Publications by authors named "Rudrashish Haldar"

86 Publications

NMR based CSF metabolomics in tuberculous meningitis: correlation with clinical and MRI findings.

Metab Brain Dis 2022 Jan 14. Epub 2022 Jan 14.

Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.

We report the potential role of H Nuclear Magnetic Resonance (NMR) based metabolomics in tuberculous meningitis (TBM). We also correlate the significant metabolites with clinical-radiological parameters. Forty-three patients with TBM were included, and their severity of meningitis was graded as stages I to III, and patients with positive Mycobacterium tuberculosis or its nucleic acid was considered as definite TBM. H NMR-based metabolomic study was performed on (CSF) samples, and the significant metabolites compared to healthy controls were identified. Outcome at three months was defined as death, poor and good based on the modified Rankin Scale. These metabolites were compared between definite and probable groups of TBM, and also correlated with MRI findings. About 11 metabolites were found to be significant for distinguishing TBM from the controls. In TBM, lactate, glutamate, alanine, arginine, 2-hydroxyisobutyrate, formate, and cis-aconitate were upregulated, and glucose, fructose, glutamine, and myo-inositol were downregulated compared to the controls. For differentiating TBM from the controls, the AUC of the ROC curve generated using these significant metabolites was 0.99, with a 95% confidence interval from 0.96 to 1, demonstrating that these metabolites were able to classify cases with good sensitivity and specificity. Lactate concentration in CSF correlated with hemoglobin, CSF glucose, and infarction. The outcome did not correlate with metabolomics parameters. NMR-based CSF metabolomics have a potential role in differentiating TBM from the controls.
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http://dx.doi.org/10.1007/s11011-021-00860-yDOI Listing
January 2022

Optimising working space for laparoscopic pyeloplasty in infants: Preliminary observations with the SGPGI Protocol.

J Minim Access Surg 2022 Jan-Mar;18(1):105-110

Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Aims: This study aimed to test the efficacy of SGPGI protocol to minimise bowel distension and optimise working space for laparoscopic pyeloplasty in infants.

Methodology: All infants who underwent laparoscopic pyeloplasty for unilateral pelvi-ureteric junction obstruction (PUJO) between January 2017 and March 2020 were included in the study. The patient cohort was divided into two groups: Group A and B. Group A included patients who underwent routine pre-operative preparation. Group B included patients wherein the SGPGI protocol was used. The key features of the protocol were fasting for 8 h, enemas, inserting a nasogastric tube in the pre-operative period and decompressing the colon on the operation table. Demographic features, pre-operative, intraoperative and post-operative parameters were compared between the two groups.

Results: A total of 26 infants with unilateral PUJO underwent laparoscopic pyeloplasty during the study period. Group A included 12 patients and Group B included 14 patients. Both the groups were similar in age, weight and sex distribution. The median surgeon's rating score for suturing conditions was 2 for Group A and 5 for Group B patients (P > 0.05). The operating time was significantly longer in Group A (196 ± 21 min) as compared to Group B (114 ± 18 min) (P < 0.05). In Group A, intra-abdominal pressure (IAP) varied between 9 and 14 mmHg (median 12 mmHg), while in Group B, IAP varied between 6 and 9 mmHg (median 8 mmHg) (P < 0.05). In Group A, in 2/12 cases (16.7%), conversion to an open procedure was necessary because of inadequate working space owing to gross intestinal distension. Two patients in Group A also had intraoperative injuries to adjacent structures due to poor working space.

Conclusions: Optimal working space is critical to the performance of advanced laparoscopic surgery like pyeloplasty in infants. SGPGI protocol significantly improves working space, which permits a faster and safer surgery with a lower intra-abdominal working pressure. This protocol is simple, safe and easy to replicate at most centres in our country.
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http://dx.doi.org/10.4103/jmas.JMAS_202_20DOI Listing
January 2022

Desperate times call for desperate measures: An innovative apparatus designed for domiciliary oxygen delivery.

Indian J Anaesth 2021 Oct 28;65(Suppl 4):S179-S180. Epub 2021 Oct 28.

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/ija.ija_627_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613472PMC
October 2021

Predictors of fever response in tuberculous meningitis: A clinical, MRI and biomarker study.

Eur J Clin Invest 2022 Feb 2;52(2):e13701. Epub 2021 Nov 2.

Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Background: Central nervous system (CNS) has a different immune surveillance system; therefore, fever at admission and timeline of fever response after antitubercular treatment (ATT) may follow a different course in CNS infection. We report the predictors of fever response in tuberculous meningitis (TBM) including the effect of tumour necrosis factor-α (TNF-α) in cerebrospinal fluid (CSF) and its gene expression at mRNA of peripheral blood mononuclear cells (PBMCs).

Methods: Fifty-seven patients with TBM were prospectively evaluated. Their clinical findings and severity of meningitis were recorded. The expression of TNF-α gene in PBMCs was quantified by real-time polymerase chain reaction and TNF-α concentration in CSF by cytokine bead array both in the patients and 14 matched controls.

Results: All the patients had history of fever for a median duration of 75 days. The admission temperature ranged between 37.2°C and 40°C and correlated with CSF cell counts (p < 0.05). Cranial MRI was abnormal in 54 (94.7%) and revealed exudates in 33(57.9%), hydrocephalus in 27(47.4%), infarction in 27(47.4%) and tuberculoma in 33(57.9%) patients. Fever subsided after a median duration of 18 (2 60) days of treatment. Twelve (21.8%) patients only became afebrile within 10 days. The expression of TNF-α gene correlated with CSF concentration of TNF-α (p = 0.02) and independently predicted duration of defervescence [adjusted hazard ratio 1.02 (95% CI 1.00-1.04; p = 0.01).

Conclusion: In the patients with TBM, defervescence takes longer time, and TNF-α gene expression predicts the duration of defervescence. Future studies are needed to evaluate the role of TNF-α-modifying drugs in TBM.
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http://dx.doi.org/10.1111/eci.13701DOI Listing
February 2022

Comparative evaluation of intubation performances using two different barrier devices used in the COVID-19 era: A manikin based pilot study.

Saudi J Anaesth 2021 Apr-Jun;15(2):86-92. Epub 2021 Apr 1.

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background And Aims: Protection of anaesthesiologists from contaminated aerosols of COVID 19 patients during endotracheal intubation has spurred the development of barrier devices like aerosol boxes and clear transparent plastic sheets and usage of videolaryngoscopes in COVID 19 patients. However, the efficiency, feasibility and difficulties faced by anaesthesiologist while performing endotracheal intubations under barrier devices require scientific validation. This manikin-based pilot study aims to assess the laryngoscopic performances of experienced anaesthesiologists under two different barrier enclosures.

Methods And Materials: 53 anaesthesiologists (14 Consultants and 39 Senior Residents) who were undergoing an airway training module as a part of preparedness for handling the COVID 19 pandemic were recruited. Using an aerosol box over a manikin, the participants attempted intubation using a Glidescope Videolaryngoscope and Macintosh laryngoscopes (GA and MA Groups). Subsequently, intubation was attempted under a transparent plastic sheet using both laryngoscopes (GP and MP groups). Time required for intubation, first pass success rates, subjective ease of intubation and the feedback obtained from the participants were recorded and analysed.

Results: Time required for accomplishing successful intubation was 38.55 ± 12.16 seconds, 26.58 ± 5.73 seconds, 46.89 ± 15.23 seconds and 37.26 ± 8.71 seconds for GA, MA, GP and MP groups respectively. Time for intubation and difficulty (VAS) was least for Macintosh group with aerosol box (MA) and maximum time was taken in Glidescope group with transparent polythene drape (GP). First attempt success rate for Glidescope groups (GP and GA) were 100% and in MA and MP group was 98% and 96% respectively. Restriction in hand movement and stylet removal were the major difficulties reported.

Conclusion: Longer intubation times were observed while using Glidescope Videolaryngoscopes with either of the two barrier devices in place compared to Macintosh laryngoscopes.
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http://dx.doi.org/10.4103/sja.sja_1062_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191263PMC
April 2021

Intraoperative lung-protective ventilation in cardiothoracic surgeries: Paradigm and practices.

Indian J Anaesth 2021 May 10;65(Suppl 2):S59-S61. Epub 2021 May 10.

Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.

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http://dx.doi.org/10.4103/ija.ija_333_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191194PMC
May 2021

Optimising working space for laparoscopic pyeloplasty in infants: Preliminary observations with the SGPGI Protocol.

J Minim Access Surg 2021 May 1. Epub 2021 May 1.

Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Aims: This study aimed to test the efficacy of SGPGI protocol to minimise bowel distension and optimise working space for laparoscopic pyeloplasty in infants.

Methodology: All infants who underwent laparoscopic pyeloplasty for unilateral pelvi-ureteric junction obstruction (PUJO) between January 2017 and March 2020 were included in the study. The patient cohort was divided into two groups: Group A and B. Group A included patients who underwent routine pre-operative preparation. Group B included patients wherein the SGPGI protocol was used. The key features of the protocol were fasting for 8 h, enemas, inserting a nasogastric tube in the pre-operative period and decompressing the colon on the operation table. Demographic features, pre-operative, intraoperative and post-operative parameters were compared between the two groups.

Results: A total of 26 infants with unilateral PUJO underwent laparoscopic pyeloplasty during the study period. Group A included 12 patients and Group B included 14 patients. Both the groups were similar in age, weight and sex distribution. The median surgeon's rating score for suturing conditions was 2 for Group A and 5 for Group B patients (P > 0.05). The operating time was significantly longer in Group A (196 ± 21 min) as compared to Group B (114 ± 18 min) (P < 0.05). In Group A, intra-abdominal pressure (IAP) varied between 9 and 14 mmHg (median 12 mmHg), while in Group B, IAP varied between 6 and 9 mmHg (median 8 mmHg) (P < 0.05). In Group A, in 2/12 cases (16.7%), conversion to an open procedure was necessary because of inadequate working space owing to gross intestinal distension. Two patients in Group A also had intraoperative injuries to adjacent structures due to poor working space.

Conclusions: Optimal working space is critical to the performance of advanced laparoscopic surgery like pyeloplasty in infants. SGPGI protocol significantly improves working space, which permits a faster and safer surgery with a lower intra-abdominal working pressure. This protocol is simple, safe and easy to replicate at most centres in our country.
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http://dx.doi.org/10.4103/jmas.JMAS_202_20DOI Listing
May 2021

Pregnancy With Large Arteriovenous Malformation of Tongue: Anesthetic Challenges and Conduct.

A A Pract 2021 May 27;15(6):e01481. Epub 2021 May 27.

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

A pregnant woman with large intraoral arteriovenous malformation of tongue obliterating the oral cavity presented for elective cesarean delivery shortly after experiencing spontaneous, large-volume, oral bleeding. This case report describes the unconventional method of securing the airway for ensuring perioperative airway protection and the anesthetic management of the case.
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http://dx.doi.org/10.1213/XAA.0000000000001481DOI Listing
May 2021

Iatrogenic Lagophthalmos or Lid Lag. An Uncommon Occurrence Following Scalp Block.

Neurol India 2021 Mar-Apr;69(2):526-527

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/0028-3886.314563DOI Listing
June 2021

Assessing adequacy of collateral foot circulation: A simple bedside test prior to lower extremity arterial cannulation.

Saudi J Anaesth 2020 Oct-Dec;14(4):552-554. Epub 2020 Sep 24.

Department of Anaesthesia, 6 Level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S), Rishikesh, Uttarakhand, India.

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http://dx.doi.org/10.4103/sja.SJA_75_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796736PMC
September 2020

Informed consent for telemedicine.

J Family Med Prim Care 2020 Oct 30;9(10):5402-5403. Epub 2020 Oct 30.

Department of Physiology, Raiganj Government Medical College and Hospital, West Bengal, India.

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http://dx.doi.org/10.4103/jfmpc.jfmpc_1752_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773075PMC
October 2020

Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials.

Indian J Crit Care Med 2020 Nov;24(11):1106-1113

Department of Critical Care, Medical Services, Artemis Hospital, Gurugram, Haryana, India.

Purpose: The present study systematically searched important medical databases, assessed the quality of available pieces of evidence, and performed a meta-analysis to test the efficacy of different therapeutic options currently available for treating COVID-19.

Materials And Methods: PubMed, CNKI, LILACS, Koreamed, WHO clinical trial registry, and medRxiv were searched since December 2019. Any observational or controlled study that tested the efficacy of any pharmacological intervention in COVID-19 patients either prospectively or retrospectively was included in the qualitative analysis. We assessed outcomes as dichotomous variables, i.e., a patient having a positive clinical outcome. Relative risks/risk ratios (RR) having a 95% confidence interval (CI) were derived. Studies conforming to inclusion criteria were pooled using the random-effect model.

Results: Nine trials on hydroxychloroquine (HCQ), six studies on antiviral, four studies on monoclonal antibodies, two on corticosteroids, two on convalescent plasma (CP), and one on interferon-α2b were included in the systematic review. Meta-analysis containing six scientific trials and analyzing 522 patients revealed that the relative risk of positive clinical outcomes with HCQ treatment was 1.042 (95% CI, 0.884 to 1.874) with a number needed to treat (NNT) of 12.6. A meta-analysis of two studies analyzing 285 patients showed that the relative risk of clinical resolution with lopinavir and ritonavir combination was 1.152 (95% CI 0.709 to 1.87). Out of various antiviral used, the only remdesivir showed a positive result in a case series. Monoclonal antibodies showed decreased C-reactive protein, decreased oxygen, and ventilator requirements. A corticosteroid may increase mortality with increased dose. Two small case series on CP showed some promising results.

Conclusion: The study showed slightly favorable results with HCQ, monoclonal antibodies, remdesivir, and CP in treating COVID-19 patients. Further research is warranted in establishing the efficacy of studied interventions.

Prospero Identifier: CRD42020180979.

How To Cite This Article: Choupoo NS, Das SK, Haldar R, Sarkar H, Tewari R, Ray S. Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials. Indian J Crit Care Med 2020;24(11):1106-1113.
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http://dx.doi.org/10.5005/jp-journals-10071-23664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751050PMC
November 2020

A novel equipment for measuring the urine output in paediatric patients.

Indian J Anaesth 2020 Sep 22;64(Suppl 4):S249-S251. Epub 2020 Sep 22.

Department of Anaesthesia, SGPGIMS, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/ija.IJA_259_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714011PMC
September 2020

A national survey evaluating the effect of COVID-19 pandemic on the teaching and training of anaesthesiology postgraduate students in India.

Indian J Anaesth 2020 Sep 22;64(Suppl 4):S227-S234. Epub 2020 Sep 22.

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background And Aims: Anaesthesiologists have been in the forefront of managing patients of the novel coronavirus disease 19 (COVID-19) globally. The rearrangement of duties of anaesthesiology professionals and trainees along with the enforced containment measures like cessation of gatherings (for classroom teaching), cancellation of large number of elective cases and restricted number of procedures that are being performed have adversely affected the training of anaesthesiology postgraduate students across the country.

Methods: An electronic survey to assess the effect of the measures taken by hospitals due to COVID-19 on postgraduate teaching was undertaken using a validated questionnaire. We used snowball sampling, and the survey invitation with the web link was shared through freeware WhatsApp. The participation in the survey was voluntary and anonymity was maintained. Data obtained from the responses was collated and analysed.

Results: A total of 595 anaesthesiology postgraduate students (males = 298, females = 297) responded to the survey. Majority of the participants reported a steep depreciation (>50%) in the quality and quantity of academic activities (57.47%), major changes or cessation of clinical rotations (73.61%) and inability to conduct thesis-related cases (55.29%). In total, 56.97% of the students reported the rise in usage of online platforms like "Zoom" for conduct of routine academic activities.

Conclusion: Teaching and training schedules of anaesthesiology postgraduate students have undergone major modifications following the COVID 19 pandemic. Resourcefulness and ingenuity in teaching methods is the need of the hour to sustain the desired standards of training courses and to maintain the quality of the budding anaesthesiologists.
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http://dx.doi.org/10.4103/ija.IJA_645_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714006PMC
September 2020

Treating Postdural Puncture Headache With Hydroxyethyl Starch Patch: A Novel Method.

Am J Ther 2020 Nov/Dec;27(6):e619-e620

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

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http://dx.doi.org/10.1097/MJT.0000000000000986DOI Listing
September 2021

Randomized Trial to Compare Plasma Glucose Trends in Patients Undergoing Surgery for Supratentorial Gliomas under Maintenance of Sevoflurane, Desflurane, and Propofol.

Asian J Neurosurg 2020 Jul-Sep;15(3):579-586. Epub 2020 Aug 28.

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background: Anesthetic agents influence the glycemic response by affecting the neuroendocrine surgical response or directly modifying pancreatic insulin release. Due to chances of neuronal damage, intraoperative hyperglycemia and hypoglycemia both are detrimental for patients undergoing neurosurgeries. Inhalational (sevoflurane and desflurane) and intravenous (propofol) agents have been found to raise intraoperative glucose levels in nonneurological surgeries.

Aim: We aimed to compare the intraoperative glucose levels in supratentorial glioma surgeries under the maintenance of three anesthetic agents such as sevoflurane, desflurane, and propofol.

Materials And Methods: This randomized trial was conducted with 90 nondiabetic adults with supratentorial glioma. Thirty patients were allocated randomly to the three groups receiving sevoflurane, desflurane, and propofol. Baseline and hourly plasma glucose levels were recorded. Postoperatively, the time required to achieve an Aldrete score of 9 and complications were assessed.

Results: Baseline plasma glucose levels were 111.23 ± 11.67, 109.47 ± 19.75, and 111.7 ± 13.88 mg/dL ( = 0.84) in sevoflurance, desflurane, and propofol group, respectively. All of them showed an elevation of plasma glucose in relation to the time of surgery with variable trends. In the 4 and 5 h, the elevations in the inhalational groups (sevoflurane and desflurane) were significantly higher than the propofol group ( = 0.003 and 0.002, respectively). The time for achieving Aldrete's score of 9 was higher in the propofol group ( < 0.0001). No differences were observed in the duration of hospital stay or complications.

Conclusions: Maintenance of anesthesia in nondiabetic patients showed clinically modest rise of plasma glucose which is higher in patients under sevoflurane and desflurane than under propofol. However, the immediate recovery was faster with inhalational agents compared to propofol-based anesthesia.
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http://dx.doi.org/10.4103/ajns.AJNS_235_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591227PMC
August 2020

Importance of Routine Laboratory Investigations Before Elective Surgery.

Discoveries (Craiova) 2020 Sep 30;8(3):e114. Epub 2020 Sep 30.

Department of Anaesthesiology, Sarojani Naidu Medical College, Agra, India.

Background And Aims:  Certain routine pre-operative laboratory investigations are performed in all patients before elective surgeries. We conducted this study to assess the value of routine pre-operative tests in the ASA (American Society of Anesthesiologists) Grade I and II adults undergoing elective surgery and their influence in the conduct of anaesthesia together with the costs incurred on unwarranted tests.

Methods: A total of 1271 patients posted for elective surgery under anaesthesia were recruited. Each patient attended the Pre-Anaesthetic Checkup Clinic and underwent clinical evaluation and investigations according to institutional policy. Demographic data and other characteristics were recorded, along with the results of laboratory test, any peri-operative intervention done as a result of abnormality and the cost incurred on tests.

Results: Majority of the patients belonged to ASA status I (74%) and underwent moderately invasive surgery (78%). The total number of routine investigations performed was 8015. Of these, 351 (4.37%) tests had abnormal results. Amongst these 333 (4.15%) abnormalities were suspected clinically and peri-operative intervention was only performed in 0.43% of patients. Anemia was the most common abnormal finding. Abnormal blood glucose was detected in 6 patients who were not clinically suspected. Abnormal electrocardiograph (ECG) was found in 54 patients. However, the intervention was required only in 13 patients. No intervention was required because of abnormal findings of the chest X-Ray. In total cost of investigations, only 6.9% was contributed by abnormal investigations and the rest was spent on the normal tests.

Conclusion: The incidence of tests with abnormal results was very low in our study, and less than 1% of the patients with abnormal tests required changes in their peri-anaesthetic management. No major complications were seen in any patient with normal or abnormal test results. Most of the expenses (93%) were related to the normal test, which did not contribute to the perioperative management, safety and outcome of the patient. Thus, pre-operative investigations should be judiciously advised to avoid inconvenience, surgical delays and escalation of the costs of surgical care.
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http://dx.doi.org/10.15190/d.2020.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557155PMC
September 2020

Bowel Oedema Necessitating Urgent Abdominal Decompression Following Cardiopulmonary Bypass: An Exaggerated Presentation of a Recognised Complication.

Turk J Anaesthesiol Reanim 2020 Aug 5;48(4):328-330. Epub 2020 Feb 5.

Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Gastrointestinal complications after the termination of cardiopulmonary bypass are uncommon; however, they can lead to serious consequences. We encountered an unusual case of an 11-month-old infant who developed gross abdominal distention, leading to ventilatory and haemodynamic embarrassment following separation from the cardiopulmonary bypass. This presumably was a severe manifestation of the inflammatory response observed with extracorporeal circulation, which manifested as bowel oedema and was diagnosed using point-of-care ultrasound. As a rescue measure, urgent abdominal decompression was performed by cutting open the abdominal wall, which restored the ventilator and haemodynamic parameters to almost normal values.
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http://dx.doi.org/10.5152/TJAR.2020.89914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434349PMC
August 2020

Evaluation of I-Gel™ versus Classic LMA™ for Airway Management by Paramedics and Medical Students: A Manikin Study.

Anesth Essays Res 2020 Jan-Mar;14(1):166-169. Epub 2020 Jun 22.

Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background And Aim: Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices.

Materials And Methods: The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device.

Results: The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA.

Conclusion: This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.
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http://dx.doi.org/10.4103/aer.AER_37_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428105PMC
June 2020

Regional Anesthesia in Neuroanesthesia Practice.

Discoveries (Craiova) 2020 Jun 29;8(2):e111. Epub 2020 Jun 29.

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.

Regional anesthesia has been an undervalued entity in neuroanesthetic practice. However, in the past few years, owing to the development of more advanced techniques, drugs and the prolific use of ultrasound guidance, the unrecognised potential of these modalities have been highlighted. These techniques confer the advantages of reduced requirements for local anesthetics, improved hemodynamic stability in the intraoperative period, better pain score postoperatively and reduced analgesic requirements in the postoperative period. Reduced analgesic requirement translates into lesser side effects associated with analgesic use. Furthermore, the transition from the traditional blind landmark-based techniques to the ultrasound guidance has increased the reliability and the safety profile. In this review, we highlight the commonly practised blocks in the neuroanesthesiologist's armamentarium and describe their characteristics, along with their individual particularities.
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http://dx.doi.org/10.15190/d.2020.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332314PMC
June 2020

Proximal penholding method - A variant to enhance safety of ultrasoundguided central venous cannulation: A prospective pilot study.

Ann Card Anaesth 2019 Oct-Dec;22(4):379-382

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Aims: A significant incidence of Posterior Vessel Wall Puncture (PVWP) was reported during ultrasound guidance (USG) for internal jugular vein (IJV) catheterization. We studied a new technique of USGIJV cannulation to minimize or avoid PVWP, thereby decreasing overall complication rate, irrespective of the operators' experience level.

Materials And Methods: After ethical approval, a prospective study was conducted on adult patients of either gender between 18-65 years of age, belonging to the American Society of Anesthesiologists Physical Status I-III, undergoing general anesthesia and requiring USG-guided IJV cannulation. After induction of general anesthesia and intubation, USG-guided IJV cannulation was done using technique of "proximal pen-holding method" in patients placed in supine position with neck rotated in 15° rotation to the opposite side. The primary outcome was defined as success rate of USG-guided IJV cannulation and incidence of PVWP. The secondary outcome was the incidences of complications such as arterial puncture, adjacent tissue damage, and performer's ease of the procedure (0-10 scale; 0 denoting no ease and extreme difficulty and 10 denoting extreme ease and no difficulty).

Results: In 135 patients, right IJV puncture, guidewire, and central line insertion were achieved in single attempt without any PVWP by nine operators which included two anesthesia consultants and seven senior registrars. No complications were reported and ease of procedure were rated as median (interquartile range) of 10 (10).

Conclusions: The "proximal pen-holding method" for real-time USG-IJV cannulation helped in avoiding PVWP with lesser complication rate and greater performer's ease.
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http://dx.doi.org/10.4103/aca.ACA_124_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813692PMC
August 2020

Patient Transportation Delays and Effects on Operation Theatres' Efficiency: A Study for Problem Analysis and Remedial Measures.

Anesth Essays Res 2019 Jul-Sep;13(3):554-559

Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background And Aims: Delay in patients' transportation to the operating theater (OT) is a globally recognized phenomenon, leading to delay in the subsequent processes (anesthesia induction, surgery, and patient turnover). This observational study was conducted to evaluate the common reasons for delay in transporting patients to the neurosurgery OT complex and its consequent effects and how the elimination of these reasons by application of feasible measures can influence the after effects.

Settings And Design: This was an anesthesiologist-based audit of transportation process of patients to the OT complex of a tertiary care teaching hospital to identify the impediments and effects of delay, suggest and implement remedial measures, and assess the outcomes.

Materials And Methods: The movement process of successive 551 patients was studied. In the evaluation phase, common reasons for transportation delays were identified. The incidences of consequent effects such as second-case cancellations and overrunning of OTs beyond scheduled hours were noted. In the implementation phase, corrective measures were instituted and the incidences of delays and the consequent effects were again noted.

Statistical Analysis: Statistical analysis was performed using SPSS 17.0.

Results: In the evaluation phase (303 patients), common reasons for delays included porter-associated delays (15), unavailable lifts (7), and pediatric patients (6). The incidences of case cancellation (20) and overrunning of OTs (9) were high. In the implementation phase, after remedial measures were enforced, the incidences of delays due to porter, lifts, and pediatric patients dropped to 1, 6, and 0, respectively. Simultaneously, a decrease in second-case cancellation (2) and overrunning of OTs (7) also reduced. As an additional finding, a significant reduction in OT turnover times was also observed (16.31 ± 9.29 min vs. 11.70 ± 5.78 min).

Conclusions: Analysis of common reasons of patient transportation delays and removal of these impediments can markedly improve the efficiency in OT functioning.
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http://dx.doi.org/10.4103/aer.AER_75_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775839PMC
October 2019

Syncope during application of stereotactic head frame. Possible etiologies during an otherwise innocuous procedure.

Saudi J Anaesth 2019 Oct-Dec;13(4):385-387

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical, Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/sja.SJA_13_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753771PMC
October 2019

Potential Neuroendoscopic Complications: An Anesthesiologist's Perspective.

Asian J Neurosurg 2019 Jul-Sep;14(3):621-625

Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Patiala, Punjab, India.

Endoscopic techniques are being used extensively used in the current times for the diagnosis and treatment of numerous intracranial pathologies. Although the morbidity associated with these procedures is lower as compared to other conventional surgical modalities, neuroendoscopic techniques have its own fair share of distinct complications such as bleeding, cerebrospinal fluid leakage, and subdural hematoma. However, certain specific complication fall within the purview of the attending anesthesiologist who should remain vigilant, anticipating these problems to occur and should be well equipped to deal with such contingencies. This review attempts to sensitize the anesthesiologists regarding the well-known as well as rare complications of intracranial neuroendoscopic procedures and to familiarize them with their diverse presentations, preventive strategies, and management protocols.
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http://dx.doi.org/10.4103/ajns.AJNS_37_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703072PMC
September 2019

The unending pursuit for subduing postoperative pain after cesarean section: Current gradation of transversus abdominis plane block.

J Anaesthesiol Clin Pharmacol 2019 Apr-Jun;35(2):145-146

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/joacp.JOACP_304_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598576PMC
July 2019

Artificial Blood: A Futuristic Dimension of Modern Day Transfusion Sciences.

Cardiovasc Hematol Agents Med Chem 2019 ;17(1):11-16

Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Artificial blood is an innovative concept of transfusion medicine where specifically designed compounds perform the task of transport and delivery of oxygen in the body to replace this function of allogenic human blood transfusion. Several molecules have been developed in the past few decades to achieve this objective and continous refinements are being continuously made in the quest of the ideal blood substitute. Currently, available technology manufactures artificial blood from haemoglobin obtained from outdated human/bovine blood (Haemoglobin Based Oxygen Carriers) or utilizing Perfluorocarbons. These synthetic blood substitutes are advantageous in that they do not require compatibility testing, are free from blood borne infections, have prolonged shelf life and do not require refrigeration. Artificial blood is projected to have a significant impact on the development of medical care in the future. It can complement the current blood products for transfusion and create a stable supply of safe and effective products. It is likely to reduce the requirements of blood transfusions drastically especially in settings of trauma and surgery thereby reducing the reliance on banked donated blood.
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http://dx.doi.org/10.2174/1871525717666190617120045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864588PMC
November 2019

Epigastric compressions facilitate complicated tracheal location during fiberoptic bronchoscopy: An unique rescue maneuver.

Saudi J Anaesth 2019 Apr-Jun;13(2):172-173

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/sja.SJA_703_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448425PMC
April 2019

Polyuria during endonasal endoscopic surgery: An atypical effect of intraoperative dexmedetomidine administration.

Indian J Anaesth 2018 Dec;62(12):1005-1007

Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.4103/ija.IJA_532_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299766PMC
December 2018

Dynamic magnetic resonance imaging parameters for objective assessment of the magnitude of tethered cord syndrome in patients with spinal dysraphism.

Acta Neurochir (Wien) 2019 01 20;161(1):147-159. Epub 2018 Nov 20.

Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.

Background: Dynamic magnetic resonance imaging (MRI)-based criteria for diagnosing magnitude of tethered cord syndrome (TCS) in occult spinal dysraphism are proposed.

Methods: In this prospective, case-control design study, MRI lumbosacral spine was performed in 51 subjects [pilot group (n = 10) without TCS (for defining radiological parameters), control group (n = 10) without TCS (for baseline assessment), and study group (n = 31) with spinal dysraphism (thick filum terminale [n = 12], lumbar/lumbosacral meningomyelocoele [n = 6], and lipomyelomeningocoele [n = 13])]. The parameters compared in control and study groups included oscillatory frequency (OF), difference in ratio, in supine/prone position, of distance between posterior margin of vertebral body and anterior margin of spinal cord (oscillatory distance [OD]), with canal diameter, at the level of conus as well as superior border of contiguous two vertebrae above that level; delta bending angle (ΔBA), difference, in supine/prone position, of angle between longitudinal axis of conus and that of lower spinal cord; and sagittal and axial root angles, subtended between exiting ventral nerve roots and longitudinal axis of cord. An outcome assessment at follow-up was also done.

Results: In the study group (cord tethered), significantly less movement at the level of conus (OF0, p = 0.013) and one level above (OF1, p = 0.03) and significant difference in ΔBA (p = 0.0) were observed in supine and prone positions, compared to controls. Ventral nerve root stretching resulted in sagittal/axial root angle changes. Median OF (0.04) in the lipomyelomeningocoele group was significantly less than that in control group (0.23). Median OF was also lesser in patients with thick filum terminale or meningomyelocele. Difference in median sagittal and axial root angles among the study and control groups was statistically significant (p = 0.00).

Conclusion: New dynamic MRI-based parameters to establish the presence and magnitude of TCS have been defined. OF measured the extent of loss of translational cord displacement in supine and prone positions; ΔBA defined the relative angulation of conus with lower spinal cord, and sagittal and axial root angles represented ventral nerve root stretching. The difference in OF or ΔBA was minimum in the group with thick filum terminale and progressively increased in the groups with lipomyelomeningocele and meningomyelocele.
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http://dx.doi.org/10.1007/s00701-018-3721-7DOI Listing
January 2019

Paediatric VIPoma: A Jamboree of Electrolytes.

Turk J Anaesthesiol Reanim 2018 Apr 29;46(2):158-160. Epub 2017 Nov 29.

Sher-I-Kashmir Institute of Medical Sciences and Associated Hospitals, Srinagar, India.

Vasoactive intestinal peptide secreting tumour (VIPoma) is a rare type of neuroendocrine tumour (NET), primarily located in the tail of pancreas. This type of tumour presents with myriad of metabolic and electrolyte misbalances in the preoperative period, mainly due to increased vasoactive intestinal peptide (VIP) levels. Perioperative management of patients with VIPoma is challenging, especially when dealing with paediatric patients. The anaesthetic management of a two-year-old girl who was selected for VIPoma resection is hereby presented.
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http://dx.doi.org/10.5152/TJAR.2017.22220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937463PMC
April 2018
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