Publications in the Year: 2009

Journal Article

Mishra, SK, Lata S, Kumar VH, Mishra G, Ezhilarasu P.  2009.  Difficult intubation; Temporomandibular joint ankylosis with limited mouth opening and hypertrophied adenoid in 6 year old child-case report and review. The Internet Journal of Anaesthesiology. 22(1) AbstractWebsite

Various methods have been described for nasal intubation in children with temporomandibular joint ankylosis with limited mouth opening. As younger children are uncooperative, they required intubation under anesthesia. When associated with hypertrophied adenoid, there is high risk of bleeding in to the unprotected airway resulting in laryngospasm and/or bronchospsm. We describe here how successful intubation was performed in a child with Magill-tipped Red rubber (Rush) cuffed tracheal tube using an adult 4.1 fibreoptic bronchoscope under intravenous anesthesia.

Sistla, SC, Sibal AK, Ravishankar M.  2009.  Intermittent wound perfusion for postoperative pain relief following upper abdominal surgery: a surgeon’s perspective, 2009/02//Jan-und. Pain Practice: The Official Journal of World Institute of Pain. 9:65-70. AbstractWebsite

BACKGROUNDAlthough there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief.
METHODS
Fifty patients undergoing truncal vagotomy and gastrojejunostomy for pyloric stenosis secondary to chronic duodenal ulceration were studied in this prospective randomized trial. Subjects were assigned to receive either wound perfusion with 8 mL of 0.25% bupivacaine every 5 hours through a catheter placed subcutaneously or intravenous pethidine 0.2 mg/kg on demand for postoperative pain relief. Postoperative pain scores at rest were measured by visual analog scale and the opioid requirement at 0-12 hours, at 12-24 hours and at 24-36 hours were compared. Changes in respiratory parameters were also compared between the two groups.
RESULTS
Pain scores at 0-12 hours were significantly lower in the wound perfusion group compared with the intravenous pethidine group (5.7 +/- 1.3 vs. 4.3 +/- 1.2, mean +/- SD; P < 0.001). The number of doses of analgesic required in the wound perfusion group was significantly lower compared with the controls during the 36 hours of study (3.5 +/- 1.3 vs. 1.4 +/- 1.0, P < 0.001). There were no differences in respiratory parameters, vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate between the two groups. The FEV1:FVC ratio, however, was significantly higher in the intravenous pethidine group. There were no wound complications due to catheter placement or systemic toxicity due to the anesthetic.
CONCLUSION
Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function.

Kundra, P, Supraja N, Agrawal K, Ravishankar M.  2009.  Flexible laryngeal mask airway for cleft palate surgery in children: a randomized clinical trial on efficacy and safety, 2009/07//. The Cleft Palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association. 46:368-373. AbstractWebsite

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OBJECTIVETo evaluate the efficacy of a flexible laryngeal mask airway in children undergoing palatoplasty.
DESIGN
Prospective, randomized, single-center study. Setting: Jawaharlal Institute of Postgraduate Medical Education and Research.
PATIENTS
Sixty-six children (American Society of Anesthesiologists physical status 1 and 2) scheduled to undergo palatoplasty were assigned randomly to an endotracheal intubation group (RAE group

Mishra, G, Lata S, Hemanth V, Mishra SK.  2009.  Bilateral pneumothorax with pneumomediastinum under anaesthesia in a neonate. The Internet Journal of Anaesthesiology. 22(1)Website
Parthasarathy, S, Ravishankar M, Selvarajan S, Anbalagan T.  2009.  Ketamine and pulmonary oedema-report of two cases, 2009/08//. Indian Journal of Anaesthesia. 53:486-488. AbstractWebsite

SUMMARY: Perioperative pulmonary oedema is one of the most challenging complications faced by anaesthesiologists. In most of the instances, coronary artery disease, valvular heart diseases, hypertension may precipitate pulmonary oedema due to increased hydrostatic pressure while acid aspiration, airway obstruction may cause it due to increased vascular permeability. In a few instances, acute pulmonary oedema can present in an otherwise healthy patient to cause diagnostic difficulties. We report two such cases of intra operative pulmonary oedema with the use of ketamine which were identified and managed successfully. The most probable cause is also described.

Mishra, G, Hemanth V, Mishra SK, Ezhilarasu P.  2009.  Anaesthetic management of repair of exomphalus and extrophy of bladder for a neonate with double outlet right ventricle with atrial septal defect. The Internet Journal of Anaesthesiology. 22(1) AbstractWebsite

A neonate with complex cardiac disease posted for emergency non cardiac surgery is a challenging task for anesthesiologists. There have complex pathophysiology, which can leads to unstable haemodynamics, arrhythmia and cardiac arrest during anesthesia. Here we report a case of a neonate with double outlet right ventricle with large atrial septal defect posted in emergency as suspected gangrenous bowel due to exomphalus which was also associated with exstrophy of bladder.

Parthasarathy, S, Ravishankar M.  2009.  Acupuncture - A preemptive analgesic technique, April 1, 2009. Journal of Anaesthesiology Clinical Pharmacology. 25:214-216. AbstractWebsite

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Hemanth Kumar, V, Mishra SK, Rupavani K, Ezhilarasu P, Prabahar R.  2009.  Ultralow concentration of epidural bupivacaine wih fentanyl along with intrathecal fentanyl for labor analgesia. Journal of anaesthesiology and clinical pharmacology. 25(3):293-6.Website