Kavitha Jinjil - Academia.edu (original) (raw)

Papers by Kavitha Jinjil

Background: Various studies have investigated the role of different drugs as adjuncts to SBPB to ... more Background: Various studies have investigated the role of different drugs as adjuncts to SBPB to prolong the duration and quality of analgesia without producing any major adverse effects. We conducted a study to compare the novel alpha 2 agonists (clonidine and dexmedetomidine) with respect to onset, duration of block and postoperative analgesia when added as adjuvants to the local anesthetic 0.25% ropivacaine. Method: A total of 60 patients, confirming to inclusion criteria, undergoing elective upper limb surgeries under SBPB, were enrolled for the study, over a period of 2 years. Sensory block was evaluated by Hollmen scale [17] and findings were recorded at an interval of every 2 min from time-0 till complete sensory block was achieved i.e Hollmen Score = 4 . Onset Time of Sensory Block, Time for complete sensory block and total duration of sensory block were recorded. Motor block was evaluated by using Bromage Scale for upper extremity and findings were again recorded at an inte...

Context: Acute postoperative pain relief is accepted as an integral part of paediatric anesthetic... more Context: Acute postoperative pain relief is accepted as an integral part of paediatric anesthetic practice. A difficulty in distinguishing pain from hunger or fear in pre-verbal children and the notion that children do not respond to pain in the same way as adults do, combined with an excessive fear of respiratory depression caused by opioids had lead to pain being under treated in children. Recent evidence suggests that pain causes psychological and physiological abnormalities in children similar to that of adults and therefore must be addressed. We designed a prospective, randomized, study to compare the efficacy and safety of caudal ropivacaine with additive dexmedetomidine versus clonidine in providing postoperative analgesia in children undergoing lower abdominal surgeries. We also studied the haemodynamic and respiratory changes in both groups and looked for any complications. Methods: A comparative prospective study was carried out amongst 100 ASA status I or II male patients...

Antiplatelet therapy plays an important role in the management of coronary artery disease (CAD) p... more Antiplatelet therapy plays an important role in the management of coronary artery disease (CAD) patients, which include the spectrum of patients with stents in situ and those suffering from acute coronary syndrome (ACS) on medical management. The percentage of patients with stents in situ, scheduled for surgery within 2 years, is approximately 5–15%. The antiplatelet therapy predisposes patients to an increased risk of bleeding in the perioperative region, which can lead to fatal outcomes in spinal or intracranial surgeries; the problem multiplies manifolds if the surgery has to be performed in an emergency situation. We report a case of a 76-year-old lady, a known case of CAD with drug eluting stent in situ, on dual antiplatelet agents who had presented to our hospital with progressive weakness of lower limbs and had to be operated on the spine in emergency situation.

Journal of Marine Medical Society, 2015

A 56 year old female underwent open cholecystectomy followed by exploratory laparotomy the follow... more A 56 year old female underwent open cholecystectomy followed by exploratory laparotomy the following day. She was not known to have any airway disease. She developed intra and postoperative hypoxemia during and after the second surgery, the first surgery being uneventful. Intra operative findings included decreased air entry over the entire left lung field but post operative there was no air entry on right side. Postoperative Chest X ray and fiber optic Bronchoscopy was performed. Chest radiography revealed right lung collapse, while Bronchoscopy revealed a thick mucus plug causing complete occlusion of the right main bronchus and near total occlusion of the left main bronchus. A Bronchoscopic lavage corrected the problem.

Indian Journal of Anaesthesia

Journal of Marine Medical Society, 2016

Endurance athletic activities, which requires top level cardio respiratory system fitness are rec... more Endurance athletic activities, which requires top level cardio respiratory system fitness are recently becoming popular in the various parts of the country. Armed Forces are forefront in participation of those sporting activities, like marathon running, prolonged swimming or cycling. It has been found to have various long term beneficial effect in body function as a result of prolonged endurance activities, but it has also found that there are various bodily changes which may affect in anaesthetising the individual during emergency and elective surgeries. Literature review of various journals related to endurance sporting activities has described those bodily changes and effects of anaesthesia and pain on those changes. Based upon the available literature a guideline has been formulated for perioperative management of those patients. Most of those available literatures are from countries other than our country. The time has come for venturing in for carrying out further studies in our scenario, especially in Armed Forces in this new horizon of anaesthesia and critical care

Anesthesia: Essays and Researches, 2018

This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal... more This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal anesthesia (SA) using bupivacaine (heavy) for closed hemorrhoidectomies. A prospective randomized study was conducted in sixty patients who underwent closed hemorrhoidectomy. Thirty patients of Group A received SA. Thirty patients in Group B received local perianal block. Patients were evaluated for onset of the block, total pain-free period, and time to ambulation. Patient satisfaction in terms of pain during injection and satisfaction with the anesthesia technique was assessed after 2-week telephonically. Data were statistically analyzed using unpaired -test for the continuous variables and Fischer's exact test for categorical variables. Onset of anesthesia was significantly earlier in Group B, mean (standard deviation [SD]) value being 3.17 (1.28) min as compared to Group A, 6.24 (4.28) min ( = 0.0004). Total pain-free period (mean [SD]) in minute was longer in Group B, 287 (120) min as compared to Group A, 128 (38) min. Time to ambulation was significantly earlier in Group B, 22.83 (29.32) min as compared to Group A 302 (92.41) min. Pain during injection between the two groups was comparable. However, more patients in Group B (60%) were satisfied with the anesthesia technique as compared to Group A (27.5%). Perianal block for hemorrhoidectomy with ropivacaine 0.2% using dexmedetomidine as an adjuvant is an effective and reliable technique which is as effective as SA. It provides prolonged postoperative analgesia and early ambulation.

Journal of Emergencies, Trauma, and Shock, 2018

The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American He... more The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American Heart Association (AHA) guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR), CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway . A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Anesthesia: Essays and Researches, 2016

The synergism between local anesthetic agents such as bupivacaine with intrathecal adjuvants such... more The synergism between local anesthetic agents such as bupivacaine with intrathecal adjuvants such as opioids and clonidine is well established. This study evaluates the clinical efficacy of clonidine75 μg versus fentanyl 25 μg as adjuvants to bupivacaine for spinal anesthesia. A prospective, randomized, parallel arm study was conducted over a period of 12 months in a tertiary care hospital. Sixty patients were divided randomly into two groups, Group C and Group F. Patients in Group C received 2.5 ml of 0.5% bupivacaine heavy mixed with 0.5 ml (75 μg) clonidine intrathecally, and patients in Group F received 2.5 ml of 0.5% bupivacaine heavy mixed with 0.5 ml (25 μg) fentanyl intrathecally. Data were analyzed using statistical tests for comparison of means. The mean durations of sensory block was 253.3 and 249.6 minutes in group C and group F respectively, which was statistically not significant (P = 0.76). The mean durations of motor block were 302.3 and 293.6 min, respectively, in Group C and Group F, which were also statistically not significant (P = 0.53). The mean durations of postoperative analgesia were 653.4 and 611.2 min, respectively, in Group C and Group F, which were statistically not significant (P = 0.09). Mean heart rate after 10 min was 82.5 in Group C and 87.2 in Group F, which was statistically not significant (P = 0.29), and mean arterial pressure in mmHg after 10 min was 96.3 in Group C and 97.3 in Group F, which was also statistically not significant (P = 0.86). Both clonidine 75 μg and fentanyl 25 μg when used as adjuvants to bupivacaine in the subarachnoid block have comparable beneficial results in terms of duration of analgesia, duration of motor blocks, and hemodynamic stability and also have a comparable incidence of complications.

Anesthesia: Essays and Researches, 2016

Hallermann–Streiff syndrome (HSS), a rare genetic disorder involving craniofacial region, was fir... more Hallermann–Streiff syndrome (HSS), a rare genetic disorder involving craniofacial region, was first described completely by Hallermann in 1948 and Streiff in 1950. The etiology remains an enigma; although sporadic mutation is considered in majority of the patients, there is an association in literature with consanguinity, antenatal rubella infection, and familial medical history.[1] We report a case of 12-year-old male child, a product of nonconsanguineous marriage, postrubella syndrome (echocardiography normal), born preterm (32 weeks of gestation), planned for urethroplasty. Anthropometry revealed weight of 23 kg (<3rd percentile), height of 128 cm (<3rd percentile), and occipital-frontal circumference of 50 cm (<3rd percentile), and karyotyping was normal. The patient had 6 out of 7 diagnostic criteria for HSS [Figure 1], dyscephalia (broad forehead) and bird face, orodental anomalies high arch palate, dental caries, and malocclusion proportionate dwarfism, atrophy of the skin, bilateral microphthalmia (also had bilateral microcornea, bilateral epicanthal folds), congenital cataracts (not present in our case), and hypotrichosis. Additional clinical features present in our case were large low-set ears, clinodactyly, syndactyly in toes, and poorly developed scrotum with hypospadias.

Anesthesia: Essays and Researches

High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for res... more High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.

Various studies have investigated the role of different drugs as adjuncts to SBPB to prolong the ... more Various studies have investigated the role of different drugs as adjuncts to SBPB to prolong the duration and quality of analgesia without producing any major adverse effects. We conducted a study to compare the novel alpha 2 agonists (clonidine and dexmedetomidine) with respect to onset, duration of block and postoperative analgesia when added as adjuvants to the local anesthetic 0.25% ropivacaine.

The success of endoscopic surgery in otolaryngology largely depends on the surgical field, where ... more The success of endoscopic surgery in otolaryngology largely depends on the surgical field, where the presence of significant bleeding is a critical factor. Bleeding obscures surgical planes and the recognition of anatomical landmarks becomes quite difficult. Various manoeuvers and drugs have been used for optimization of the surgical field. Conventionally, beta blockers and sodium nitroprusside have been used to control the intraoperative blood pressure. Newer agents such as remifentanil and adrenergic alpha-2 agonists such as clonidine and dexmedetomidine are also being tried. We report two cases of endoscopic sinus surgery (ESS) where dexmedetomidine infusion as adjunct to propofol infusion and inhalational anesthesia with sevoflurane [minimum alveolar concentration (MAC) 0.5-0.8] were utilized for providing an optimal surgical field.

Paediatric spinal anesthesia is not only a safe alternative to general anaesthesia but often the ... more Paediatric spinal anesthesia is not only a safe alternative to general anaesthesia but often the anaesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and feasibility is broken and is now found to be even more cost-effective. It is a much preferred technique especially for the common daycase surgeries generally performed in the paediatric age group. There is no requirement of any additional expensive equipment either and this procedure can be easily performed in peripheral centers. However, greater acceptance and experience is yet desired for this technique to become popular.

Background: Various studies have investigated the role of different drugs as adjuncts to SBPB to ... more Background: Various studies have investigated the role of different drugs as adjuncts to SBPB to prolong the duration and quality of analgesia without producing any major adverse effects. We conducted a study to compare the novel alpha 2 agonists (clonidine and dexmedetomidine) with respect to onset, duration of block and postoperative analgesia when added as adjuvants to the local anesthetic 0.25% ropivacaine. Method: A total of 60 patients, confirming to inclusion criteria, undergoing elective upper limb surgeries under SBPB, were enrolled for the study, over a period of 2 years. Sensory block was evaluated by Hollmen scale [17] and findings were recorded at an interval of every 2 min from time-0 till complete sensory block was achieved i.e Hollmen Score = 4 . Onset Time of Sensory Block, Time for complete sensory block and total duration of sensory block were recorded. Motor block was evaluated by using Bromage Scale for upper extremity and findings were again recorded at an inte...

Context: Acute postoperative pain relief is accepted as an integral part of paediatric anesthetic... more Context: Acute postoperative pain relief is accepted as an integral part of paediatric anesthetic practice. A difficulty in distinguishing pain from hunger or fear in pre-verbal children and the notion that children do not respond to pain in the same way as adults do, combined with an excessive fear of respiratory depression caused by opioids had lead to pain being under treated in children. Recent evidence suggests that pain causes psychological and physiological abnormalities in children similar to that of adults and therefore must be addressed. We designed a prospective, randomized, study to compare the efficacy and safety of caudal ropivacaine with additive dexmedetomidine versus clonidine in providing postoperative analgesia in children undergoing lower abdominal surgeries. We also studied the haemodynamic and respiratory changes in both groups and looked for any complications. Methods: A comparative prospective study was carried out amongst 100 ASA status I or II male patients...

Antiplatelet therapy plays an important role in the management of coronary artery disease (CAD) p... more Antiplatelet therapy plays an important role in the management of coronary artery disease (CAD) patients, which include the spectrum of patients with stents in situ and those suffering from acute coronary syndrome (ACS) on medical management. The percentage of patients with stents in situ, scheduled for surgery within 2 years, is approximately 5–15%. The antiplatelet therapy predisposes patients to an increased risk of bleeding in the perioperative region, which can lead to fatal outcomes in spinal or intracranial surgeries; the problem multiplies manifolds if the surgery has to be performed in an emergency situation. We report a case of a 76-year-old lady, a known case of CAD with drug eluting stent in situ, on dual antiplatelet agents who had presented to our hospital with progressive weakness of lower limbs and had to be operated on the spine in emergency situation.

Journal of Marine Medical Society, 2015

A 56 year old female underwent open cholecystectomy followed by exploratory laparotomy the follow... more A 56 year old female underwent open cholecystectomy followed by exploratory laparotomy the following day. She was not known to have any airway disease. She developed intra and postoperative hypoxemia during and after the second surgery, the first surgery being uneventful. Intra operative findings included decreased air entry over the entire left lung field but post operative there was no air entry on right side. Postoperative Chest X ray and fiber optic Bronchoscopy was performed. Chest radiography revealed right lung collapse, while Bronchoscopy revealed a thick mucus plug causing complete occlusion of the right main bronchus and near total occlusion of the left main bronchus. A Bronchoscopic lavage corrected the problem.

Indian Journal of Anaesthesia

Journal of Marine Medical Society, 2016

Endurance athletic activities, which requires top level cardio respiratory system fitness are rec... more Endurance athletic activities, which requires top level cardio respiratory system fitness are recently becoming popular in the various parts of the country. Armed Forces are forefront in participation of those sporting activities, like marathon running, prolonged swimming or cycling. It has been found to have various long term beneficial effect in body function as a result of prolonged endurance activities, but it has also found that there are various bodily changes which may affect in anaesthetising the individual during emergency and elective surgeries. Literature review of various journals related to endurance sporting activities has described those bodily changes and effects of anaesthesia and pain on those changes. Based upon the available literature a guideline has been formulated for perioperative management of those patients. Most of those available literatures are from countries other than our country. The time has come for venturing in for carrying out further studies in our scenario, especially in Armed Forces in this new horizon of anaesthesia and critical care

Anesthesia: Essays and Researches, 2018

This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal... more This study compared if perianal block using ropivacaine and dexmedetomidine was as good as spinal anesthesia (SA) using bupivacaine (heavy) for closed hemorrhoidectomies. A prospective randomized study was conducted in sixty patients who underwent closed hemorrhoidectomy. Thirty patients of Group A received SA. Thirty patients in Group B received local perianal block. Patients were evaluated for onset of the block, total pain-free period, and time to ambulation. Patient satisfaction in terms of pain during injection and satisfaction with the anesthesia technique was assessed after 2-week telephonically. Data were statistically analyzed using unpaired -test for the continuous variables and Fischer&amp;amp;#39;s exact test for categorical variables. Onset of anesthesia was significantly earlier in Group B, mean (standard deviation [SD]) value being 3.17 (1.28) min as compared to Group A, 6.24 (4.28) min ( = 0.0004). Total pain-free period (mean [SD]) in minute was longer in Group B, 287 (120) min as compared to Group A, 128 (38) min. Time to ambulation was significantly earlier in Group B, 22.83 (29.32) min as compared to Group A 302 (92.41) min. Pain during injection between the two groups was comparable. However, more patients in Group B (60%) were satisfied with the anesthesia technique as compared to Group A (27.5%). Perianal block for hemorrhoidectomy with ropivacaine 0.2% using dexmedetomidine as an adjuvant is an effective and reliable technique which is as effective as SA. It provides prolonged postoperative analgesia and early ambulation.

Journal of Emergencies, Trauma, and Shock, 2018

The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American He... more The cardiopulmonary resuscitation (CPR) in prone position has been dealt with in 2010 American Heart Association (AHA) guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR), CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway . A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Anesthesia: Essays and Researches, 2016

The synergism between local anesthetic agents such as bupivacaine with intrathecal adjuvants such... more The synergism between local anesthetic agents such as bupivacaine with intrathecal adjuvants such as opioids and clonidine is well established. This study evaluates the clinical efficacy of clonidine75 μg versus fentanyl 25 μg as adjuvants to bupivacaine for spinal anesthesia. A prospective, randomized, parallel arm study was conducted over a period of 12 months in a tertiary care hospital. Sixty patients were divided randomly into two groups, Group C and Group F. Patients in Group C received 2.5 ml of 0.5% bupivacaine heavy mixed with 0.5 ml (75 μg) clonidine intrathecally, and patients in Group F received 2.5 ml of 0.5% bupivacaine heavy mixed with 0.5 ml (25 μg) fentanyl intrathecally. Data were analyzed using statistical tests for comparison of means. The mean durations of sensory block was 253.3 and 249.6 minutes in group C and group F respectively, which was statistically not significant (P = 0.76). The mean durations of motor block were 302.3 and 293.6 min, respectively, in Group C and Group F, which were also statistically not significant (P = 0.53). The mean durations of postoperative analgesia were 653.4 and 611.2 min, respectively, in Group C and Group F, which were statistically not significant (P = 0.09). Mean heart rate after 10 min was 82.5 in Group C and 87.2 in Group F, which was statistically not significant (P = 0.29), and mean arterial pressure in mmHg after 10 min was 96.3 in Group C and 97.3 in Group F, which was also statistically not significant (P = 0.86). Both clonidine 75 μg and fentanyl 25 μg when used as adjuvants to bupivacaine in the subarachnoid block have comparable beneficial results in terms of duration of analgesia, duration of motor blocks, and hemodynamic stability and also have a comparable incidence of complications.

Anesthesia: Essays and Researches, 2016

Hallermann–Streiff syndrome (HSS), a rare genetic disorder involving craniofacial region, was fir... more Hallermann–Streiff syndrome (HSS), a rare genetic disorder involving craniofacial region, was first described completely by Hallermann in 1948 and Streiff in 1950. The etiology remains an enigma; although sporadic mutation is considered in majority of the patients, there is an association in literature with consanguinity, antenatal rubella infection, and familial medical history.[1] We report a case of 12-year-old male child, a product of nonconsanguineous marriage, postrubella syndrome (echocardiography normal), born preterm (32 weeks of gestation), planned for urethroplasty. Anthropometry revealed weight of 23 kg (<3rd percentile), height of 128 cm (<3rd percentile), and occipital-frontal circumference of 50 cm (<3rd percentile), and karyotyping was normal. The patient had 6 out of 7 diagnostic criteria for HSS [Figure 1], dyscephalia (broad forehead) and bird face, orodental anomalies high arch palate, dental caries, and malocclusion proportionate dwarfism, atrophy of the skin, bilateral microphthalmia (also had bilateral microcornea, bilateral epicanthal folds), congenital cataracts (not present in our case), and hypotrichosis. Additional clinical features present in our case were large low-set ears, clinodactyly, syndactyly in toes, and poorly developed scrotum with hypospadias.

Anesthesia: Essays and Researches

High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for res... more High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.

Various studies have investigated the role of different drugs as adjuncts to SBPB to prolong the ... more Various studies have investigated the role of different drugs as adjuncts to SBPB to prolong the duration and quality of analgesia without producing any major adverse effects. We conducted a study to compare the novel alpha 2 agonists (clonidine and dexmedetomidine) with respect to onset, duration of block and postoperative analgesia when added as adjuvants to the local anesthetic 0.25% ropivacaine.

The success of endoscopic surgery in otolaryngology largely depends on the surgical field, where ... more The success of endoscopic surgery in otolaryngology largely depends on the surgical field, where the presence of significant bleeding is a critical factor. Bleeding obscures surgical planes and the recognition of anatomical landmarks becomes quite difficult. Various manoeuvers and drugs have been used for optimization of the surgical field. Conventionally, beta blockers and sodium nitroprusside have been used to control the intraoperative blood pressure. Newer agents such as remifentanil and adrenergic alpha-2 agonists such as clonidine and dexmedetomidine are also being tried. We report two cases of endoscopic sinus surgery (ESS) where dexmedetomidine infusion as adjunct to propofol infusion and inhalational anesthesia with sevoflurane [minimum alveolar concentration (MAC) 0.5-0.8] were utilized for providing an optimal surgical field.

Paediatric spinal anesthesia is not only a safe alternative to general anaesthesia but often the ... more Paediatric spinal anesthesia is not only a safe alternative to general anaesthesia but often the anaesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and feasibility is broken and is now found to be even more cost-effective. It is a much preferred technique especially for the common daycase surgeries generally performed in the paediatric age group. There is no requirement of any additional expensive equipment either and this procedure can be easily performed in peripheral centers. However, greater acceptance and experience is yet desired for this technique to become popular.