Northern Journal of ISA https://www.i-scholar.in/index.php/NJISA <p>The Indian Society of Anaesthesiologists was born on 30th December 1947. The launching of Northern Journal of ISA (NJISA) in December 2015 is another milestone in the history of the Indian Society of Anaesthesiologists. We hope NJISA, an open access peer reviewed journal as per the standards of ICMJE, will give a wider platform to present and publish our clinical and research work.</p><p>NJISA will be commited to publish the highest quality of work in the form of original studies, randomised controlled trials and meta-analyses along with informative correspondences in all branches of Anaesthesia. We hope that NIJA will improve our clinical practice and transform the practice of medicine in our speciality in India.</p> en-US sbalabhaskar@gmail.com (Dr. Sukhminder Jit Singh Bajwa) sbalabhaskar@gmail.com (Dr. Bala Bhaskar S) Mon, 01 Jan 2018 00:00:00 +0000 OJS 2.4.2.0 http://blogs.law.harvard.edu/tech/rss 60 Enhancing Motivation and Minimizing Constraints in Research Academics:An Acute Need for a Growing Specialty https://www.i-scholar.in/index.php/NJISA/article/view/188994 In 1946, when Sir Morton demonstrated the ETHER SHOW, nobody would have thought in their wildest of dreams that such innovation will mark the beginning of a much safer surgical atmosphere. It was his motivation, innovative thinking, and dedication that led to birth of a newer specialty, The Anaesthesia. The next few decades saw more of such innovations which led to the further development and advancement of our specialty. However, during all these times research academics played a minimal role and it was mainly the motivation and dedication of individuals which helped in advancement of the specialty with their hard work. Sukhminder Jit Singh Bajwa, Naveen Malhotra https://www.i-scholar.in/index.php/NJISA/article/view/188994 Mon, 01 Jan 2018 00:00:00 +0000 Challenges of Cancer Staging and Therapy in Critically Ill Patients https://www.i-scholar.in/index.php/NJISA/article/view/188995 The number of patients diagnosed with malignancy has increased significantly with the advent of new diagnostic modalities, so has the overall prognosis with the dawn of new therapeutic interventions. However many of these patients require critical care admissions as an aftermath of cancer or its treatment. There still exists a dilemma as to which cancer patients to admit and when to admit. The purpose of this review is therefore to outline principles of critical care in cancer patients with special emphasis on critical and palliative care as well as appraisal of economic and ethical aspects in their management. Sukhminder Jit Singh Bajwa, Smriti Anand https://www.i-scholar.in/index.php/NJISA/article/view/188995 Mon, 01 Jan 2018 00:00:00 +0000 Comparative Evaluation of Combined Ilioinguinal Iliohypogastric Block Versus Caudal Block using Ropivacaine and Clonidine for Paediatric Postoperative Analgesia Following Inguinal Hernia Repair https://www.i-scholar.in/index.php/NJISA/article/view/188996 <strong>Background</strong>: Inguinal hernia repair is a commonly performed surgery in children. Various regional techniques have been used for postoperative analgesia however the duration of analgesia is limited by local anesthetics. <strong>Objectives</strong>: To compare the postoperative analgesia and complications of combined ilioinguinal iliohypogastric block versus caudal block following inguinal hernia repair surgery in children using 0.2% ropivacaine and clonidine (1 μg/kg). <strong>Methods:</strong> Forty children of age one month to three years undergoing inguinal hernia repair were randomly allocated to two Group C (receiving Caudal block) and group I (receiving combined ilioinguinal iliohypogastric block). Ropivacaine 0.2% and clonidine1 μg/kg used. Patients were evaluated for pain postoperatively at 30 minutes, 1, 1 ½, 2, 4, 8, 12 and 24 hours. <strong>Results</strong>: Both techniques were effective for postoperative analgesia following hernia repair in children for 24 hours postoperatively. <strong>Conclusion</strong>: Both combined Ilioinguinal iliohypogastric and caudal block were effective for postoperative analgesia for 24 hours using ropivacaine 0.2% and clonidine 1 μg/kg following inguinal hernia repair in children and no complications were seen in any of the two blocks. Sadhana Saini Sapra, Kirti Nath Saxena, Bharti Taneja, Shikha Bansal, Yogesh Kumar Sarin https://www.i-scholar.in/index.php/NJISA/article/view/188996 Mon, 01 Jan 2018 00:00:00 +0000 An Evaluation of Retrograde Light-Guided Laryngoscopic Intubation and its Comparison with Conventional Direct Laryngoscopic Intubation https://www.i-scholar.in/index.php/NJISA/article/view/188997 Background: Conventional Direct Laryngoscopic (DL) tracheal intubation requires certain amount of skill for its successful outcome. To improve the success of intubation, various alternatives to conventional laryngoscopy have been described in recent years. Retrograde Light-Guided Laryngoscopy (RLGL) is a recently described technique for endotracheal intubation. Methods: A prospective randomized study was conducted in 100 patients, randomly intubated according to a computer generated procedure using either DL or RLGL by a single operator. The primary outcome was the success rate of tracheal intubation. The parameters evaluated were: success rate of tracheal intubation, time to glottic exposure and time to tracheal intubation, Cormack and Lehane grades, haemodynamic parameters and post operative sore-throat and hoarseness of voice. Results: Compared with DL, the overall success rate was greater in the RLGL group (P = 0.004). This was associated with a shorter time to glottic exposure [4.0(±1.09) vs 4.72±(1.16) sec, P = 0.001], shorter intubation time [5.28(±1.34) vs 6.10(±1.22) sec, P &lt; 0.001]. The laryngoscopic grades using RLGL were better than using DL (p = 0.002). The haemodynamic responses were comparable in both the groups. There was decreased incidence of sore-throat (p = 0.083) and hoarseness (0.005) at 24 hrs with RLGL compared to DL. Conclusions: RLGL is an alternative approach for intubation. We conclude that the RLGL is a safe and effective device for achieving endotracheal intubation in normotensive adults with normal airways. Mohd Shakir Naeem, Kirti N. Saxena, Bharti Taneja https://www.i-scholar.in/index.php/NJISA/article/view/188997 Mon, 01 Jan 2018 00:00:00 +0000 To Study and Compare the Reliability of Four Different Techniques for Identifying the Correct Needle Placement in Caudal Epidural Space-Loss of Resistance, Whoosh Test, Swoosh Test and Nerve Stimulation in Paediatric Age Group https://www.i-scholar.in/index.php/NJISA/article/view/188998 <strong>Background</strong>: Precise knowledge of anatomical land marks of sacral hiatus and the proper identification of the epidural space is indispensable for successful caudal epidural anaesthesia. <strong>Aim</strong>: To test the reliability of loss of resistance, whoosh test, swoosh test and nerve stimulation in identifying the correct caudal needle placement in children. <strong>Methods</strong>: 40 children aged between 1-6 years with ASA-I and ASA-II undergoing infra umbilical surgical procedures studied. On completion of surgery under general anaesthesia, neuromuscular blockade was reversed and caudal given. Nerve stimulator needle was inserted with Loss of Resistance (LOR) as reference and gradually current increased until a motor response visible in the anal sphincter (S2-S3). Then, whoosh and swoosh test performed by another observer blinded and local anaesthetic given using Armitage formula. <strong>Results</strong>: LOR was appreciated in 34 (85%) patients. Elicitation of nerve stimulation test was positive in all 40 (100%) of patients. The mean current used was 7.47 ± 2.52 mA. The whoosh test (1ml of air) and swoosh test was positive in all 40 (100%) of the patients. In one patient sacral hiatus could not be identified. The most frequent difficulty noticed was multiple attempts in six out of 20 cases. <strong>Conclusion</strong>: LOR technique requires experience, thus not a good teaching tool for beginners. Nerve stimulator is an excellent objective tool however; limited availability and time constraints make its use impractical. Whoosh and swoosh are the preferred clinical techniques if ultrasound is unavailable. Anupam Sharma, Surinder Singh, Sonali Kaushal https://www.i-scholar.in/index.php/NJISA/article/view/188998 Mon, 01 Jan 2018 00:00:00 +0000 Anaesthetic Management of a Parturient with Clinoid Meningioma for Caesarean Section https://www.i-scholar.in/index.php/NJISA/article/view/188999 Certain tumours such as meningiomas manifest during pregnancy due to rapid growth following increased blood volume which results in increasing size of vascular tumours. A 25 years old primi-gravida (weight 60 kg) presented at 34 weeks gestation with the complaints of headache, generalized grand mal seizure, diminished vision and loss of speech for 1 week and was diagnosed with intracranial meningioma. Caesarean section was performed followed by neurosurgery for removal of tumour. Anaesthetic management of these cases could be challenging due to lack of adequate guidelines. Kirti N. Saxena, Ayushi Mahajan https://www.i-scholar.in/index.php/NJISA/article/view/188999 Mon, 01 Jan 2018 00:00:00 +0000 Spasmodic Dysphonia Presenting in a Post Trauma Tracheostomised Patient with Inadequate Laryngeal Muscle Relaxation https://www.i-scholar.in/index.php/NJISA/article/view/189000 <p>Spasmodic Dysphonia is a chronic long-term voice disorder, with a very rare incidence of 1 per 100,000 cases in which the movement of vocal cords is both forced and strained resulting in hoarse, quivery and jerky voice. We present a very rare and interesting case of spasmodic Dysphonia that was adequately relaxed after administration of muscle relaxants but had undue contractions of adductor group of muscles at the level of vocal cords. Little is known about the genetic basis of the disease but symptoms improve when the kinetic output of the laryngeal muscles is reduced either by unilateral recurrent laryngeal nerve section, or by botulinum injections into the affected muscles.</p> Bhavna Gupta, Kavita Sharma, Vikas Malhotra https://www.i-scholar.in/index.php/NJISA/article/view/189000 Mon, 01 Jan 2018 00:00:00 +0000 Caudal Block with Monitored Anaesthesia Care for Bilateral Orchidopexy in 5 Year Old Child Having Down Syndrome (Trisomy 21):A Case Report https://www.i-scholar.in/index.php/NJISA/article/view/189001 Children with Down syndrome have an increased risk of cryptorchidism. We are reporting a case of 5 year - old male child weighing 15 kg, a known case of Down syndrome with congenital hypothyroidism with complaint of bilateral empty scrotal sac. In our case, a detailed preoperative assessment and optimization was done. In preoperative assessment atlantoaxial instability was not observed and for cardiovascular anomalies 2D echo report showed normal mitral, tricuspid, aortic and pulmonary valve with intact atrial and ventricular septum. Anaesthetic management was planned with possible anticipation for atlantoaxial abnormality and difficult airway, sensitivity to drugs and ventilation challenges during surgery. A meticulous anaesthetic management by caudal block with monitored anaesthesia care resulted in a good peri-operative outcome in our case. Chetan Suwalka, S. C. Dulara, Upendra Kumar https://www.i-scholar.in/index.php/NJISA/article/view/189001 Mon, 01 Jan 2018 00:00:00 +0000