Mahesh Chandrashekaraiah - Academia.edu (original) (raw)

Papers by Mahesh Chandrashekaraiah

Research paper thumbnail of Simulated Difficult Airway: CMAC D Blade or Glidescope?

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.

Research paper thumbnail of Comparison between local infiltration analgesia and ultrasound guided single shot adductor canal block post total knee replacement surgery- A randomized controlled trial

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.

Research paper thumbnail of 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.

Research paper thumbnail of Difficult airway management: burning no bridges

Sri Lankan Journal of Anaesthesiology, Jul 26, 2019

Research paper thumbnail of Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study

Sri Lankan Journal of Anaesthesiology, Jan 30, 2017

Research paper thumbnail of Simulated Difficult Airway: CMAC D Blade or Glidescope?

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...

Research paper thumbnail of 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.

Research paper thumbnail of Pre-anesthesia evaluation leading to a diagnosis of long QT syndrome-a case study ABSTRACT

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.

Research paper thumbnail of Pre-anesthesia evaluation leading to a diagnosis of long QT syndrome – a case study

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...

Research paper thumbnail of Difficult airway management: burning no bridges

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".

Research paper thumbnail of Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study

Sri Lankan Journal of Anaesthesiology, 2017

Research paper thumbnail of 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.

Research paper thumbnail of Simulated Difficult Airway: CMAC D Blade or Glidescope?

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.

Research paper thumbnail of Comparison between local infiltration analgesia and ultrasound guided single shot adductor canal block post total knee replacement surgery- A randomized controlled trial

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.

Research paper thumbnail of 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.

Research paper thumbnail of Difficult airway management: burning no bridges

Sri Lankan Journal of Anaesthesiology, Jul 26, 2019

Research paper thumbnail of Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study

Sri Lankan Journal of Anaesthesiology, Jan 30, 2017

Research paper thumbnail of Simulated Difficult Airway: CMAC D Blade or Glidescope?

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...

Research paper thumbnail of 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.

Research paper thumbnail of Pre-anesthesia evaluation leading to a diagnosis of long QT syndrome-a case study ABSTRACT

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.

Research paper thumbnail of Pre-anesthesia evaluation leading to a diagnosis of long QT syndrome – a case study

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...

Research paper thumbnail of Difficult airway management: burning no bridges

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".

Research paper thumbnail of Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study

Sri Lankan Journal of Anaesthesiology, 2017

Research paper thumbnail of 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.