Publications by authors named "Snehal Bhalsing"

2 Publications

  • Page 1 of 1

Resurgence of combined intravenous Ketamine and regional anesthesia in pediatric ocular surgery in COVID-19 pandemic.

Indian J Ophthalmol 2021 Feb;69(2):395-399

Department of Vitreoretinal Services, Prime Vision Superspeciality Eye Care, Ahmednagar, Maharashtra, India.

Purpose: The current pandemic of COVID-19 has made airway procedures like intubation and extubation, potential sources of virus transmission among health care workers. The aim of this work was to study the safety profile of combined ketamine and regional anesthesia in pediatric ocular surgeries during the COVID-19 pandemic.

Methods: This prospective study included pediatric patients undergoing ocular surgery under general anesthesia from April to October 2020. Children were premedicated with oral midazolam (0.25-0.50 mg/kg) or intramuscular ketamine (7-10 mg/kg), ondensetron (0.1 mg/kg) and atropine (0.02 mg/kg). Anesthesia was achieved with intravenous ketamine (4-5 mg/kg) and local anesthesia (peribulbar block or local infiltration). The patient's vital signs were monitored. Serious complications and postoperative adverse reactions related to anesthesia were documented.

Results: A total of 55 children (62 eyes) were operated. Lid tear was the most common surgical procedure performed [n = 18 (32.7%)]. Dose of ketamine needed ranged from 30 to 120 mg (66.67 ± 30.45). No intubation or resuscitation was needed. Four children complained of nausea and two needed an additional dose of intravenous ondansetron due to vomiting in the post-operative period. Incidence of postoperative nausea and vomiting was not affected by age, duration of surgery or dose of ketamine used (P > 0.05). There was no correlation between increase in pulse and dose of ketamine.

Conclusion: Combined ketamine and regional anesthesia is a safe and effective alternative to administer anesthesia in a child during ocular surgeries.
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http://dx.doi.org/10.4103/ijo.IJO_2839_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933828PMC
February 2021

Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia.

Indian J Ophthalmol 2021 Feb;69(2):268-273

Department of Preventive and Social Medicine, DVVPF, Ahmednagar, Maharashtra, India.

Purpose: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA).

Methods: The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. A positive test was indicated by the ability to maintain downward gaze and the lack of squeezing of eyes or withdrawal. Chi-square and Fisher's exact tests were used to assess the association between LDLD results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Complications (intra- and post-operative) and postoperative inflammation at day 1 and week 6 were compared between the ATA and ALA groups.

Results: A total of 250 patients were included in the study, 138 in ALA group and 112 in ATA group. There were 109 males (43.6%) and 141 females (56.4%). Around 7.4% of LDLD- positive patients were converted to ALA during the surgery. Chi-square and Fisher's exact tests demonstrated a significant association of a positive LDLD test with successful ATA (P value 0.002). The positive predictive value and specificity of the test were 92.56% (95% CI86.87-95.9%) and 93.48% (95% CI87.98-96.97%), respectively. Intraoperative complications were similar in both the groups. Congestion and visually significant corneal edema were significantly less in ATA group.

Conclusion: The LDLD is a simple, highly specific, OPD-based test to determine patient suitability for MSICS under ATA.
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http://dx.doi.org/10.4103/ijo.IJO_280_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933868PMC
February 2021