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Papers by Mahesh Chandrashekaraiah

Bahrain medical bulletin, Mar 1, 2017

Purpose: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The pneumope... more Purpose: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The pneumoperitoneum used for laparoscopic procedures leads to significant impairment of cardiopulmonary function. Methods: This randomized double blind study started with institute ethics committee approval. Sixty ASA 1 and ASA 2 patients undergoing elective laparoscopic cholecystectomy with no cardiovascular co-morbidity were enrolled for the study and received either tab clonidine 150 mcg [group C-30] or placebo drug tab lorazepam 2mg [group L-30] orally one hour before the induction. Heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure were recorded. The data obtained was analyzed using student's-test, ANOVA and Chi-square test. Results: There is significant reduction of heart rate (16.6003), systolic pressure (22.433) and mean arterial pressure (14.8) (p<0.001) in study group. Conclusion: From our study we found that oral clonidine 150mcg can effectively counteract the cardiovascular changes induced by pneumoperitoneum.

Bahrain Medical Bulletin, 2017

Knowledge and awareness of labor analgesia services available in our tertiary hospital among the pregnant women: A prospective study

Bali Journal of Anesthesiology, 2021

Background: Knowledge regarding labor analgesia is poor among the pregnant women. This hinders th... more Background: Knowledge regarding labor analgesia is poor among the pregnant women. This hinders them from utilizing the services in centers where it is available. In this study, we tried to analyze the awareness and knowledge of the antenatal women and their beliefs regarding labor analgesia. Patients and Methods: This prospective, observational study done in antenatal clinic for 1 month. Antenatal women who attended the clinic voluntarily filled the semi-structured questionnaire after the written and informed consent. Results: A total of 170 women filled the questionnaire out of 1099 antenatal visits. 68.8% were multipara and 50.58% had previous vaginal delivery. 63.3% study population had prior information of labor analgesia; while only 42.6% had information that labor analgesia services are available in our hospital (P = 0.002). Age, education, and parity were considered as predictors; however, parity is the only predictor for knowledge of labor analgesia odds ratio = 2.368 (95% CI–1.24, 4.51; P = 0.009). Majority (60.23%) of the study sample believe that there is no effective method of pain relief during labor. Binary logistic regression and Chi-square test used for the statistical analysis. Conclusion: Antenatal women still believe that there is no effective method of labor analgesia. Women prefer obstetrician advice for getting information regarding labor analgesia. In our study, the level of education has no impact on awareness of labor analgesia. Only parity is a predictive factor for knowledge of labor analgesia.

Sri Lankan Journal of Anaesthesiology, Apr 28, 2021

Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the... more Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the cervical spine in suspected cervical spine injuries, but creates special challenges in airway management. The present study compares two different video laryngoscope (VL) namely CMAC D blade (CMAC) and glidescope blade 4 (GL) for intubation in patients with a simulated difficult airway by applying MIAS. Methodology This was a hospital based prospective, single blind, randomized comparative pilot study. A total of 60 patients, having no predictors of difficult airway and scheduled for elective surgery were recruited and randomized into 2 equal sized groups based on a software generated random sequence. The Primary outcome was Intubation Difficulty Score (IDS), whereas the time taken to secure the airway and obtain a capnographic wave, Cormack Lehane Grade (CL) and hemodynamic parameter comprised the secondary outcomes. The following tests-Fischer's exact test, Chi-square test and Student 't' test used for analysis. Results GL group had an IDS score of zero in 46.7% patients compared to 26.7% in CMAC group, IDS score of 0-5 was found to be 50 % in GL group while CMAC group scored 66.6%. This was found to be statistically insignificant (p=0.18). Time taken for successful intubation was 43.70±9.91 and 54.60±20.47 seconds (p=0.011) in GL and CMAC group respectively. Conclusions VL is a vital tool in the management of difficult airway. The superiority of one over the other device tested here could not be established, although GL showed slightly better scores but were statistically insignificant.

Anesthesia: Essays and Researches, 2021

Context:Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mob... more Context:Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay.Aim:To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA.Settings and Design:This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital.Materials and Methods:Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores.Statistical Analysis:Statistical analysis was performed using the Student's t-test, Mann–Whitney test, and Chi-square test.Results:The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h.Conclusion:Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.

Ultrasound-guided transversus abdominis plane block: An evaluation of its efficacy in reducing post-operative opioid requirements in caesarean section

Journal of Obstetric Anaesthesia and Critical Care, 2017

Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (T... more Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (TAP) block to provide analgesia for lower abdominal surgeries. Our aim was to compare the efficacy of high versus low volume of bupivacaine TAP block in providing postoperative analgesia for caesarean sections. Settings and Design: Prospective, single-blind, randomized comparative study was performed during post-operative period. Materials and Methods: Sixty patients who had received spinal anaesthesia for caesarean section were randomly allocated to one of three groups: Group A received 20 ml of 0.25% bupivacaine, Group B received 30 ml of 0.166% bupivacaine on each side TAP block under ultrasound guidance, respectively, and Group C did not receive TAP block. Multi-modal analgesia comprising paracetamol, diclofenac and patient-controlled analgesia (PCA) morphine was administered to all patients. The primary outcome measure in our study was 24-h post-operative morphine consumption through intravenous (IV) PCA. Other secondary outcome measures were pain scores, nausea, sedation and patient satisfaction scores. Statistical Analysis: Statistical analysis done using analysis of variance, Fisher's Exact test and Kruskal–Wallis test. Results: Our primary outcome measure of 24-h cumulative PCA morphine consumption was 18.2 ± 6.5, 17.9 ± 8.6 and 19.4 ± 8.4 mg in groups A, B and C, respectively (P = 0.819). In the secondary outcome measures, 100% of study population in group A & B and 95% of group C had pain score of 0-3 on Numerical Rating Scale (P = 1.000) at 24 hr. 19, 15 and17 patients in group A, B and C, respectively, agreed and 1, 5 and 3 patients in group A, B and C, respectively, very strongly agreed with patient satisfaction survey for pain management (P = 0.265). Conclusion: TAP block as a part of multi-modal analgesia is debatable in the context of reducing the need of post-operative opioids. The present study was unequivocal in that two different volumes of same dose of local anaesthetic failed to demonstrate any clinical or statistical significance in decreasing post-operative opioid consumption following caesarean section.

Sri Lankan Journal of Anaesthesiology, Jul 26, 2019

Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challen... more Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challenge to anaesthetists as it can distort the facial contours and can make bag-mask ventilation difficult. We present a first case of ameloblastoma in our hospital where a 38year-old female was scheduled for a right mandibulectomy and reconstruction of the mandible with a custom-made titanium implant. Awake fiberoptic intubation was planned as a first choice for induction of anaesthesia as any other technique may have led to serious airway complications. We believe that airway management in difficult airway cases should always be based on the principle of "burning no bridges".

Sri Lankan Journal of Anaesthesiology, Jan 30, 2017

Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challe... more Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challenging particularly in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm. Methods: Sixty ASA 1 and 2 patients with normal airway requiring general anesthesia with endotracheal intubation were recruited for this randomized comparative simulative study. Neck was stabilized using manual inline axial stabilization maneuver and endotracheal intubation was carried out using either C-MAC or Macintosh laryngoscope. The following parameters were compared: intubation difficulty score (IDS), Cormack Lehane (CL) glottis view, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Hemodynamic parameters were noted at following intervals: pre-induction, pre intubation, immediate post intubation and 3 minutes after intubation. The data was analyzed using statistical tests Fischer exact test, Chi-square and independent two tailed student t test Results: Superior glottis view was observed in C-MAC group (CL-1: 56.7 % vs 30%, CL-2: 36.7% vs 56.7%, CL-3: 6.7% vs 10%, CL-4: none vs 3.3% in C-MAC and Macintosh group respectively). There was no difference in intubation difficulty score (p=0.822) and hemodynamic parameters also showed no clinical and statistical differences. The present study shows good glottis view with C-MAC; although, IDS score is similar to conventional Macintosh laryngoscopy. The haemodynamic parameters are comparable in both groups. Overall, the C-MAC laryngoscope gives better glottis view indicating clinical significance.

Sri Lankan Journal of Anaesthesiology

Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the... more Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the cervical spine in suspected cervical spine injuries, but creates special challenges in airway management. The present study compares two different video laryngoscope (VL) namely CMAC D blade (CMAC) and glidescope blade 4 (GL) for intubation in patients with a simulated difficult airway by applying MIAS. Methodology This was a hospital based prospective, single blind, randomized comparative pilot study. A total of 60 patients, having no predictors of difficult airway and scheduled for elective surgery were recruited and randomized into 2 equal sized groups based on a software generated random sequence. The Primary outcome was Intubation Difficulty Score (IDS), whereas the time taken to secure the airway and obtain a capnographic wave, Cormack Lehane Grade (CL) and hemodynamic parameter comprised the secondary outcomes. The following tests- Fischer’s exact test, Chi-square test and Studen...

Ultrasound-guided transversus abdominis plane block: An evaluation of its efficacy in reducing post-operative opioid requirements in caesarean section

Journal of Obstetric Anaesthesia and Critical Care

Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (T... more Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (TAP) block to provide analgesia for lower abdominal surgeries. Our aim was to compare the efficacy of high versus low volume of bupivacaine TAP block in providing postoperative analgesia for caesarean sections. Settings and Design: Prospective, single-blind, randomized comparative study was performed during post-operative period. Materials and Methods: Sixty patients who had received spinal anaesthesia for caesarean section were randomly allocated to one of three groups: Group A received 20 ml of 0.25% bupivacaine, Group B received 30 ml of 0.166% bupivacaine on each side TAP block under ultrasound guidance, respectively, and Group C did not receive TAP block. Multi-modal analgesia comprising paracetamol, diclofenac and patient-controlled analgesia (PCA) morphine was administered to all patients. The primary outcome measure in our study was 24-h post-operative morphine consumption through intravenous (IV) PCA. Other secondary outcome measures were pain scores, nausea, sedation and patient satisfaction scores. Statistical Analysis: Statistical analysis done using analysis of variance, Fisher's Exact test and Kruskal–Wallis test. Results: Our primary outcome measure of 24-h cumulative PCA morphine consumption was 18.2 ± 6.5, 17.9 ± 8.6 and 19.4 ± 8.4 mg in groups A, B and C, respectively (P = 0.819). In the secondary outcome measures, 100% of study population in group A & B and 95% of group C had pain score of 0-3 on Numerical Rating Scale (P = 1.000) at 24 hr. 19, 15 and17 patients in group A, B and C, respectively, agreed and 1, 5 and 3 patients in group A, B and C, respectively, very strongly agreed with patient satisfaction survey for pain management (P = 0.265). Conclusion: TAP block as a part of multi-modal analgesia is debatable in the context of reducing the need of post-operative opioids. The present study was unequivocal in that two different volumes of same dose of local anaesthetic failed to demonstrate any clinical or statistical significance in decreasing post-operative opioid consumption following caesarean section.

Long QT Syndrome is a rare disorder characterized by prolongation of QT interval on an ECG. Patie... more Long QT Syndrome is a rare disorder characterized by prolongation of QT interval on an ECG. Patients with this disorder have an increased risk of developing life-threatening arrhythmias such as torsades de pointes, and occasionally sudden cardiac arrest. We present this case of undiagnosed Long QT Syndrome in a 7 years old boy, who presented to our service for incision and drainage of an abscess in the left axilla under general anesthesia. This case highlights the importance of proper and meticulous pre-anesthesia evaluation, even in low risk patients, so that potentially harmful medical conditions are diagnosed well in time and managed accordingly.

Mobeen Ashfaq, Shaimaa Mohammed Yousef, Mahesh M Chandrashekaraiah, Shahid Adeel ANAESTHESIA, PAI... more Mobeen Ashfaq, Shaimaa Mohammed Yousef, Mahesh M Chandrashekaraiah, Shahid Adeel ANAESTHESIA, PAIN & INTENSIVE CARE; VOL 21(2) APR-JUN 2017 263 Long QT Syndrome is a rare disorder characterized by prolongation of QT interval on an ECG. Patients with this disorder have an increased risk of developing life-threatening arrhythmias such as torsades de pointes, and occasionally sudden cardiac arrest. We present this case of undiagnosed Long QT Syndrome in a 7 years old boy, who presented to our service for incision and drainage of an abscess in the left axilla under general anesthesia. This case highlights the importance of proper and meticulous preanesthesia evaluation, even in low risk patients, so that potentially harmful medical conditions are diagnosed well in time and managed accordingly. Key word: Long QT Syndrome; Anesthesia; Pediatrics; Torsades de Pointes Citation: Ashfaq M, Yousef SM, Chandrashekaraiah MM, Adeel S. Pre-anesthesia evaluation leading to a diagnosis of long QT sy...

Sri Lankan Journal of Anaesthesiology, 2019

Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challen... more Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challenge to anaesthetists as it can distort the facial contours and can make bag-mask ventilation difficult. We present a first case of ameloblastoma in our hospital where a 38year-old female was scheduled for a right mandibulectomy and reconstruction of the mandible with a custom-made titanium implant. Awake fiberoptic intubation was planned as a first choice for induction of anaesthesia as any other technique may have led to serious airway complications. We believe that airway management in difficult airway cases should always be based on the principle of "burning no bridges".

Sri Lankan Journal of Anaesthesiology, 2017

Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challe... more Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challenging particularly in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm. Methods: Sixty ASA 1 and 2 patients with normal airway requiring general anesthesia with endotracheal intubation were recruited for this randomized comparative simulative study. Neck was stabilized using manual inline axial stabilization maneuver and endotracheal intubation was carried out using either C-MAC or Macintosh laryngoscope. The following parameters were compared: intubation difficulty score (IDS), Cormack Lehane (CL) glottis view, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Hemodynamic parameters were noted at following intervals: pre-induction, pre intubation, immediate post intubation and 3 minutes after intubation. The data was analyzed using statistical tests Fischer exact test, Chi-square and independent two tailed student t test Results: Superior glottis view was observed in C-MAC group (CL-1: 56.7 % vs 30%, CL-2: 36.7% vs 56.7%, CL-3: 6.7% vs 10%, CL-4: none vs 3.3% in C-MAC and Macintosh group respectively). There was no difference in intubation difficulty score (p=0.822) and hemodynamic parameters also showed no clinical and statistical differences. The present study shows good glottis view with C-MAC; although, IDS score is similar to conventional Macintosh laryngoscopy. The haemodynamic parameters are comparable in both groups. Overall, the C-MAC laryngoscope gives better glottis view indicating clinical significance.

Impact of intra-articular local anesthesia infiltration versus femoral nerve block for postoperative pain management in total knee arthroplasty

Anesthesia: Essays and Researches, 2021

Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by usin... more Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by using several techniques such as intravenous analgesia, epidural analgesia, and peripheral nerve blocks that include femoral nerve and saphenous nerve. Several authors recommended intra-articular injection of local anesthetic (IALA) as a part of multimodal analgesia regimens for TKA instead of other techniques. Aims: The present study compares IALA technique efficacy with single-shot femoral nerve block (FNB) as part of multimodal analgesia regimen in TKA patients for postoperative pain management. Setting and Design: Perioperative care, randomized double-blind comparative study. Subjects and Methods: We recruited a total of 60 patients scheduled for unilateral total knee replacement under spinal anesthesia. Subjects were allocated randomly into two groups FNB and IALA receiving ultrasound-guided FNB and Intra-articular local anesthesia and morphine mix infiltration, respectively. Twenty-four hour postoperative morphine consumption through patient-controlled analgesia was the primary outcome measure in our study. Secondary outcome measures were pain scores, nausea and vomiting. Statistical Analysis: Chi-square test, Mann–Whitney test. Results: The amount of morphine consumed at the end of 24 h was noted to be higher in IALA group as compared to FNB (FNB − 16.03 ± 9.37 mgs; IALA − 23.60 ± 13.73 mgs P = 0.03). Visual analog score at 24 h with knee flexion was better in FNB group (FNB − 1.27 ± 1.43; IALA 2.42 ± 2.54, P = 0.04). Conclusion: FNB technique provides better analgesia in comparison to IALA for postoperative pain management in terms of PCA morphine consumption.

Bahrain medical bulletin, Mar 1, 2017

Purpose: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The pneumope... more Purpose: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The pneumoperitoneum used for laparoscopic procedures leads to significant impairment of cardiopulmonary function. Methods: This randomized double blind study started with institute ethics committee approval. Sixty ASA 1 and ASA 2 patients undergoing elective laparoscopic cholecystectomy with no cardiovascular co-morbidity were enrolled for the study and received either tab clonidine 150 mcg [group C-30] or placebo drug tab lorazepam 2mg [group L-30] orally one hour before the induction. Heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure were recorded. The data obtained was analyzed using student's-test, ANOVA and Chi-square test. Results: There is significant reduction of heart rate (16.6003), systolic pressure (22.433) and mean arterial pressure (14.8) (p<0.001) in study group. Conclusion: From our study we found that oral clonidine 150mcg can effectively counteract the cardiovascular changes induced by pneumoperitoneum.

Bahrain Medical Bulletin, 2017

Knowledge and awareness of labor analgesia services available in our tertiary hospital among the pregnant women: A prospective study

Bali Journal of Anesthesiology, 2021

Background: Knowledge regarding labor analgesia is poor among the pregnant women. This hinders th... more Background: Knowledge regarding labor analgesia is poor among the pregnant women. This hinders them from utilizing the services in centers where it is available. In this study, we tried to analyze the awareness and knowledge of the antenatal women and their beliefs regarding labor analgesia. Patients and Methods: This prospective, observational study done in antenatal clinic for 1 month. Antenatal women who attended the clinic voluntarily filled the semi-structured questionnaire after the written and informed consent. Results: A total of 170 women filled the questionnaire out of 1099 antenatal visits. 68.8% were multipara and 50.58% had previous vaginal delivery. 63.3% study population had prior information of labor analgesia; while only 42.6% had information that labor analgesia services are available in our hospital (P = 0.002). Age, education, and parity were considered as predictors; however, parity is the only predictor for knowledge of labor analgesia odds ratio = 2.368 (95% CI–1.24, 4.51; P = 0.009). Majority (60.23%) of the study sample believe that there is no effective method of pain relief during labor. Binary logistic regression and Chi-square test used for the statistical analysis. Conclusion: Antenatal women still believe that there is no effective method of labor analgesia. Women prefer obstetrician advice for getting information regarding labor analgesia. In our study, the level of education has no impact on awareness of labor analgesia. Only parity is a predictive factor for knowledge of labor analgesia.

Sri Lankan Journal of Anaesthesiology, Apr 28, 2021

Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the... more Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the cervical spine in suspected cervical spine injuries, but creates special challenges in airway management. The present study compares two different video laryngoscope (VL) namely CMAC D blade (CMAC) and glidescope blade 4 (GL) for intubation in patients with a simulated difficult airway by applying MIAS. Methodology This was a hospital based prospective, single blind, randomized comparative pilot study. A total of 60 patients, having no predictors of difficult airway and scheduled for elective surgery were recruited and randomized into 2 equal sized groups based on a software generated random sequence. The Primary outcome was Intubation Difficulty Score (IDS), whereas the time taken to secure the airway and obtain a capnographic wave, Cormack Lehane Grade (CL) and hemodynamic parameter comprised the secondary outcomes. The following tests-Fischer's exact test, Chi-square test and Student 't' test used for analysis. Results GL group had an IDS score of zero in 46.7% patients compared to 26.7% in CMAC group, IDS score of 0-5 was found to be 50 % in GL group while CMAC group scored 66.6%. This was found to be statistically insignificant (p=0.18). Time taken for successful intubation was 43.70±9.91 and 54.60±20.47 seconds (p=0.011) in GL and CMAC group respectively. Conclusions VL is a vital tool in the management of difficult airway. The superiority of one over the other device tested here could not be established, although GL showed slightly better scores but were statistically insignificant.

Anesthesia: Essays and Researches, 2021

Context:Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mob... more Context:Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay.Aim:To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA.Settings and Design:This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital.Materials and Methods:Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores.Statistical Analysis:Statistical analysis was performed using the Student's t-test, Mann–Whitney test, and Chi-square test.Results:The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h.Conclusion:Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.

Ultrasound-guided transversus abdominis plane block: An evaluation of its efficacy in reducing post-operative opioid requirements in caesarean section

Journal of Obstetric Anaesthesia and Critical Care, 2017

Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (T... more Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (TAP) block to provide analgesia for lower abdominal surgeries. Our aim was to compare the efficacy of high versus low volume of bupivacaine TAP block in providing postoperative analgesia for caesarean sections. Settings and Design: Prospective, single-blind, randomized comparative study was performed during post-operative period. Materials and Methods: Sixty patients who had received spinal anaesthesia for caesarean section were randomly allocated to one of three groups: Group A received 20 ml of 0.25% bupivacaine, Group B received 30 ml of 0.166% bupivacaine on each side TAP block under ultrasound guidance, respectively, and Group C did not receive TAP block. Multi-modal analgesia comprising paracetamol, diclofenac and patient-controlled analgesia (PCA) morphine was administered to all patients. The primary outcome measure in our study was 24-h post-operative morphine consumption through intravenous (IV) PCA. Other secondary outcome measures were pain scores, nausea, sedation and patient satisfaction scores. Statistical Analysis: Statistical analysis done using analysis of variance, Fisher's Exact test and Kruskal–Wallis test. Results: Our primary outcome measure of 24-h cumulative PCA morphine consumption was 18.2 ± 6.5, 17.9 ± 8.6 and 19.4 ± 8.4 mg in groups A, B and C, respectively (P = 0.819). In the secondary outcome measures, 100% of study population in group A & B and 95% of group C had pain score of 0-3 on Numerical Rating Scale (P = 1.000) at 24 hr. 19, 15 and17 patients in group A, B and C, respectively, agreed and 1, 5 and 3 patients in group A, B and C, respectively, very strongly agreed with patient satisfaction survey for pain management (P = 0.265). Conclusion: TAP block as a part of multi-modal analgesia is debatable in the context of reducing the need of post-operative opioids. The present study was unequivocal in that two different volumes of same dose of local anaesthetic failed to demonstrate any clinical or statistical significance in decreasing post-operative opioid consumption following caesarean section.

Sri Lankan Journal of Anaesthesiology, Jul 26, 2019

Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challen... more Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challenge to anaesthetists as it can distort the facial contours and can make bag-mask ventilation difficult. We present a first case of ameloblastoma in our hospital where a 38year-old female was scheduled for a right mandibulectomy and reconstruction of the mandible with a custom-made titanium implant. Awake fiberoptic intubation was planned as a first choice for induction of anaesthesia as any other technique may have led to serious airway complications. We believe that airway management in difficult airway cases should always be based on the principle of "burning no bridges".

Sri Lankan Journal of Anaesthesiology, Jan 30, 2017

Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challe... more Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challenging particularly in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm. Methods: Sixty ASA 1 and 2 patients with normal airway requiring general anesthesia with endotracheal intubation were recruited for this randomized comparative simulative study. Neck was stabilized using manual inline axial stabilization maneuver and endotracheal intubation was carried out using either C-MAC or Macintosh laryngoscope. The following parameters were compared: intubation difficulty score (IDS), Cormack Lehane (CL) glottis view, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Hemodynamic parameters were noted at following intervals: pre-induction, pre intubation, immediate post intubation and 3 minutes after intubation. The data was analyzed using statistical tests Fischer exact test, Chi-square and independent two tailed student t test Results: Superior glottis view was observed in C-MAC group (CL-1: 56.7 % vs 30%, CL-2: 36.7% vs 56.7%, CL-3: 6.7% vs 10%, CL-4: none vs 3.3% in C-MAC and Macintosh group respectively). There was no difference in intubation difficulty score (p=0.822) and hemodynamic parameters also showed no clinical and statistical differences. The present study shows good glottis view with C-MAC; although, IDS score is similar to conventional Macintosh laryngoscopy. The haemodynamic parameters are comparable in both groups. Overall, the C-MAC laryngoscope gives better glottis view indicating clinical significance.

Sri Lankan Journal of Anaesthesiology

Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the... more Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the cervical spine in suspected cervical spine injuries, but creates special challenges in airway management. The present study compares two different video laryngoscope (VL) namely CMAC D blade (CMAC) and glidescope blade 4 (GL) for intubation in patients with a simulated difficult airway by applying MIAS. Methodology This was a hospital based prospective, single blind, randomized comparative pilot study. A total of 60 patients, having no predictors of difficult airway and scheduled for elective surgery were recruited and randomized into 2 equal sized groups based on a software generated random sequence. The Primary outcome was Intubation Difficulty Score (IDS), whereas the time taken to secure the airway and obtain a capnographic wave, Cormack Lehane Grade (CL) and hemodynamic parameter comprised the secondary outcomes. The following tests- Fischer’s exact test, Chi-square test and Studen...

Ultrasound-guided transversus abdominis plane block: An evaluation of its efficacy in reducing post-operative opioid requirements in caesarean section

Journal of Obstetric Anaesthesia and Critical Care

Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (T... more Background: Different volumes of local anaesthetic are employed in transversus abdominis plane (TAP) block to provide analgesia for lower abdominal surgeries. Our aim was to compare the efficacy of high versus low volume of bupivacaine TAP block in providing postoperative analgesia for caesarean sections. Settings and Design: Prospective, single-blind, randomized comparative study was performed during post-operative period. Materials and Methods: Sixty patients who had received spinal anaesthesia for caesarean section were randomly allocated to one of three groups: Group A received 20 ml of 0.25% bupivacaine, Group B received 30 ml of 0.166% bupivacaine on each side TAP block under ultrasound guidance, respectively, and Group C did not receive TAP block. Multi-modal analgesia comprising paracetamol, diclofenac and patient-controlled analgesia (PCA) morphine was administered to all patients. The primary outcome measure in our study was 24-h post-operative morphine consumption through intravenous (IV) PCA. Other secondary outcome measures were pain scores, nausea, sedation and patient satisfaction scores. Statistical Analysis: Statistical analysis done using analysis of variance, Fisher's Exact test and Kruskal–Wallis test. Results: Our primary outcome measure of 24-h cumulative PCA morphine consumption was 18.2 ± 6.5, 17.9 ± 8.6 and 19.4 ± 8.4 mg in groups A, B and C, respectively (P = 0.819). In the secondary outcome measures, 100% of study population in group A & B and 95% of group C had pain score of 0-3 on Numerical Rating Scale (P = 1.000) at 24 hr. 19, 15 and17 patients in group A, B and C, respectively, agreed and 1, 5 and 3 patients in group A, B and C, respectively, very strongly agreed with patient satisfaction survey for pain management (P = 0.265). Conclusion: TAP block as a part of multi-modal analgesia is debatable in the context of reducing the need of post-operative opioids. The present study was unequivocal in that two different volumes of same dose of local anaesthetic failed to demonstrate any clinical or statistical significance in decreasing post-operative opioid consumption following caesarean section.

Long QT Syndrome is a rare disorder characterized by prolongation of QT interval on an ECG. Patie... more Long QT Syndrome is a rare disorder characterized by prolongation of QT interval on an ECG. Patients with this disorder have an increased risk of developing life-threatening arrhythmias such as torsades de pointes, and occasionally sudden cardiac arrest. We present this case of undiagnosed Long QT Syndrome in a 7 years old boy, who presented to our service for incision and drainage of an abscess in the left axilla under general anesthesia. This case highlights the importance of proper and meticulous pre-anesthesia evaluation, even in low risk patients, so that potentially harmful medical conditions are diagnosed well in time and managed accordingly.

Mobeen Ashfaq, Shaimaa Mohammed Yousef, Mahesh M Chandrashekaraiah, Shahid Adeel ANAESTHESIA, PAI... more Mobeen Ashfaq, Shaimaa Mohammed Yousef, Mahesh M Chandrashekaraiah, Shahid Adeel ANAESTHESIA, PAIN & INTENSIVE CARE; VOL 21(2) APR-JUN 2017 263 Long QT Syndrome is a rare disorder characterized by prolongation of QT interval on an ECG. Patients with this disorder have an increased risk of developing life-threatening arrhythmias such as torsades de pointes, and occasionally sudden cardiac arrest. We present this case of undiagnosed Long QT Syndrome in a 7 years old boy, who presented to our service for incision and drainage of an abscess in the left axilla under general anesthesia. This case highlights the importance of proper and meticulous preanesthesia evaluation, even in low risk patients, so that potentially harmful medical conditions are diagnosed well in time and managed accordingly. Key word: Long QT Syndrome; Anesthesia; Pediatrics; Torsades de Pointes Citation: Ashfaq M, Yousef SM, Chandrashekaraiah MM, Adeel S. Pre-anesthesia evaluation leading to a diagnosis of long QT sy...

Sri Lankan Journal of Anaesthesiology, 2019

Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challen... more Ameloblastoma is a benign tumor that arises from odontogenic epithelium. It may present a challenge to anaesthetists as it can distort the facial contours and can make bag-mask ventilation difficult. We present a first case of ameloblastoma in our hospital where a 38year-old female was scheduled for a right mandibulectomy and reconstruction of the mandible with a custom-made titanium implant. Awake fiberoptic intubation was planned as a first choice for induction of anaesthesia as any other technique may have led to serious airway complications. We believe that airway management in difficult airway cases should always be based on the principle of "burning no bridges".

Sri Lankan Journal of Anaesthesiology, 2017

Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challe... more Background and Aims: Endotracheal intubation in patients with cervical spine injury can be challenging particularly in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm. Methods: Sixty ASA 1 and 2 patients with normal airway requiring general anesthesia with endotracheal intubation were recruited for this randomized comparative simulative study. Neck was stabilized using manual inline axial stabilization maneuver and endotracheal intubation was carried out using either C-MAC or Macintosh laryngoscope. The following parameters were compared: intubation difficulty score (IDS), Cormack Lehane (CL) glottis view, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Hemodynamic parameters were noted at following intervals: pre-induction, pre intubation, immediate post intubation and 3 minutes after intubation. The data was analyzed using statistical tests Fischer exact test, Chi-square and independent two tailed student t test Results: Superior glottis view was observed in C-MAC group (CL-1: 56.7 % vs 30%, CL-2: 36.7% vs 56.7%, CL-3: 6.7% vs 10%, CL-4: none vs 3.3% in C-MAC and Macintosh group respectively). There was no difference in intubation difficulty score (p=0.822) and hemodynamic parameters also showed no clinical and statistical differences. The present study shows good glottis view with C-MAC; although, IDS score is similar to conventional Macintosh laryngoscopy. The haemodynamic parameters are comparable in both groups. Overall, the C-MAC laryngoscope gives better glottis view indicating clinical significance.

Impact of intra-articular local anesthesia infiltration versus femoral nerve block for postoperative pain management in total knee arthroplasty

Anesthesia: Essays and Researches, 2021

Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by usin... more Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by using several techniques such as intravenous analgesia, epidural analgesia, and peripheral nerve blocks that include femoral nerve and saphenous nerve. Several authors recommended intra-articular injection of local anesthetic (IALA) as a part of multimodal analgesia regimens for TKA instead of other techniques. Aims: The present study compares IALA technique efficacy with single-shot femoral nerve block (FNB) as part of multimodal analgesia regimen in TKA patients for postoperative pain management. Setting and Design: Perioperative care, randomized double-blind comparative study. Subjects and Methods: We recruited a total of 60 patients scheduled for unilateral total knee replacement under spinal anesthesia. Subjects were allocated randomly into two groups FNB and IALA receiving ultrasound-guided FNB and Intra-articular local anesthesia and morphine mix infiltration, respectively. Twenty-four hour postoperative morphine consumption through patient-controlled analgesia was the primary outcome measure in our study. Secondary outcome measures were pain scores, nausea and vomiting. Statistical Analysis: Chi-square test, Mann–Whitney test. Results: The amount of morphine consumed at the end of 24 h was noted to be higher in IALA group as compared to FNB (FNB − 16.03 ± 9.37 mgs; IALA − 23.60 ± 13.73 mgs P = 0.03). Visual analog score at 24 h with knee flexion was better in FNB group (FNB − 1.27 ± 1.43; IALA 2.42 ± 2.54, P = 0.04). Conclusion: FNB technique provides better analgesia in comparison to IALA for postoperative pain management in terms of PCA morphine consumption.