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Papers by PARAG GHARDE

Research paper thumbnail of Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2017

Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in ... more Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. Design: Prospective observational study Setting: Single university hospital Participants: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG Interventions: None Measurements and Main Results: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic scoreZ20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for Z24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p ¼ 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p ¼ 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p ¼ 0.000) were found to be predictors of poor postoperative outcome. Conclusion: Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG.

Research paper thumbnail of Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2017

Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in ... more Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. Design: Prospective observational study Setting: Single university hospital Participants: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG Interventions: None Measurements and Main Results: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic scoreZ20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for Z24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p ¼ 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p ¼ 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p ¼ 0.000) were found to be predictors of poor postoperative outcome. Conclusion: Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG.

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of Cardiac Anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.l mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation scores were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25±0.44), but the separation and acceptance of intravenous catheter was poor (2.9±0.31 and 2.85±0.37 respectively). Sedation scores in group A and C were excellent (3.75±0.44 and 3.80±0.41 respectively). Separation from parent was excellent in group A (ketamine) and group C (mixture) (group A-3.90±0.28 and group C-3.83±0.35 respectively). Children of both these groups allowed easy placement of intravenous cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal midazolam and mixture containing ketamine and midazolam (group B and C respectively), while it remained high in children who received ketamine. We conclude that intranasal ketamine is better than intranasal midazolam. The combination of two is better than midazolam alone but provides no benefit as compared with ketamine alone.

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of Cardiac Anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.l mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation scores were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25±0.44), but the separation and acceptance of intravenous catheter was poor (2.9±0.31 and 2.85±0.37 respectively). Sedation scores in group A and C were excellent (3.75±0.44 and 3.80±0.41 respectively). Separation from parent was excellent in group A (ketamine) and group C (mixture) (group A-3.90±0.28 and group C-3.83±0.35 respectively). Children of both these groups allowed easy placement of intravenous cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal midazolam and mixture containing ketamine and midazolam (group B and C respectively), while it remained high in children who received ketamine. We conclude that intranasal ketamine is better than intranasal midazolam. The combination of two is better than midazolam alone but provides no benefit as compared with ketamine alone.

Research paper thumbnail of Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction

The Annals of Thoracic Surgery, 2016

Research paper thumbnail of Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction

The Annals of Thoracic Surgery, 2016

Research paper thumbnail of Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot

Echocardiography, 2015

Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blo... more Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF. Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration). Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate. Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis.

Research paper thumbnail of Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot

Echocardiography, 2015

Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blo... more Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF. Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration). Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate. Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis.

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of cardiac anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.1 mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sed...

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of cardiac anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.1 mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sed...

Research paper thumbnail of Post-intubation tracheal stenosis in paediatric patients after cardiac surgery

Annals of cardiac anaesthesia, 2005

Research paper thumbnail of Post-intubation tracheal stenosis in paediatric patients after cardiac surgery

Annals of cardiac anaesthesia, 2005

Research paper thumbnail of What new will EuroSCORE 2010 offer?

Annals of cardiac anaesthesia

Research paper thumbnail of What new will EuroSCORE 2010 offer?

Annals of cardiac anaesthesia

Research paper thumbnail of Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

Annals of Cardiac Anaesthesia, 2010

Indian patients undergoing cardiac surgery have different demographics, clinical profile as well ... more Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

Research paper thumbnail of Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

Annals of Cardiac Anaesthesia, 2010

Indian patients undergoing cardiac surgery have different demographics, clinical profile as well ... more Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

Research paper thumbnail of Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients with Severe left Ventricular Systolic Dysfunction Undergoing on Pump Coronary Artery Bypass Grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2016

Research paper thumbnail of Incomplete Left Atrial Appendage Ligation Diagnosed Intraoperatively Using Transesophageal Echocardiography Following Mitral Valve Repair

J Cardiothorac Vasc Anesth, 2011

Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011,... more Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011, Authors:Parag Gharde, MD, DM; Madhur Malik, MD; Anubhav Gupta, MS, MCh; Sandeep Chauhan, MD, PDCC; Arkalgud S. Kumar, MS, MCh; Usha Kiran, MD. ...

Research paper thumbnail of Incomplete Left Atrial Appendage Ligation Diagnosed Intraoperatively Using Transesophageal Echocardiography Following Mitral Valve Repair

J Cardiothorac Vasc Anesth, 2011

Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011,... more Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011, Authors:Parag Gharde, MD, DM; Madhur Malik, MD; Anubhav Gupta, MS, MCh; Sandeep Chauhan, MD, PDCC; Arkalgud S. Kumar, MS, MCh; Usha Kiran, MD. ...

Research paper thumbnail of Repair of Concomitant Double Orifice Mitral and Tricuspid Valves

World journal for pediatric & congenital heart surgery, 2016

The coexistence of double orifice mitral and tricuspid valves is rare. We report a five-year-old ... more The coexistence of double orifice mitral and tricuspid valves is rare. We report a five-year-old boy with double orifice mitral and tricuspid valves requiring surgical correction of hemodynamically significant mitral and tricuspid stenosis.

Research paper thumbnail of Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2017

Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in ... more Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. Design: Prospective observational study Setting: Single university hospital Participants: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG Interventions: None Measurements and Main Results: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic scoreZ20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for Z24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p ¼ 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p ¼ 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p ¼ 0.000) were found to be predictors of poor postoperative outcome. Conclusion: Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG.

Research paper thumbnail of Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2017

Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in ... more Objectives: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. Design: Prospective observational study Setting: Single university hospital Participants: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG Interventions: None Measurements and Main Results: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic scoreZ20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for Z24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p ¼ 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p ¼ 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p ¼ 0.000) were found to be predictors of poor postoperative outcome. Conclusion: Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG.

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of Cardiac Anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.l mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation scores were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25±0.44), but the separation and acceptance of intravenous catheter was poor (2.9±0.31 and 2.85±0.37 respectively). Sedation scores in group A and C were excellent (3.75±0.44 and 3.80±0.41 respectively). Separation from parent was excellent in group A (ketamine) and group C (mixture) (group A-3.90±0.28 and group C-3.83±0.35 respectively). Children of both these groups allowed easy placement of intravenous cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal midazolam and mixture containing ketamine and midazolam (group B and C respectively), while it remained high in children who received ketamine. We conclude that intranasal ketamine is better than intranasal midazolam. The combination of two is better than midazolam alone but provides no benefit as compared with ketamine alone.

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of Cardiac Anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.l mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation scores were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25±0.44), but the separation and acceptance of intravenous catheter was poor (2.9±0.31 and 2.85±0.37 respectively). Sedation scores in group A and C were excellent (3.75±0.44 and 3.80±0.41 respectively). Separation from parent was excellent in group A (ketamine) and group C (mixture) (group A-3.90±0.28 and group C-3.83±0.35 respectively). Children of both these groups allowed easy placement of intravenous cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal midazolam and mixture containing ketamine and midazolam (group B and C respectively), while it remained high in children who received ketamine. We conclude that intranasal ketamine is better than intranasal midazolam. The combination of two is better than midazolam alone but provides no benefit as compared with ketamine alone.

Research paper thumbnail of Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction

The Annals of Thoracic Surgery, 2016

Research paper thumbnail of Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction

The Annals of Thoracic Surgery, 2016

Research paper thumbnail of Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot

Echocardiography, 2015

Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blo... more Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF. Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration). Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate. Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis.

Research paper thumbnail of Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot

Echocardiography, 2015

Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blo... more Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF. Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration). Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate. Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis.

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of cardiac anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.1 mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sed...

Research paper thumbnail of Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

Annals of cardiac anaesthesia, 2006

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in ... more We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.1 mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sed...

Research paper thumbnail of Post-intubation tracheal stenosis in paediatric patients after cardiac surgery

Annals of cardiac anaesthesia, 2005

Research paper thumbnail of Post-intubation tracheal stenosis in paediatric patients after cardiac surgery

Annals of cardiac anaesthesia, 2005

Research paper thumbnail of What new will EuroSCORE 2010 offer?

Annals of cardiac anaesthesia

Research paper thumbnail of What new will EuroSCORE 2010 offer?

Annals of cardiac anaesthesia

Research paper thumbnail of Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

Annals of Cardiac Anaesthesia, 2010

Indian patients undergoing cardiac surgery have different demographics, clinical profile as well ... more Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

Research paper thumbnail of Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

Annals of Cardiac Anaesthesia, 2010

Indian patients undergoing cardiac surgery have different demographics, clinical profile as well ... more Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

Research paper thumbnail of Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients with Severe left Ventricular Systolic Dysfunction Undergoing on Pump Coronary Artery Bypass Grafting

Journal of Cardiothoracic and Vascular Anesthesia, 2016

Research paper thumbnail of Incomplete Left Atrial Appendage Ligation Diagnosed Intraoperatively Using Transesophageal Echocardiography Following Mitral Valve Repair

J Cardiothorac Vasc Anesth, 2011

Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011,... more Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011, Authors:Parag Gharde, MD, DM; Madhur Malik, MD; Anubhav Gupta, MS, MCh; Sandeep Chauhan, MD, PDCC; Arkalgud S. Kumar, MS, MCh; Usha Kiran, MD. ...

Research paper thumbnail of Incomplete Left Atrial Appendage Ligation Diagnosed Intraoperatively Using Transesophageal Echocardiography Following Mitral Valve Repair

J Cardiothorac Vasc Anesth, 2011

Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011,... more Journal of Cardiothoracic and Vascular Anesthesia, Volume 25, Issue 2, Pages 383-385, April 2011, Authors:Parag Gharde, MD, DM; Madhur Malik, MD; Anubhav Gupta, MS, MCh; Sandeep Chauhan, MD, PDCC; Arkalgud S. Kumar, MS, MCh; Usha Kiran, MD. ...

Research paper thumbnail of Repair of Concomitant Double Orifice Mitral and Tricuspid Valves

World journal for pediatric & congenital heart surgery, 2016

The coexistence of double orifice mitral and tricuspid valves is rare. We report a five-year-old ... more The coexistence of double orifice mitral and tricuspid valves is rare. We report a five-year-old boy with double orifice mitral and tricuspid valves requiring surgical correction of hemodynamically significant mitral and tricuspid stenosis.