APEKSH PATWA - Academia.edu (original) (raw)

Papers by APEKSH PATWA

Research paper thumbnail of Mechanics and dynamics of the pharynx: An insight into pharyngeal collapse

Research paper thumbnail of Videolaryngoscopy for all intubations: Is direct laryngoscopy obsolete?

Indian Journal of Anaesthesia, 2022

Research paper thumbnail of Flexible Video Endoscopes

Research paper thumbnail of Flexible Video Endoscopic Guided Airway Management: Principles and Practice

Research paper thumbnail of Airway management in patients with thyroid swelling

Goitre is a common clinical entity with high prevalence in adult populations in endemic areas. On... more Goitre is a common clinical entity with high prevalence in adult populations in endemic areas. One of the mechanical results of goitre is deviation and compression of the trachea. Difficulty with intubation may be caused by deviation and compression. Thyroid surgery is usually considered a risk factor for difficult intubation. However the incidence of difficult intubation in thyroid surgery had rarely been studied. Anaesthesia for thyroid surgery requires an anaesthetist who is experienced in the recognition, assessment and management of a patient who may also have significant co morbidity. The aim of this review is to recognise highly significant predictive criteria for difficult airway, to understand the difference between difficult & compromised airway, to identify application of newer devices like video laryngoscopy, fibre optic bronchoscopes in airway management, & also to diagnosis and advance treatment of complication related to airway management in patients with thyroid swel...

Research paper thumbnail of Anatomy and physiology of respiratory system relevant to anaesthesia

Indian Journal of Anaesthesia, 2015

Clinical application of anatomical and physiological knowledge of respiratory system improves pat... more Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's ventilatory condition and airway patency. Such knowledge has influence on airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and optimising ventilator strategies in the perioperative period. Understanding of ventilation, perfusion and their relation with each other is important for understanding respiratory physiology. Ventilation to perfusion ratio alters with anaesthesia, body position and with one-lung anaesthesia. Hypoxic pulmonary vasoconstriction, an important safety mechanism, is inhibited by majority of the anaesthetic drugs. Ventilation perfusion mismatch leads to reduced arterial oxygen concentration mainly because of early closure of airway, thus leading to decreased ventilation and atelectasis during anaesthesia. Various anaesthetic drugs alter neuronal control of the breathing and bronchomotor tone.

Research paper thumbnail of All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic

Indian Journal of Anaesthesia

Research paper thumbnail of Critical language during an airway emergency: Time to rethink terminology?

Indian Journal of Anaesthesia

Research paper thumbnail of Use of Airtraq ® optical laryngoscope for the intubation in Pierre Robin sequence in a teenage child

Indian Journal of Anaesthesia, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Research paper thumbnail of Comparison of channelled blade with non-channelled Blade of King Vision™ videolaryngoscope for orotracheal intubation: A randomised, controlled, multicentric study

Research paper thumbnail of All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

Indian journal of anaesthesia, 2016

The various physiological changes in pregnancy make the parturient vulnerable for early and rapid... more The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or co...

Research paper thumbnail of Republication: All India difficult airway association 2016 guidelines for tracheal intubation in the intensive care unit

Indian Journal of Critical Care Medicine

IntroductIon Difficult intubations are common in the Intensive Care Unit (ICU), emergency departm... more IntroductIon Difficult intubations are common in the Intensive Care Unit (ICU), emergency department (ED), and prehospital settings, with the incidence ranging being between 8% and 13%. [1-5] Compromised cardiorespiratory physiology, risk of aspiration, and the presence of specific factors related to the environment and inadequately trained operators render tracheal intubation (TI) in the ICU more likely to be associated with complications compared to that in the operating room (OR). Unlike in the OR, postponing airway management is not an option in critically ill patients who need a definite airway to be secured at the earliest. [6] The Fourth National Audit Project (NAP4) report of the Royal College of Anaesthesiologist and the Difficult Airway Society [7] found Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60-70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

Research paper thumbnail of Mechanics and dynamics of the pharynx: An insight into pharyngeal collapse

Research paper thumbnail of Videolaryngoscopy for all intubations: Is direct laryngoscopy obsolete?

Indian Journal of Anaesthesia, 2022

Research paper thumbnail of Flexible Video Endoscopes

Research paper thumbnail of Flexible Video Endoscopic Guided Airway Management: Principles and Practice

Research paper thumbnail of Airway management in patients with thyroid swelling

Goitre is a common clinical entity with high prevalence in adult populations in endemic areas. On... more Goitre is a common clinical entity with high prevalence in adult populations in endemic areas. One of the mechanical results of goitre is deviation and compression of the trachea. Difficulty with intubation may be caused by deviation and compression. Thyroid surgery is usually considered a risk factor for difficult intubation. However the incidence of difficult intubation in thyroid surgery had rarely been studied. Anaesthesia for thyroid surgery requires an anaesthetist who is experienced in the recognition, assessment and management of a patient who may also have significant co morbidity. The aim of this review is to recognise highly significant predictive criteria for difficult airway, to understand the difference between difficult & compromised airway, to identify application of newer devices like video laryngoscopy, fibre optic bronchoscopes in airway management, & also to diagnosis and advance treatment of complication related to airway management in patients with thyroid swel...

Research paper thumbnail of Anatomy and physiology of respiratory system relevant to anaesthesia

Indian Journal of Anaesthesia, 2015

Clinical application of anatomical and physiological knowledge of respiratory system improves pat... more Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's ventilatory condition and airway patency. Such knowledge has influence on airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and optimising ventilator strategies in the perioperative period. Understanding of ventilation, perfusion and their relation with each other is important for understanding respiratory physiology. Ventilation to perfusion ratio alters with anaesthesia, body position and with one-lung anaesthesia. Hypoxic pulmonary vasoconstriction, an important safety mechanism, is inhibited by majority of the anaesthetic drugs. Ventilation perfusion mismatch leads to reduced arterial oxygen concentration mainly because of early closure of airway, thus leading to decreased ventilation and atelectasis during anaesthesia. Various anaesthetic drugs alter neuronal control of the breathing and bronchomotor tone.

Research paper thumbnail of All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic

Indian Journal of Anaesthesia

Research paper thumbnail of Critical language during an airway emergency: Time to rethink terminology?

Indian Journal of Anaesthesia

Research paper thumbnail of Use of Airtraq ® optical laryngoscope for the intubation in Pierre Robin sequence in a teenage child

Indian Journal of Anaesthesia, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Research paper thumbnail of Comparison of channelled blade with non-channelled Blade of King Vision™ videolaryngoscope for orotracheal intubation: A randomised, controlled, multicentric study

Research paper thumbnail of All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

Indian journal of anaesthesia, 2016

The various physiological changes in pregnancy make the parturient vulnerable for early and rapid... more The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or co...

Research paper thumbnail of Republication: All India difficult airway association 2016 guidelines for tracheal intubation in the intensive care unit

Indian Journal of Critical Care Medicine

IntroductIon Difficult intubations are common in the Intensive Care Unit (ICU), emergency departm... more IntroductIon Difficult intubations are common in the Intensive Care Unit (ICU), emergency department (ED), and prehospital settings, with the incidence ranging being between 8% and 13%. [1-5] Compromised cardiorespiratory physiology, risk of aspiration, and the presence of specific factors related to the environment and inadequately trained operators render tracheal intubation (TI) in the ICU more likely to be associated with complications compared to that in the operating room (OR). Unlike in the OR, postponing airway management is not an option in critically ill patients who need a definite airway to be secured at the earliest. [6] The Fourth National Audit Project (NAP4) report of the Royal College of Anaesthesiologist and the Difficult Airway Society [7] found Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60-70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.