GIRIJA RATH | All India Institute of Medical Sciences (original) (raw)

Papers by GIRIJA RATH

Research paper thumbnail of Balloon-Assisted Coil Embolization of Intracranial Aneurysm and Zero Bispectral Index

Research paper thumbnail of Perioperative Management of Children With Encephalocele

Journal of Neurosurgical Anesthesiology, 2011

Encephaloceles are neural tube defects that are characterized by protrusion of the brain and meni... more Encephaloceles are neural tube defects that are characterized by protrusion of the brain and meninges through a defect in the cranium. The inherent implications of pediatric anesthesia and difficult airway make surgical correction challenging for anesthesiologists Available medical records of 118 children who underwent excision and repair of encephalocele over a period of 10 years were analyzed retrospectively. Data on associated anomalies, anesthetic management, perioperative complications, and outcome at discharge were reviewed. The average age of presentation was 1 year and 6 months. The most common site of lesion was the occiput (67%). Encephaloceles were giant (size of sac larger than the head) in 15.3% of children. Hydrocephalus was the most common complication (45.8%) and was predominantly associated in children with occipital encephaloceles (P=0.00). Difficult mask ventilation and intubation were encountered in 5.9% and 19.5% of children, respectively. In children with occipital encephalocele, the trachea was intubated commonly by direct laryngoscopy in the lateral position (47.5%). The average blood loss was 69.6±13.2 mL, and 56 children required transfusion, the average being 13.2±9.6 mL/kg. Intraoperative hemodynamic disturbances and respiratory complications were observed in 21.1% and 13.5% of children, respectively. The mean intensive care unit and hospital stay were 1.8±2.1 and 8.6±4.9 days, respectively. The stays were prolonged significantly whenever the children developed hydrocephalus, meningitis, and respiratory infection, predisposing to poor outcome. Difficult airway is not the only concern in children with encephalocele, but associated congenital malformations, hydrocephalus, large size of sac, and hemodynamic disturbances all require careful consideration.

Research paper thumbnail of Asystole during posterior fossa surgery: Report of two cases

Asian journal of neurosurgery, 2012

Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have bee... more Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have been implicated, especially when surgical manipulation is carried out in the vicinity of the brain stem. The trigemino-cardiac reflex has been attributed as one of the causes. Here, we report two cases who suffered asystole during the resection of posterior fossa tumors. The vago-glossopharyngeal reflex and the direct stimulation of the brainstem were hypothesized as the causes of asytole. These episodes resolved spontaneously following withdrawal of the surgical stimulus emphasizing the importance of anticipation and vigilance during critical moments of tumor dissection during posterior fossa surgery.

Research paper thumbnail of Local warming at injection site helps alleviate pain after rocuronium administration

Journal of Anesthesia, 2010

Purpose Various strategies have been proposed to reduce discomfort of pain after rocuronium injec... more Purpose Various strategies have been proposed to reduce discomfort of pain after rocuronium injection. These studies have shown pretreatment of drugs such as fentanyl and lidocaine to be effective. In a prospective randomized study, we evaluated whether pretreatment with local warming at injection site using an air-warming device could effectively alleviate pain induced by rocuronium. Methods Ninety patients undergoing spinal surgeries were randomly divided into two groups: group C (control) and group T (treatment). Patients in group T were subjected to warming at 40°C for 1 min prior to injecting 1 ml (10 mg) of rocuronium at the site of venous access. Patients were then assessed for any discomfort and to quantify their discomfort on a 5-point scale. Results Age, sex, and weight were comparable between the two groups. Pain on rocuronium administration was reported by 88.9% patient in group C versus 66.7% in group T (p \ 0.05). Severe pain was significantly less in group T (35.6% vs. 8.9%). Conclusion Application of warmth over the vascular access prior to rocuronium administration effectively reduces injection-related pain.

Research paper thumbnail of Posterior fossa haematoma following sudden decompression of acute hydrocephalus resulting from neuroendoscopy

Anaesthesia and Intensive Care, Sep 1, 2007

We report a case of a 47-year-old male undergoing endoscopic removal of a third ventricular collo... more We report a case of a 47-year-old male undergoing endoscopic removal of a third ventricular colloid cyst. After uneventful surgery, the patient remained drowsy and was transferred to the intensive care unit for supportive care. In the postoperative period, the patient developed hydrocephalus due to clot in the region of the cyst. A posterior fossa haematoma and further neurological deterioration complicated external ventricular drainage, presumably due to sudden intracranial hypotension. Gradual ventricular decompression is recommended to reduce the risk of this complication.

Research paper thumbnail of Bispectral index monitoring may have alternate uses!

Anaesthesia and Intensive Care, 2007

Research paper thumbnail of Variations in cerebral haemodynamics during irrigation phase in neuroendoscopic procedures

Anaesthesia and intensive care

Not many centres measure intracranial pressure during an endoscopic procedure. However, if the ir... more Not many centres measure intracranial pressure during an endoscopic procedure. However, if the irrigation fluid during endoscopy is not simultaneously drained, then some rise in intracranial pressure can be anticipated. This study was carried out to measure and monitor changes in intracranial pressure during the irrigation phase in a neuroendoscopic procedure using a Codman catheter placed in the parenchyma. Intracranial pressure was monitored in 13 patients undergoing surgical neuroendoscopic procedures under a standardised anaesthetic technique. Heart rate, mean arterial pressure, intracranial pressure and cerebral perfusion pressure were recorded at baseline and during the irrigation phase of the procedure. The heart rate during irrigation was comparable to baseline values, but the mean arterial pressure at the time of irrigation increased an average of 7 mmHg (P = 0.02). At the same time there was an average 34 mmHg increase in intracranial pressure (P < 0.001), producing an average 26 mmHg decrease in the cerebral perfusion pressure (P < 0.001) during irrigation. There was an average of four episodes of raised intracranial pressure (>25 mmHg) during the irrigation phase per patient. We suggest that the intracranial pressure be routinely monitored during neuroendoscopic procedures. Only then can the potential adverse effect of irrigation on intracranial pressure and cerebral perfusion pressure be assessed.

Research paper thumbnail of Ventriculo-peritoneal shunt surgery in an infant with double aortic arch, patent ductus arteriosus and atrial septal defect

Middle East journal of anaesthesiology

Double aortic arch with patent ductus arteriosus and atrial septal defect is an uncommon associat... more Double aortic arch with patent ductus arteriosus and atrial septal defect is an uncommon association. Such complex cardiac lesions may complicate an otherwise normal anesthetic course. We came across a case with aqueductal stenosis and hydrocephalus, scheduled for ventriculoperitoneal shunt surgery, on an emergent basis. The child was managed successfully. The anesthetic implications of resultant left-to-right shunt with increased intracranial pressure have been described.

Research paper thumbnail of Beware kinking of disposable plastic circuit tubing during anaesthesia

Anaesthesia and intensive care

Research paper thumbnail of Catheter malposition following supraclavicular approach for subclavian vein catheterisation – Case reports

Middle East journal of anaesthesiology

The supraclavicular approach of subclavian vein catheterization is associated with the lowest inc... more The supraclavicular approach of subclavian vein catheterization is associated with the lowest incidence of malposition. We report two cases of unusual malpositions seen during central venous cathelerization of subclavian vein via supraclavicular approach. Literature search did not reveal such malpositions. The possible cause for the malposition and method to prevent it is discussed.

Research paper thumbnail of Mallampati Class Zero Airway in a 5-yr-old Child

Journal of Anaesthesiology Clinical Pharmacology

Research paper thumbnail of Anaesthetic management in a child with frontonasal encephalocele

Journal of anaesthesiology, clinical pharmacology, 2010

Research paper thumbnail of Intraoperative neurophysiological monitoring by anesthesiologists

Research paper thumbnail of Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

Indian Journal of Anaesthesia, 2015

Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological ev... more Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Sixty children, aged 1-12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h) and rocuronium. The anaesthetic depth was guided by bispectral index (BIS(®)) monitoring with a target BIS(®) between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS), pain (objective pain score), agitation (Cole's agitation score), time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA) and data are presented as median (range) or mean ± standard deviation. The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05). The emergence time was shorter in desflurane group (2.75 [0.85-12] min) as compared to sevoflurane (8 [2.5-14] min) (P < 0.0001). The extubation time was also shorter in desflurane group (3 [0.8-10] min) as compared to the sevoflurane group (5.5 [1.2-14] min) (P = 0.0003). Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism.

Research paper thumbnail of Anaesthetic consideration of a child with concomitant craniovertebral junction anomaly and arrested hydrocephalus

Acta anaesthesiologica Belgica, 2015

Congenital malformations of various sorts account for a large percentage of childhood hydrocephal... more Congenital malformations of various sorts account for a large percentage of childhood hydrocephalus but associated Craniovertebral junction (CVJ) anomaly has not been reported earlier. Though the anaesthetic concerns for isolated arrested hydrocephalus and CVJ anomaly has been reported but the concomitant occurrence of both and its anaesthetic implications is not mentioned in literature. Here we present the anaesthetic management of a child with arrested hydrocephalus along with CVJ anomaly leading to compression of cervicomedullary junction and myelopathy scheduled for decompression and fixation of craniovertebral junction.

Research paper thumbnail of Persistent postoperative hypertension following posterior fossa surgery--a case report

Middle East journal of anaesthesiology

We report a case of a 20-month-old male child who underwent surgery for posterior fossa tumor. Po... more We report a case of a 20-month-old male child who underwent surgery for posterior fossa tumor. Post operatively the child developed persistent hypertension. No active intervention was done as it could have compromised cerebral perfusion pressure. The possible cause is discussed.

Research paper thumbnail of Anaesthesia for awake craniotomy: A retrospective study of 54 cases

Indian Journal of Anaesthesia, 2015

The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respir... more The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respiratory and haemodynamic stability in an awake patient who should be able to co-operate during intraoperative neurological assessment. The current literature, sharing the experience on awake craniotomy, in Indian context, is minimal. Hence, we carried out a retrospective study with the aim to review and analyse the anaesthetic management and perioperative complications in patients undergoing awake craniotomy, at our centre. Medical records of 54 patients who underwent awake craniotomy for intracranial lesions over a period of 10 years were reviewed, retrospectively. Data regarding anaesthetic management, intraoperative complications and post-operative course were recorded. Propofol (81.5%) and dexmedetomidine (18.5%) were the main agents used for providing conscious sedation to facilitate awake craniotomy. Hypertension (16.7%) was the most commonly encountered complication during intraoperative period, followed by seizures (9.3%), desaturation (7.4%), tight brain (7.4%), and shivering (5.6%). The procedure had to be converted to general anaesthesia in one of patients owing to refractory brain bulge. The incidence of respiratory and haemodynamic complications were comparable in the both groups (P > 0.05). There was less incidence of intraoperative seizures in patients who received propofol (P = 0.03). In post-operative period, 20% of patients developed new motor deficit. Mean intensive care unit stay was 2.8 ± 1.9 day (1-14 days) and mean hospital stay was 7.0 ± 5.0 day (3-30 days). 'Conscious sedation' was the technique of choice for awake craniotomy, at our institute. Fentanyl, propofol, and dexmedetomidine were the main agents used for this purpose. Patients receiving propofol had less incidence of intraoperative seizure. Appropriate selection of patients, understanding the procedure of surgery, and judicious use of sedatives or anaesthetic agents are key to the success for awake craniotomy as a procedure.

Research paper thumbnail of Tracheal deviation may be a normal anatomical variant in children

Anaesthesia and intensive care, 2009

Research paper thumbnail of Effects of butorphanol and fentanyl on cerebral pressures and cardiovascular hemodynamics during tunneling phase for ventriculoperitoneal shunt insertion

Middle East journal of anaesthesiology, 2008

Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this ... more Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this surgery. It is associated with intense hemodynamic response, may influence the intracranial pressure, and thus may worsen the existing intracranial pathology. The purpose of this report is to evaluate the commonly used opioid fentanyl, along with butorphanol, an agonist-antagonist compound. Twenty adult patients undergoing ventriculoperitoneal shunt surgery were induced with fentanyl 2-mcg.kg(-1) and thiopentone 4-5 mg.kg(-1). Intubation followed the administration of rocuronium 1 mg.kg(-1). All patients were put on mechanical ventilation to maintain end-tidal carbon dioxide levels of 32 +/- 2 mmHg. Anesthesia was maintained with isoflurane in N2O and O2 (MAC 1.0 +/- 0.2). Routine monitoring, arterial blood pressure and intracranial pressures were measured. Three minutes prior to the tunneling phase, patients received either fentanyl 1 mcg.kg(-1) or butorphanol 1 mg in a randomized manne...

Research paper thumbnail of Effects of phenytoin therapy on bispectral index and haemodynamic changes following induction and tracheal intubation

Indian journal of anaesthesia, 2009

Laryngoscopy and tracheal intubation (LTI) increase blood pressure and heart rate (HR). Intensity... more Laryngoscopy and tracheal intubation (LTI) increase blood pressure and heart rate (HR). Intensity of these changes is influenced by the anaesthetic depth assessed by the bispectral index (BIS). We determined the effect of phenytoin on anaesthetic depth and its influence on haemodynamics following LTI. Fifty patients of ASA grades I and II on oral phenytoin 200 to 300mg per day for more than one week were compared with 48 control patients. Standard anaesthesia technique was followed. BIS, non invasive mean blood pressure (MBP) and HR were recorded 30, 60, 90 and 120 sec after LTI. Phenytoin group needed lesser thiopentone for induction, 5 mg (1.1) vs. 4.3 mg (0.7) [p=0.036]. BIS was significantly lower in the phenytoin group vs. the control 30, 60, 90 and 120 sec after LTI [43.1 (16.0) vs. 48.9 (14.9), p=0.068, 56.3 (16.7) vs. 64.3 (14.4), p=0.013, 59.8 (15.8) vs. 67.5 (12.1), p=0.008, 62.6 (14) vs. 68.9 (11.2), p=0.017, and 64.2 (11.3) vs. 69 (11.7), p=0.033], respectively. MBP was ...

Research paper thumbnail of Balloon-Assisted Coil Embolization of Intracranial Aneurysm and Zero Bispectral Index

Research paper thumbnail of Perioperative Management of Children With Encephalocele

Journal of Neurosurgical Anesthesiology, 2011

Encephaloceles are neural tube defects that are characterized by protrusion of the brain and meni... more Encephaloceles are neural tube defects that are characterized by protrusion of the brain and meninges through a defect in the cranium. The inherent implications of pediatric anesthesia and difficult airway make surgical correction challenging for anesthesiologists Available medical records of 118 children who underwent excision and repair of encephalocele over a period of 10 years were analyzed retrospectively. Data on associated anomalies, anesthetic management, perioperative complications, and outcome at discharge were reviewed. The average age of presentation was 1 year and 6 months. The most common site of lesion was the occiput (67%). Encephaloceles were giant (size of sac larger than the head) in 15.3% of children. Hydrocephalus was the most common complication (45.8%) and was predominantly associated in children with occipital encephaloceles (P=0.00). Difficult mask ventilation and intubation were encountered in 5.9% and 19.5% of children, respectively. In children with occipital encephalocele, the trachea was intubated commonly by direct laryngoscopy in the lateral position (47.5%). The average blood loss was 69.6±13.2 mL, and 56 children required transfusion, the average being 13.2±9.6 mL/kg. Intraoperative hemodynamic disturbances and respiratory complications were observed in 21.1% and 13.5% of children, respectively. The mean intensive care unit and hospital stay were 1.8±2.1 and 8.6±4.9 days, respectively. The stays were prolonged significantly whenever the children developed hydrocephalus, meningitis, and respiratory infection, predisposing to poor outcome. Difficult airway is not the only concern in children with encephalocele, but associated congenital malformations, hydrocephalus, large size of sac, and hemodynamic disturbances all require careful consideration.

Research paper thumbnail of Asystole during posterior fossa surgery: Report of two cases

Asian journal of neurosurgery, 2012

Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have bee... more Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have been implicated, especially when surgical manipulation is carried out in the vicinity of the brain stem. The trigemino-cardiac reflex has been attributed as one of the causes. Here, we report two cases who suffered asystole during the resection of posterior fossa tumors. The vago-glossopharyngeal reflex and the direct stimulation of the brainstem were hypothesized as the causes of asytole. These episodes resolved spontaneously following withdrawal of the surgical stimulus emphasizing the importance of anticipation and vigilance during critical moments of tumor dissection during posterior fossa surgery.

Research paper thumbnail of Local warming at injection site helps alleviate pain after rocuronium administration

Journal of Anesthesia, 2010

Purpose Various strategies have been proposed to reduce discomfort of pain after rocuronium injec... more Purpose Various strategies have been proposed to reduce discomfort of pain after rocuronium injection. These studies have shown pretreatment of drugs such as fentanyl and lidocaine to be effective. In a prospective randomized study, we evaluated whether pretreatment with local warming at injection site using an air-warming device could effectively alleviate pain induced by rocuronium. Methods Ninety patients undergoing spinal surgeries were randomly divided into two groups: group C (control) and group T (treatment). Patients in group T were subjected to warming at 40°C for 1 min prior to injecting 1 ml (10 mg) of rocuronium at the site of venous access. Patients were then assessed for any discomfort and to quantify their discomfort on a 5-point scale. Results Age, sex, and weight were comparable between the two groups. Pain on rocuronium administration was reported by 88.9% patient in group C versus 66.7% in group T (p \ 0.05). Severe pain was significantly less in group T (35.6% vs. 8.9%). Conclusion Application of warmth over the vascular access prior to rocuronium administration effectively reduces injection-related pain.

Research paper thumbnail of Posterior fossa haematoma following sudden decompression of acute hydrocephalus resulting from neuroendoscopy

Anaesthesia and Intensive Care, Sep 1, 2007

We report a case of a 47-year-old male undergoing endoscopic removal of a third ventricular collo... more We report a case of a 47-year-old male undergoing endoscopic removal of a third ventricular colloid cyst. After uneventful surgery, the patient remained drowsy and was transferred to the intensive care unit for supportive care. In the postoperative period, the patient developed hydrocephalus due to clot in the region of the cyst. A posterior fossa haematoma and further neurological deterioration complicated external ventricular drainage, presumably due to sudden intracranial hypotension. Gradual ventricular decompression is recommended to reduce the risk of this complication.

Research paper thumbnail of Bispectral index monitoring may have alternate uses!

Anaesthesia and Intensive Care, 2007

Research paper thumbnail of Variations in cerebral haemodynamics during irrigation phase in neuroendoscopic procedures

Anaesthesia and intensive care

Not many centres measure intracranial pressure during an endoscopic procedure. However, if the ir... more Not many centres measure intracranial pressure during an endoscopic procedure. However, if the irrigation fluid during endoscopy is not simultaneously drained, then some rise in intracranial pressure can be anticipated. This study was carried out to measure and monitor changes in intracranial pressure during the irrigation phase in a neuroendoscopic procedure using a Codman catheter placed in the parenchyma. Intracranial pressure was monitored in 13 patients undergoing surgical neuroendoscopic procedures under a standardised anaesthetic technique. Heart rate, mean arterial pressure, intracranial pressure and cerebral perfusion pressure were recorded at baseline and during the irrigation phase of the procedure. The heart rate during irrigation was comparable to baseline values, but the mean arterial pressure at the time of irrigation increased an average of 7 mmHg (P = 0.02). At the same time there was an average 34 mmHg increase in intracranial pressure (P < 0.001), producing an average 26 mmHg decrease in the cerebral perfusion pressure (P < 0.001) during irrigation. There was an average of four episodes of raised intracranial pressure (>25 mmHg) during the irrigation phase per patient. We suggest that the intracranial pressure be routinely monitored during neuroendoscopic procedures. Only then can the potential adverse effect of irrigation on intracranial pressure and cerebral perfusion pressure be assessed.

Research paper thumbnail of Ventriculo-peritoneal shunt surgery in an infant with double aortic arch, patent ductus arteriosus and atrial septal defect

Middle East journal of anaesthesiology

Double aortic arch with patent ductus arteriosus and atrial septal defect is an uncommon associat... more Double aortic arch with patent ductus arteriosus and atrial septal defect is an uncommon association. Such complex cardiac lesions may complicate an otherwise normal anesthetic course. We came across a case with aqueductal stenosis and hydrocephalus, scheduled for ventriculoperitoneal shunt surgery, on an emergent basis. The child was managed successfully. The anesthetic implications of resultant left-to-right shunt with increased intracranial pressure have been described.

Research paper thumbnail of Beware kinking of disposable plastic circuit tubing during anaesthesia

Anaesthesia and intensive care

Research paper thumbnail of Catheter malposition following supraclavicular approach for subclavian vein catheterisation – Case reports

Middle East journal of anaesthesiology

The supraclavicular approach of subclavian vein catheterization is associated with the lowest inc... more The supraclavicular approach of subclavian vein catheterization is associated with the lowest incidence of malposition. We report two cases of unusual malpositions seen during central venous cathelerization of subclavian vein via supraclavicular approach. Literature search did not reveal such malpositions. The possible cause for the malposition and method to prevent it is discussed.

Research paper thumbnail of Mallampati Class Zero Airway in a 5-yr-old Child

Journal of Anaesthesiology Clinical Pharmacology

Research paper thumbnail of Anaesthetic management in a child with frontonasal encephalocele

Journal of anaesthesiology, clinical pharmacology, 2010

Research paper thumbnail of Intraoperative neurophysiological monitoring by anesthesiologists

Research paper thumbnail of Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

Indian Journal of Anaesthesia, 2015

Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological ev... more Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Sixty children, aged 1-12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h) and rocuronium. The anaesthetic depth was guided by bispectral index (BIS(®)) monitoring with a target BIS(®) between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS), pain (objective pain score), agitation (Cole's agitation score), time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA) and data are presented as median (range) or mean ± standard deviation. The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05). The emergence time was shorter in desflurane group (2.75 [0.85-12] min) as compared to sevoflurane (8 [2.5-14] min) (P < 0.0001). The extubation time was also shorter in desflurane group (3 [0.8-10] min) as compared to the sevoflurane group (5.5 [1.2-14] min) (P = 0.0003). Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism.

Research paper thumbnail of Anaesthetic consideration of a child with concomitant craniovertebral junction anomaly and arrested hydrocephalus

Acta anaesthesiologica Belgica, 2015

Congenital malformations of various sorts account for a large percentage of childhood hydrocephal... more Congenital malformations of various sorts account for a large percentage of childhood hydrocephalus but associated Craniovertebral junction (CVJ) anomaly has not been reported earlier. Though the anaesthetic concerns for isolated arrested hydrocephalus and CVJ anomaly has been reported but the concomitant occurrence of both and its anaesthetic implications is not mentioned in literature. Here we present the anaesthetic management of a child with arrested hydrocephalus along with CVJ anomaly leading to compression of cervicomedullary junction and myelopathy scheduled for decompression and fixation of craniovertebral junction.

Research paper thumbnail of Persistent postoperative hypertension following posterior fossa surgery--a case report

Middle East journal of anaesthesiology

We report a case of a 20-month-old male child who underwent surgery for posterior fossa tumor. Po... more We report a case of a 20-month-old male child who underwent surgery for posterior fossa tumor. Post operatively the child developed persistent hypertension. No active intervention was done as it could have compromised cerebral perfusion pressure. The possible cause is discussed.

Research paper thumbnail of Anaesthesia for awake craniotomy: A retrospective study of 54 cases

Indian Journal of Anaesthesia, 2015

The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respir... more The anaesthetic challenge of awake craniotomy is to maintain adequate sedation, analgesia, respiratory and haemodynamic stability in an awake patient who should be able to co-operate during intraoperative neurological assessment. The current literature, sharing the experience on awake craniotomy, in Indian context, is minimal. Hence, we carried out a retrospective study with the aim to review and analyse the anaesthetic management and perioperative complications in patients undergoing awake craniotomy, at our centre. Medical records of 54 patients who underwent awake craniotomy for intracranial lesions over a period of 10 years were reviewed, retrospectively. Data regarding anaesthetic management, intraoperative complications and post-operative course were recorded. Propofol (81.5%) and dexmedetomidine (18.5%) were the main agents used for providing conscious sedation to facilitate awake craniotomy. Hypertension (16.7%) was the most commonly encountered complication during intraoperative period, followed by seizures (9.3%), desaturation (7.4%), tight brain (7.4%), and shivering (5.6%). The procedure had to be converted to general anaesthesia in one of patients owing to refractory brain bulge. The incidence of respiratory and haemodynamic complications were comparable in the both groups (P > 0.05). There was less incidence of intraoperative seizures in patients who received propofol (P = 0.03). In post-operative period, 20% of patients developed new motor deficit. Mean intensive care unit stay was 2.8 ± 1.9 day (1-14 days) and mean hospital stay was 7.0 ± 5.0 day (3-30 days). 'Conscious sedation' was the technique of choice for awake craniotomy, at our institute. Fentanyl, propofol, and dexmedetomidine were the main agents used for this purpose. Patients receiving propofol had less incidence of intraoperative seizure. Appropriate selection of patients, understanding the procedure of surgery, and judicious use of sedatives or anaesthetic agents are key to the success for awake craniotomy as a procedure.

Research paper thumbnail of Tracheal deviation may be a normal anatomical variant in children

Anaesthesia and intensive care, 2009

Research paper thumbnail of Effects of butorphanol and fentanyl on cerebral pressures and cardiovascular hemodynamics during tunneling phase for ventriculoperitoneal shunt insertion

Middle East journal of anaesthesiology, 2008

Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this ... more Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this surgery. It is associated with intense hemodynamic response, may influence the intracranial pressure, and thus may worsen the existing intracranial pathology. The purpose of this report is to evaluate the commonly used opioid fentanyl, along with butorphanol, an agonist-antagonist compound. Twenty adult patients undergoing ventriculoperitoneal shunt surgery were induced with fentanyl 2-mcg.kg(-1) and thiopentone 4-5 mg.kg(-1). Intubation followed the administration of rocuronium 1 mg.kg(-1). All patients were put on mechanical ventilation to maintain end-tidal carbon dioxide levels of 32 +/- 2 mmHg. Anesthesia was maintained with isoflurane in N2O and O2 (MAC 1.0 +/- 0.2). Routine monitoring, arterial blood pressure and intracranial pressures were measured. Three minutes prior to the tunneling phase, patients received either fentanyl 1 mcg.kg(-1) or butorphanol 1 mg in a randomized manne...

Research paper thumbnail of Effects of phenytoin therapy on bispectral index and haemodynamic changes following induction and tracheal intubation

Indian journal of anaesthesia, 2009

Laryngoscopy and tracheal intubation (LTI) increase blood pressure and heart rate (HR). Intensity... more Laryngoscopy and tracheal intubation (LTI) increase blood pressure and heart rate (HR). Intensity of these changes is influenced by the anaesthetic depth assessed by the bispectral index (BIS). We determined the effect of phenytoin on anaesthetic depth and its influence on haemodynamics following LTI. Fifty patients of ASA grades I and II on oral phenytoin 200 to 300mg per day for more than one week were compared with 48 control patients. Standard anaesthesia technique was followed. BIS, non invasive mean blood pressure (MBP) and HR were recorded 30, 60, 90 and 120 sec after LTI. Phenytoin group needed lesser thiopentone for induction, 5 mg (1.1) vs. 4.3 mg (0.7) [p=0.036]. BIS was significantly lower in the phenytoin group vs. the control 30, 60, 90 and 120 sec after LTI [43.1 (16.0) vs. 48.9 (14.9), p=0.068, 56.3 (16.7) vs. 64.3 (14.4), p=0.013, 59.8 (15.8) vs. 67.5 (12.1), p=0.008, 62.6 (14) vs. 68.9 (11.2), p=0.017, and 64.2 (11.3) vs. 69 (11.7), p=0.033], respectively. MBP was ...