day for patients with brain tumor resection. Methods: In this study, an open-accessible dataset was used, which included preoperative, perioperative, and intensive care follow-up data of 400 patients who were admitted to intensive care unit (ICU) after craniotomy due to brain tumor. The patients were divided into two groups according to the length of stay in the ICU. Patients who had less than a day stay were included in the short-term intensive care need (SICN) group and those staying more than 1 day were included in the long-term intensive care need (LICN). The effect of patients' data on ICU length of stay in ICU was investigated by logistic regression analysis. Results: Thirty-nine (9.75%) patients and 361 (90.25%) patients were assigned to the LICN group and SICN group, respectively. In the multivariate binary logistic regression model, the increase in total intravenous anesthesia (TIVA) and patient-controlled analgesia (PCA) applications decreases the patients' LICN likelihood while being intubated at ICU admission, need of mechanical ventilation (MV), postoperative hematoma formation, and increased duration of anesthesia increase the patients' LICN likelihood. Conclusions: The results of our study showed that the likelihood of patients' stay in ICU for more than 1 day could be estimated by such parameters as anesthesia duration, TIVA application, use of PCA device, being intubated at ICU admission, MV requirement, and postoperative hematoma formation.

Predictability of airway evaluation indices in diabetic and nondiabetic patients requiring general anesthesia with endotracheal intubation Ravindra Kute, Rajendra Gosavi, Prashant Bhaleker, Deepak Phalgune The Indian Anaesthetists Forum 2019 20(2):70-75 Introduction: Difficult airway management (intubation and/or ventilation) results in significant morbidity and mortality. In the present study, we evaluated various clinical parameters of airway assessment and their ability to predict difficult laryngoscopy and intubation in patients with diabetes mellitus (DM) compared to nondiabetic individuals. Methods: In this prospective comparative study, we enrolled an equal number of 110 patients in DM group and non-DM group. Patients were examined for body mass index (BMI), Modified Mallampati class (MMC), mouth opening, neck extension (NE), mobility of mandible by upper lip bite test, thyromental distance (TMD), collar size, palm print sign, and prayer sign. Primary outcome measure was Cormack and Lehane's grading on direct laryngoscopy. The comparison of quantitative and qualitative variables between the groups was done using unpaired Student's “t”-test and Chi-square test, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of each test were done. Results: In DM patients, sensitivity was highest for MMC followed by prayer sign, whereas specificity was highest for palm print, followed by TMD, BMI, prayer sign, and other predictors. In non-DM individuals, sensitivity was highest for MMC whereas specificity was highest for prayer sign, followed by TMD, palm print and NE, and other predictors. Conclusions: In DM patients, sensitivity and specificity was highest for MMC and palm print, respectively. In non-DM individuals, sensitivity was highest for MMC whereas specificity was highest for prayer sign. A combination of tests may predict difficult laryngoscopy.

Comparison of three different doses of dexmedetomidine for prevention of postspinal anesthesia shivering in transurethral resection of prostate surgery Fahd Hossain, Swati Singh The Indian Anaesthetists Forum 2019 20(2):76-81 Background and Aims: Postanesthetic shivering (PAS) is an unpleasant and potentially serious complication. It is often neglected, and no universal protocols are established for its prevention. The efficacy of dexmedetomidine for the treatment and prevention of PAS is well demonstrated. Very few studies have been done regarding the optimal effective dose of dexmedetomidine for the prevention of postspinal anesthesia (SA) shivering. Thus, we aimed to compare and evaluate three different doses of intravenous dexmedetomidine and to investigate the optimum dose of dexmedetomidine that effectively prevents shivering in patients undergoing transurethral resection of the prostate (TURP). Methods: In this randomized, double-blind, prospective study, 150 patients of the American Society of Anesthesiologists I and II scheduled for elective TURP under SA were enrolled. Patients were randomly allocated into one of the three groups receiving dexmedetomidine: Group P: 0.5 μg/kg, Group Q: 0.75 μg/kg, and Group R: 1.0 μg/kg. The primary outcome of the study was intraoperative incidence of shivering. The secondary outcomes, such as hemodynamic parameters and adverse reactions, were also noted. Results: Shivering score of different groups revealed statistically significant lower incidence and severity of shivering in Group Q and Group R when compared to Group P(P = 0.0395). Incidences of nausea/vomiting, bradycardia, and hypotension were more in Group R when compared to Group P and Group Q. Axillary temperature and sedation scores were comparable among different groups (P > 0.05). Conclusion: Dexmedetomidine in the dose of 0.75 μg/kg provides adequate antishivering effect with added benefit of sedation and less hemodynamic instability.

Efficacy of nalbuphine as an adjuvant to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries: A prospective randomized double-blind study Kavita Jain, Surendra Kumar Sethi, Suman Gupta, Arvind Khare The Indian Anaesthetists Forum 2019 20(2):82-88 Background: The benefit of postoperative analgesia in regional block is short lived due to limited duration of action of local anesthetics. Various adjuvants have been tried to enhance the duration of analgesia. The aim of this study was to evaluate the analgesic efficacy and safety of nalbuphine as an adjuvant to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block. Methods: A prospective, randomized, double-blind study was conducted on 100 patients of American Society of Anesthesiologists physical status I/II aged 18–70 years scheduled for upper limb surgeries under USG supraclavicular brachial plexus block. The patients were randomly allocated into two groups of 50 each to receive either 20 ml of 0.5% ropivacaine with 1 ml of normal saline (Group A) or 20 ml of 0.5% ropivacaine with 1 ml (10 mg) of nalbuphine (Group B). The onset and duration of sensory and motor block, duration of analgesia, and side effects were noted. Results: There was no significant difference in mean onset of sensory and motor blocks between the two groups; but in Group B, there was significantly longer duration of sensory block (401.20 ± 19.963 vs. 387.60 ± 29.731 min, P = 0.009), longer duration of motor block (333.20 ± 20.941 vs. 323.00 ± 26.283 min, P = 0.03), and prolonged duration of analgesia (502.60 ± 22.751 vs. 441.20 ± 30.815 min, P < 0.0001) as compared to Group A. No significant side effects were observed in any of the two groups (P > 0.05). Conclusion: Nalbuphine (10 mg) used as an adjuvant to 0.5% ropivacaine for supraclavicular brachial plexus block prolonged the duration of both sensory and motor blockade along with the duration of postoperative analgesia without any increase in side effects.

Intubation with King Vision® video laryngoscope and Macintosh laryngoscope in cervical spine injured: A randomized controlled trial Mohit Kumar, Abhinav Gupta, Harikishan Mahajan, Ravinder Dhanerwa, Parashuram Chauhan The Indian Anaesthetists Forum 2019 20(2):89-94 Background: Intubation of trachea with conventional laryngoscopy requires alignment of the oropharyngeal–laryngeal axis in a straight line. This causes significant movement of the cervical spine, which in case of any previous injury to the spinal cord, may be further damaged due to impingement of the cord between the broken vertebrae. King Vision® video laryngoscope due to its particular J shape and a channel to carry the tube, causes less movement of the spine and hence provides better and safer intubation conditions in patients who have cervical injury. Methods: The study was conducted in a tertiary-level orthopedic and spine center. It was a single-blind randomized control study. After obtaining permission from Hospital Ethics Committee and patient's consent, 60 patients of cervical spine injury of American Society of Anesthesiologists I-III, and normal airway anatomy, were assessed for ease and safety of intubation by – (a) King Vision® video laryngoscope and (b) Macintosh laryngoscope. The primary criteria were Intubation Difficulty Scale (IDS), while the secondary criteria were duration of intubation, heart rate, and mean arterial pressure. Results: Results were analyzed by Chi-square, Mann–Whitney, and Student t-test using SPSS software. P value was 0.05. The mean IDS in King Vision® video laryngoscope group was significantly less than Macintosh group. However, there was no statistical difference in duration of intubation and hemodynamic parameters. Conclusions: Intubation in cervical spine injury patients with neck immobilization is easier with King Vision® video laryngoscope, but duration of intubation, complication rate, and hemodynamic parameters remain the same as compared with Macintosh laryngoscope.

A study to evaluate the efficacy of topical quick penetrating solution of heparin in preventing thrombophlebitis Teena Bansal, Prashant Kumar, Garima Vashisht The Indian Anaesthetists Forum 2019 20(2):95-98 Background and Aims: Superficial thrombophlebitis is the most common complication with intravenous cannulation which is characterized by cord-like painful veins and discoloration of skin over puncture site. The study was conducted to evaluate the efficacy of topical quick penetrating solution (QPS) of heparin to prevent superficial thrombophlebitis. Methods: This prospective randomized study included 200 patients who were divided into two groups. In Group I (control group), cannula site was observed using Phlebitis Assessment Grading Scale at 12, 24, 48, and 72 h. In Group II (heparin group), QPS of heparin was applied 12 hourly for up to 72 h, and cannula site was examined at the same time intervals as in Group I. Results: In Group I, at 12 h, score of 0 and 1 was observed in 96 and 4 patients, respectively, whereas all patients had a score of 0 in Group II (P = 0.044). At 24 h, the score was 0, 1, and 2 in 28, 60, and 12 patients, respectively, in Group I, whereas it was 0 and 1 in 96 and 4 patients in Group II (P = 0.001). At 48 h, the score was 1 and 2 in 36 and 64 patients in Group I, whereas it was 0 and 1 in 60 and 40 patients in Group II (P = 0.001), respectively. At 72 h, the score of 2, 3, and 4 was observed in 32, 44, and 24 patients in Group I, respectively, whereas the score of 0, 1, and 2 was observed in 36, 48, and 16 patients, respectively, in Group II (P = .001). Conclusion: Heparin QPS when applied prophylactically significantly decreased thrombophlebitis.

Anesthesia consideration for cesarean section in chronic myeloid leukemia diagnosed during pregnancy: An interesting case report and brief review of literature Veena Ganeriwal, Priyanka Agrawal, Pranav Thote, Mitali Parkar, Sayli S Waiker The Indian Anaesthetists Forum 2019 20(2):99-102 Chronic myeloid leukemia (CML) is a myeloproliferative disorder with clonal expansion of transformed primitive hematopoietic progenitor cells without loss of their capacity to differentiate. Annual incidence of CML in females ranges from 0.6 to 1.6 per 100,000 populations. In developing countries like India where onset of hematological malignancy occurs in early age, thereby increases chances of concomitant occurrence of CML and pregnancy together. Although the incidence is rare, anesthesia management of pregnant female presenting more so for an emergency cesarean section (C/S) is challenging because of the physiological changes during pregnancy, presence of anemia, coagulopathy, immunosuppressant drugs, leukocytosis, and rarely blast cells in circulation. We report the successful management of a 19-year-old primigravida, recently diagnosed with CML, planned for emergency C/S under general anesthesia in view of meconium-stained liquor with fetal distress.

Anesthetic management of a teen with MURCS variant with tetralogy of Fallot for vaginoplasty Avantika Sandeep Bhat, Aparna Yadav The Indian Anaesthetists Forum 2019 20(2):103-105 MRKH (Mayer Rockytonsky Kuster Houster) Syndrome is a rare congenital disorder of reproductive system affecting females (Incidence is 1:4500 newborn girls). There are 2 types of this syndrome. Type 1 involves maldevelopment of only the reproductive system. Type 2 is also known as MURCS syndrome which involves reproductive, cardiovascular systems, renal agenesis, somatic, vertebral and hearing defects. The MURCS variant with congenital heart defects is very rare type. Morbidity and mortality of patients having corrected Tetralogy of Fallot (TOF) depends upon the severity of residual right ventricular outflow tract (RVOT) obstruction and the amount of pulmonary regurgitation. Successful anaesthetic management of such a case is similar to a tightrope walk. Acute kidney injury (AKI) to the single kidney and deranged coagulation profile were additional challenges that we addressed to during the conduct of this case.

Airway management of a neonate with huge teratoma of tongue and concomitant cleft palate: A challenge for the anesthesiologist Hemlata , Reetu Verma, Ahsan Khaliq Siddiqui, Prem Raj Singh The Indian Anaesthetists Forum 2019 20(2):106-107

Videolaryngoscopy-assisted intubation in a patient of Pendred syndrome with a pendulous goiter Kanika Gupta, Reena , Pradeepika Gangwar, Shweta Agarwal, Anil Kumar The Indian Anaesthetists Forum 2019 20(2):107-109