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Papers by Anurag Tewari MD

Journal of Anaesthesiology Clinical Pharmacology, 2019

The refractory seizures have significant impact on the quality of life and increase long term neu... more The refractory seizures have significant impact on the quality of life and increase long term neurologic and non-neurologic complications. Implantation of Stereotactic Electroencephalography (SEEG) leads is one of the newer surgical techniques intended to localize seizure foci with higher accuracy than the conventional methods. Most of the commonly utilized anesthetic agents depress EEG waveforms affecting intra operative monitoring during these surgeries. Hence, the anesthetic goals include a stable induction and maintenance with agents which have minimal effect on EEG. This article discusses the peri-operative considerations of multiple anti-epileptic medications, recent advances in anesthetic management, and important post-operative concerns.

Oxford Textbook of Anaesthesia for the Obese Patient

Obesity has nearly doubled in the world since 1980. Obesity is a common, serious, and costly prob... more Obesity has nearly doubled in the world since 1980. Obesity is a common, serious, and costly problem. More than 10% of the world’s adult population is suffering from obesity. In 2009–2010, more than one-third of adults in the United States (35.7%) were obese. The prevalence of obesity is continuously increasing and causing problems in all aspects of healthcare including anaesthesiology. Obesity is an energy imbalance and is linked with increased morbidity and mortality and associated with a wide spectrum of medical and surgical issues. Fat-containing intracranial tumours and developmental lesions such as lipomas, dermoid and epidermoid cysts, and teratomas are common. An increased prevalence of obesity in patients undergoing craniotomy for meningiomas suggests an increased incidence of meningiomas in obese men. In this chapter, physiological changes associated with obesity, pharmacology, and the anaesthetic considerations and challenges for spine and neurosurgery are addressed.

Brazilian Journal of Anesthesiology (English Edition), 2017

Medication errors are the common causes of patient morbidity and mortality. It adds financial bur... more Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to 'treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame-game, accept mistakes and develop a safe and 'just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors.

Journal of Clinical Monitoring and Computing

Journal of clinical anesthesia, Mar 21, 2017

Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of c... more Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children. MEDLINE and PubMed peer-reviewed manuscripts in obesity and pediatric anesthesia. When there was no information in pediatric literature, we included adult studies in our review. Defining obesity in a growing child is based on body mass index percentiles specific to age and sex. The precursors of adult obesity-related comorbidities are often seen in obese children. Respiratory and cardiovascular comorbidities increase perioperative risk in the severely obese child [>...

The Annals of otology, rhinology, and laryngology, 2017

Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and he... more Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and head and neck surgery have increased over recent years. Organizational support for neural monitoring during surgery is becoming evident and is increasingly recognized as an adjunct to visual nerve identification. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. This review will explore the potential advantages of IONM to improve the outcomes among patients undergoing anterior neck surgery.

The Journal of the American Society of Anesthesiologists, Jul 1, 2004

Because the data are limited and the problem is complex, decisions must be tailored to the indivi... more Because the data are limited and the problem is complex, decisions must be tailored to the individual patient and the surgical procedure. Anesthesiologists are increasingly involved in perioperative antibiotic administration and postoperative infection control. In a study by Silver et al., 5 it ...

Paediatric anaesthesia, 2016

Examination of dynamic airway collapse in patients with obstructive sleep apnea (OSA) during drug... more Examination of dynamic airway collapse in patients with obstructive sleep apnea (OSA) during drug-induced sleep endoscopy (DISE) can help identify the anatomic causes of airway obstruction. We hypothesized that a combination of dexmedetomidine and ketamine (Group DK) would result in fewer oxygen desaturations and a higher successful completion rate during DISE in children with OSA when compared to propofol (Group P) or sevoflurane/propofol (Group SP). In this retrospective study, we reviewed the records of 59 children who presented for DISE between October 2013 and March 2015. Data analyzed included demographics, OSA severity, and hemodynamics (heart rate and blood pressure). The primary outcomes were airway desaturation during DISE to <85% and successful completion of DISE; these were compared between the three groups: DK, P, and SP. Preoperative polysomnography was available for 49 patients. There were significantly more patients with severe OSA in Group P as compared to the ot...

Journal of Anaesthesiology Clinical Pharmacology, Dec 1, 2008

Journal of anaesthesiology, clinical pharmacology

Various adjuncts to local anesthetics have been used with the purpose of improving the quality of... more Various adjuncts to local anesthetics have been used with the purpose of improving the quality of subarachnoid block. This randomized double-blind study was conducted to evaluate the efficacy of adding clonidine to bupivacaine and bupivacaine-fentanyl combination. A total of 100 patients scheduled for surgery under spinal anesthesia were randomly allocated into four groups (n = 25 each) to receive intrathecal bupivacaine 7.5 mg plus normal saline 0.5 ml (group BS), intrathecal bupivacaine 7.5 mg, and fentanyl 25 μg (group BF), intrathecal bupivacaine 7.5 mg and clonidine 75 μg (group BC), intrathecal bupivacaine 7.5 mg, clonidine 37.5 μg, and fentanyl 12.5 μg (group BCF). The time of onset and duration of sensory block, highest dermatome level of sensory block, time of onset of motor block, time to complete motor block recovery and duration of spinal anesthesia, intraoperative and postoperative hemodynamics and side effects if any were recorded. VAS, total number of patients who wer...

Journal of neurosurgical sciences, Jan 15, 2015

Intraoperative neurophysiology (ION) is the gold standard to map and monitor brain functions duri... more Intraoperative neurophysiology (ION) is the gold standard to map and monitor brain functions during supratentorial surgery in critical areas. This is of great value for the surgery of brain gliomas in adults but the same ION techniques can be used in the pediatric population with respect to both epilepsy and brain tumor surgery. While the principles of most ION techniques are the same for adults and children, the developing nervous system has peculiar characteristics in terms of anatomical and physiological maturation of afferent and efferent pathways within the brain and the spinal cord. Accordingly, some adjustments, particularly with regards to stimulation parameters, are needed in younger children. This paper will review current ION techniques to assist during the resection of brain tumors in children, focusing on the aspects peculiar to mapping and monitoring of sensori-motor functions in the pediatric population. On the other hand, awake surgery, of common use in adult patient...

European Journal of Anaesthesiology, 2014