Rashmi Salhotra | University of Delhi (original) (raw)

Papers by Rashmi Salhotra

Ain-Shams Journal of Anesthesiology

Background Airway management by intubation is considered a major responsibility and vital skill f... more Background Airway management by intubation is considered a major responsibility and vital skill for anaesthesiologists. Direct laryngoscopy and endotracheal intubation under vision continues to be the gold standard for airway management. Though conventional laryngoscopy is done with Macintosh blade, it has its own drawbacks. The Airtraq™ is a tube/guide channelled video-laryngoscope and can be used in patients with normal as well as difficult airway. On literature review, studies comparing intubation time with Airtraq™ and Macintosh laryngoscopes have shown heterogeneous results. Therefore, the present study was designed to compare the Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults. Results The median time to intubation was significantly longer in group A [45 (27–77) s] than in group M [24 (21–26) s] (p < 0.001). In both groups, 96% patients had POGO score 75–100% and CL grade I. Intubation was noted to be easy in 88% cases in group A and...

Journal of Anaesthesiology Clinical Pharmacology

Indian Journal of Clinical Anaesthesia, Mar 15, 2023

Cureus

Background Coronavirus disease 2019 (COVID-19) is an infectious disease that poses health risks t... more Background Coronavirus disease 2019 (COVID-19) is an infectious disease that poses health risks to everyone exposed to the virus and frontline healthcare workers (HCWs) are at very high risk. COVID-19 vaccines have been developed to offer protection from the disease and reduce the severity of illness. Objective This questionnaire-based cross-sectional survey aimed to determine COVID-19 vaccination trends and protection among HCWs in a dedicated COVID-19 tertiary care hospital in Northern India. Methods A printout of the questionnaire was distributed. Part 1 of the questionnaire included voluntary consent and demographics information, and part 2 dealt with COVID-19 vaccination, COVID-19 illness, and postvaccination illness. The outcomes of the study comprised trends and protection offered by COVID-19 vaccination, post-vaccination side-effects, and reasons for vaccine hesitancy. The responses were analyzed using Stata version 15.0. Results: A total of 256 HCWs were approached to take the questionnaire, out of whom 241 consented to participate in the survey. One-hundred and fifty-five (64.3%) of these HCWs were fully vaccinated, 53 (21.9%) were partially vaccinated, and 33 (13.7%) were non-vaccinated. The overall rate of infection was 45.64% (110/241). The rate of infection was 58.18% among non-vaccinated HCWs, 21.81% after partial vaccination, and 20% after full vaccination. The odds of infection among vaccinated versus non-vaccinated HCWs was 0.338 (95% CI: 0.224 to 0.512; P<0.001). The overall hospitalization rate among infected HCWs was 6.36% and there was no incidence of hospitalization among fully vaccinated HCWs. Conclusions: Vaccination was shown to reduce the rates of infection and hospitalization among HCWs. A sizeable number of HCWs remained unvaccinated due to either recent COVID-19 infection or apprehension about vaccinerelated side-effects.

Indian Journal of Anaesthesia, 2022

Journal of Anaesthesiology Clinical Pharmacology, 2021

Background and Aims: Patient cooperation, sedation, anxiolysis, and topicalization are important ... more Background and Aims: Patient cooperation, sedation, anxiolysis, and topicalization are important prerequisites for the successful and safe conduct of awake intubation. Because of the pharmacological properties, opioids can facilitate this process. Fentanyl is an opioid agonist and nalbuphine is an agonist-antagonist. This study aims to compare these two opioids for their effect on sedation and intubating conditions during awake fiberoptic intubation. Material and Methods: This randomized double-blind controlled study was conducted on 62 ASA I/II patients of either sex between the age of 20 and 60 years, weight between 40 and 80 kg, with MP class I/II airways requiring general anesthesia with endotracheal intubation. All patients received standard airway topicalization and nebulization. Patients were randomly allocated to one of the two groups according to a computer-generated random number table. Group F (n = 31) received fentanyl 2 µg/kg i.v. and group N (n = 31) received nalbuphine 0.2 mg/kg i.v. over 10 min before intubation. Fiberoptic intubation was attempted and lignocaine spray and propofol boluses were administered as and when required. Hemodynamic responses and intubating conditions were recorded. Repeated measure ANOVA, McNemar test, and Chi-square test or Fischer's exact test were used for data analysis. A P < 0.05 was considered significant. Results: Cough score (P = 0.458), post-intubation score (P = 1.000), and sedation score (P = 1.000) were comparable among the two groups. Hemodynamic responses and propofol and lignocaine requirements were also comparable. Conclusion: Both fentanyl and nalbuphine provide comparable intubating conditions when used before awake fiberoptic intubation with minimal adverse effects on hemodynamic profile.

Indian Journal of Clinical Anaesthesia

This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative... more This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Videolaryngoscopes are nowadays very commonly being used. This study evaluated McGrath®, GlideSco... more Videolaryngoscopes are nowadays very commonly being used. This study evaluated McGrath®, GlideScope® and Macintosh laryngoscopes for intubation in patients with normal airways but immobilised cervical spine, thereby simulating a difficult airway scenario.This prospective, randomised controlled trial was conducted on60 adult ASA I/II patients of either sex, between 18-60 years of age undergoing elective surgical procedures requiring general anaesthesia with tracheal intubation.Patients were randomly allocated to one of the three groups, depending on the laryngoscope used for intubation; Group MVL, McGrath® videolaryngoscope; Group GVL, GlideScope® and Group ML, Macintosh laryngoscope. Cervical collar was applied after induction of anaesthesia. Success rate of intubation in the first attempt was similar with all three laryngoscopes.Time taken to intubate was longer with McGrath® (41.1±8.6 s) compared to GlideScope®(34.5±7.1 s) and Macintosh (31.8±9.3 s) laryngoscopes. The mean percent...

Indian Journal of Clinical Anaesthesia

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. Howe... more Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after i...

Indian Journal of Clinical Anaesthesia

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. Howe... more Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after i...

Objective: To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory res... more Objective: To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection. Methods: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. Results: Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory powe...

Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the i... more Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified.

An important preventable medical error is the inadvertent administration of wrong medication. Med... more An important preventable medical error is the inadvertent administration of wrong medication. Medication errors are best seen as failure in the treatment process that lead to, or have the potential to lead to, harm to the patient.[1] The error can be classified as either a mistake in the planning or mistake while executing a well‐planned therapy. Mistake in planning may be due to knowledge‐based errors or rule‐based errors, whereas execution errors may be action‐based or memory‐based errors.[2]

Total hip arthroplasty (THA) is a very common and successful surgical intervention. It involves s... more Total hip arthroplasty (THA) is a very common and successful surgical intervention. It involves surgery of the femoral head and acetabulum, and could be partial or total, and cemented or uncemented. With increased life expectancy and availability of low‐cost surgery, the number of THAs is on the rise in the country. In 2013, the Indian Society of Hip and Knee Surgeons noted in its registry a total of 3604 THAs performed over the past 6 years, with the indication being avascular necrosis (AVN) in 49% cases.[1] THA has been on the rise since then, and it is estimated that more than 950,000 primary and revision procedures were performed globally in 2010.[2] A key factor for success of THA has been early mobilization within as little as 48 h in “fast track” cases.[3] Contribution of adequate postoperative pain relief toward early mobilization is of paramount importance and undeniable.[3]

Anesthesia: Essays and Researches

Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative peri... more Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. Aim: The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. Settings and Design: This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. Patients and Methods: Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. Statistical Analysis: Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. Results: Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). Conclusion: Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS.

Indian Journal of Critical Care Medicine

Background: Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk fa... more Background: Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk factors for acute kidney injury (AKI). Although the use of neutrophil gelatinase-associated lipocalcin (NGAL) to predict AKI is previously validated, we could locate only scanty data regarding the epidemiology of AKI and role of NGAL in preeclamptic patients admitted to ICU. Methods: Patients with preeclampsia admitted to our ICU were included. The incidence and severity of AKI during the entire ICU stay were assessed using kidney disease improving global outcomes criteria, while the a priori risk factors and serum NGAL were also evaluated. Results: A total of 52 preeclamptic patients admitted to ICU were included, among whom the majority had eclampsia (75%). AKI developed in 25 (48.1%) patients with stages 1, 2, and 3 in 56, 36, and 8%, respectively. The incidence of sepsis (16 vs 0%), shock (40 vs 7.4%), and anemia (84 vs 59.3%) was significantly greater in patients with AKI (p < 0.05). ICU mortality (28 vs 3.7%), duration of ICU, and hospital stay were significantly higher in patients who developed AKI (p < 0.05). There was no association of serum NGAL [274 (240-335) ng/mL] with AKI or the mortality (p = 0.725, 0.861); there was, however, a significant discriminatory value for eclampsia [p = 0.019; area under curve = 0.736 (95% confidence interval: 0.569-0.904)]. Conclusions: Although AKI is common among patients with preeclampsia admitted to ICU, serum NGAL does not predict its occurrence.

Indian Journal of Clinical Anaesthesia

Background and Aim: To compare the efficacy of intrathecal 0.5% hyperbaric bupivacaine, 0.5% isob... more Background and Aim: To compare the efficacy of intrathecal 0.5% hyperbaric bupivacaine, 0.5% isobaric levobupivacaine and 0.5% isobaric ropivacaine with fentanyl as adjuvant for outpatient knee arthroscopic surgeries. Material and Methods: This prospective, randomized, double-blind study was conducted on 60 ASA I/II patients between 18-60 years, scheduled for knee arthroscopy under subarachnoid block. Patients were randomised into three groups; group BF: 10 mg 0.5% hyperbaric bupivacaine (2 ml), group LF: 10 mg 0.5% isobaric levobupivacaine (2 ml), group RF: 10 mg 0.5% isobaric ropivacaine (2 ml). In addition, each patient received fentanyl 25 µg (0.5 ml) as an adjuvant to the local anaesthetic (total intrathecal volume 2.5 ml in all three groups). The sensory and motor block characteristics, time to ambulation and discharge were recorded. Demographic profile, sensory and motor block characteristics were compared using one way ANOVA followed by Tukey's test and hemodynamic parameters were compared using repeated measure ANOVA. Dunnett's test was applied wherever required. Qualitative data was compared using Chi square or Fisher's exact test. P-value <0.05 was considered significant. Results: Mean time to ambulation and discharge was significantly less in group RF (10.10 ± 3.63 hr) compared to 14.80±3.63 hr in group BF and 12.40±2.30 hr in group LF (p<0.001). Mean time to complete motor recovery was significantly less in group RF (204.75±34.39 min) compared to 260±40.78 min in group BF and 280.25±28.72 min in group LF (p<0.001). Duration of subarachnoid block was comparable in all the three groups (p=0.522). Conclusion: Isobaric ropivacaine with fentanyl is better drug combination than isobaric levobupivacaine with fentanyl or hyperbaric bupivacaine with fentanyl as spinal anaesthetic for outpatient knee arthroscopic surgery.

Indian Journal of Orthopaedics

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan,... more Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/ burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Academia Anesthesiologica International

Ain-Shams Journal of Anesthesiology

Background Airway management by intubation is considered a major responsibility and vital skill f... more Background Airway management by intubation is considered a major responsibility and vital skill for anaesthesiologists. Direct laryngoscopy and endotracheal intubation under vision continues to be the gold standard for airway management. Though conventional laryngoscopy is done with Macintosh blade, it has its own drawbacks. The Airtraq™ is a tube/guide channelled video-laryngoscope and can be used in patients with normal as well as difficult airway. On literature review, studies comparing intubation time with Airtraq™ and Macintosh laryngoscopes have shown heterogeneous results. Therefore, the present study was designed to compare the Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults. Results The median time to intubation was significantly longer in group A [45 (27–77) s] than in group M [24 (21–26) s] (p < 0.001). In both groups, 96% patients had POGO score 75–100% and CL grade I. Intubation was noted to be easy in 88% cases in group A and...

Journal of Anaesthesiology Clinical Pharmacology

Indian Journal of Clinical Anaesthesia, Mar 15, 2023

Cureus

Background Coronavirus disease 2019 (COVID-19) is an infectious disease that poses health risks t... more Background Coronavirus disease 2019 (COVID-19) is an infectious disease that poses health risks to everyone exposed to the virus and frontline healthcare workers (HCWs) are at very high risk. COVID-19 vaccines have been developed to offer protection from the disease and reduce the severity of illness. Objective This questionnaire-based cross-sectional survey aimed to determine COVID-19 vaccination trends and protection among HCWs in a dedicated COVID-19 tertiary care hospital in Northern India. Methods A printout of the questionnaire was distributed. Part 1 of the questionnaire included voluntary consent and demographics information, and part 2 dealt with COVID-19 vaccination, COVID-19 illness, and postvaccination illness. The outcomes of the study comprised trends and protection offered by COVID-19 vaccination, post-vaccination side-effects, and reasons for vaccine hesitancy. The responses were analyzed using Stata version 15.0. Results: A total of 256 HCWs were approached to take the questionnaire, out of whom 241 consented to participate in the survey. One-hundred and fifty-five (64.3%) of these HCWs were fully vaccinated, 53 (21.9%) were partially vaccinated, and 33 (13.7%) were non-vaccinated. The overall rate of infection was 45.64% (110/241). The rate of infection was 58.18% among non-vaccinated HCWs, 21.81% after partial vaccination, and 20% after full vaccination. The odds of infection among vaccinated versus non-vaccinated HCWs was 0.338 (95% CI: 0.224 to 0.512; P<0.001). The overall hospitalization rate among infected HCWs was 6.36% and there was no incidence of hospitalization among fully vaccinated HCWs. Conclusions: Vaccination was shown to reduce the rates of infection and hospitalization among HCWs. A sizeable number of HCWs remained unvaccinated due to either recent COVID-19 infection or apprehension about vaccinerelated side-effects.

Indian Journal of Anaesthesia, 2022

Journal of Anaesthesiology Clinical Pharmacology, 2021

Background and Aims: Patient cooperation, sedation, anxiolysis, and topicalization are important ... more Background and Aims: Patient cooperation, sedation, anxiolysis, and topicalization are important prerequisites for the successful and safe conduct of awake intubation. Because of the pharmacological properties, opioids can facilitate this process. Fentanyl is an opioid agonist and nalbuphine is an agonist-antagonist. This study aims to compare these two opioids for their effect on sedation and intubating conditions during awake fiberoptic intubation. Material and Methods: This randomized double-blind controlled study was conducted on 62 ASA I/II patients of either sex between the age of 20 and 60 years, weight between 40 and 80 kg, with MP class I/II airways requiring general anesthesia with endotracheal intubation. All patients received standard airway topicalization and nebulization. Patients were randomly allocated to one of the two groups according to a computer-generated random number table. Group F (n = 31) received fentanyl 2 µg/kg i.v. and group N (n = 31) received nalbuphine 0.2 mg/kg i.v. over 10 min before intubation. Fiberoptic intubation was attempted and lignocaine spray and propofol boluses were administered as and when required. Hemodynamic responses and intubating conditions were recorded. Repeated measure ANOVA, McNemar test, and Chi-square test or Fischer's exact test were used for data analysis. A P < 0.05 was considered significant. Results: Cough score (P = 0.458), post-intubation score (P = 1.000), and sedation score (P = 1.000) were comparable among the two groups. Hemodynamic responses and propofol and lignocaine requirements were also comparable. Conclusion: Both fentanyl and nalbuphine provide comparable intubating conditions when used before awake fiberoptic intubation with minimal adverse effects on hemodynamic profile.

Indian Journal of Clinical Anaesthesia

This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative... more This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Videolaryngoscopes are nowadays very commonly being used. This study evaluated McGrath®, GlideSco... more Videolaryngoscopes are nowadays very commonly being used. This study evaluated McGrath®, GlideScope® and Macintosh laryngoscopes for intubation in patients with normal airways but immobilised cervical spine, thereby simulating a difficult airway scenario.This prospective, randomised controlled trial was conducted on60 adult ASA I/II patients of either sex, between 18-60 years of age undergoing elective surgical procedures requiring general anaesthesia with tracheal intubation.Patients were randomly allocated to one of the three groups, depending on the laryngoscope used for intubation; Group MVL, McGrath® videolaryngoscope; Group GVL, GlideScope® and Group ML, Macintosh laryngoscope. Cervical collar was applied after induction of anaesthesia. Success rate of intubation in the first attempt was similar with all three laryngoscopes.Time taken to intubate was longer with McGrath® (41.1±8.6 s) compared to GlideScope®(34.5±7.1 s) and Macintosh (31.8±9.3 s) laryngoscopes. The mean percent...

Indian Journal of Clinical Anaesthesia

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. Howe... more Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after i...

Indian Journal of Clinical Anaesthesia

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. Howe... more Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after i...

Objective: To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory res... more Objective: To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection. Methods: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. Results: Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory powe...

Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the i... more Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified.

An important preventable medical error is the inadvertent administration of wrong medication. Med... more An important preventable medical error is the inadvertent administration of wrong medication. Medication errors are best seen as failure in the treatment process that lead to, or have the potential to lead to, harm to the patient.[1] The error can be classified as either a mistake in the planning or mistake while executing a well‐planned therapy. Mistake in planning may be due to knowledge‐based errors or rule‐based errors, whereas execution errors may be action‐based or memory‐based errors.[2]

Total hip arthroplasty (THA) is a very common and successful surgical intervention. It involves s... more Total hip arthroplasty (THA) is a very common and successful surgical intervention. It involves surgery of the femoral head and acetabulum, and could be partial or total, and cemented or uncemented. With increased life expectancy and availability of low‐cost surgery, the number of THAs is on the rise in the country. In 2013, the Indian Society of Hip and Knee Surgeons noted in its registry a total of 3604 THAs performed over the past 6 years, with the indication being avascular necrosis (AVN) in 49% cases.[1] THA has been on the rise since then, and it is estimated that more than 950,000 primary and revision procedures were performed globally in 2010.[2] A key factor for success of THA has been early mobilization within as little as 48 h in “fast track” cases.[3] Contribution of adequate postoperative pain relief toward early mobilization is of paramount importance and undeniable.[3]

Anesthesia: Essays and Researches

Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative peri... more Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. Aim: The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. Settings and Design: This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. Patients and Methods: Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. Statistical Analysis: Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. Results: Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). Conclusion: Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS.

Indian Journal of Critical Care Medicine

Background: Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk fa... more Background: Patients with preeclampsia admitted to the intensive care unit (ICU) may have risk factors for acute kidney injury (AKI). Although the use of neutrophil gelatinase-associated lipocalcin (NGAL) to predict AKI is previously validated, we could locate only scanty data regarding the epidemiology of AKI and role of NGAL in preeclamptic patients admitted to ICU. Methods: Patients with preeclampsia admitted to our ICU were included. The incidence and severity of AKI during the entire ICU stay were assessed using kidney disease improving global outcomes criteria, while the a priori risk factors and serum NGAL were also evaluated. Results: A total of 52 preeclamptic patients admitted to ICU were included, among whom the majority had eclampsia (75%). AKI developed in 25 (48.1%) patients with stages 1, 2, and 3 in 56, 36, and 8%, respectively. The incidence of sepsis (16 vs 0%), shock (40 vs 7.4%), and anemia (84 vs 59.3%) was significantly greater in patients with AKI (p < 0.05). ICU mortality (28 vs 3.7%), duration of ICU, and hospital stay were significantly higher in patients who developed AKI (p < 0.05). There was no association of serum NGAL [274 (240-335) ng/mL] with AKI or the mortality (p = 0.725, 0.861); there was, however, a significant discriminatory value for eclampsia [p = 0.019; area under curve = 0.736 (95% confidence interval: 0.569-0.904)]. Conclusions: Although AKI is common among patients with preeclampsia admitted to ICU, serum NGAL does not predict its occurrence.

Indian Journal of Clinical Anaesthesia

Background and Aim: To compare the efficacy of intrathecal 0.5% hyperbaric bupivacaine, 0.5% isob... more Background and Aim: To compare the efficacy of intrathecal 0.5% hyperbaric bupivacaine, 0.5% isobaric levobupivacaine and 0.5% isobaric ropivacaine with fentanyl as adjuvant for outpatient knee arthroscopic surgeries. Material and Methods: This prospective, randomized, double-blind study was conducted on 60 ASA I/II patients between 18-60 years, scheduled for knee arthroscopy under subarachnoid block. Patients were randomised into three groups; group BF: 10 mg 0.5% hyperbaric bupivacaine (2 ml), group LF: 10 mg 0.5% isobaric levobupivacaine (2 ml), group RF: 10 mg 0.5% isobaric ropivacaine (2 ml). In addition, each patient received fentanyl 25 µg (0.5 ml) as an adjuvant to the local anaesthetic (total intrathecal volume 2.5 ml in all three groups). The sensory and motor block characteristics, time to ambulation and discharge were recorded. Demographic profile, sensory and motor block characteristics were compared using one way ANOVA followed by Tukey's test and hemodynamic parameters were compared using repeated measure ANOVA. Dunnett's test was applied wherever required. Qualitative data was compared using Chi square or Fisher's exact test. P-value <0.05 was considered significant. Results: Mean time to ambulation and discharge was significantly less in group RF (10.10 ± 3.63 hr) compared to 14.80±3.63 hr in group BF and 12.40±2.30 hr in group LF (p<0.001). Mean time to complete motor recovery was significantly less in group RF (204.75±34.39 min) compared to 260±40.78 min in group BF and 280.25±28.72 min in group LF (p<0.001). Duration of subarachnoid block was comparable in all the three groups (p=0.522). Conclusion: Isobaric ropivacaine with fentanyl is better drug combination than isobaric levobupivacaine with fentanyl or hyperbaric bupivacaine with fentanyl as spinal anaesthetic for outpatient knee arthroscopic surgery.

Indian Journal of Orthopaedics

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan,... more Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/ burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Academia Anesthesiologica International