Keshav Goyal - Academia.edu (original) (raw)

Papers by Keshav Goyal

Journal of Neuroanaesthesiology and Critical Care, May 11, 2019

Journal of Neuroanaesthesiology and Critical Care, Feb 1, 2017

Neurology India, 2011

Background: Surgical procedures for correction of craniosynostosis are often performed in pediatr... more Background: Surgical procedures for correction of craniosynostosis are often performed in pediatric patients who have a small blood volume; it represents major surgery. Literature is scarce on factors affecting blood loss, intensive care unit (ICU) and hospital stay in these patients. Objectives: To identify the factors which directly affect the outcome of craniosynostosis surgery. Materials and Methods: A detailed review of records pertaining to preanesthetic evaluation, associated anomalies, intraoperative course, and postoperative follow-up was done for patients who underwent craniosynostosis surgery between June 2000 and June 2010. The correlation between different variables was evaluated using Spearman's rank correlation. Results: During the study period 95 patients (mean age 29 months, range: 3 months-13 years) underwent corrective surgery for craniosynostosis. Hospital stay was found to be significantly associated with type of surgery and postoperative complications (P<0.001) Factors such as number of associated medical conditions, number of postoperative complications, type of induction of anesthesia, duration of surgery, type of recovery affected the ICU stay in these patients (P = 0.01). Conclusion: The outcome of patients undergoing craniosynostosis in terms of ICU and hospital stay is affected by the number of medical and postoperative conditions, type of anesthesia induction, duration of surgery and type of recovery.

Research Square (Research Square), Mar 11, 2021

Background: The equipment and medications that would be required to treat a patient in the rst th... more Background: The equipment and medications that would be required to treat a patient in the rst thirty minutes or so of a medical emergency are stored in resuscitation cart. There was no standardization of resuscitation cart as observed during ward rounds in our super specialty hospital. Hence the study was conducted with an aim of streamlining the contents of the resuscitation cart and to develop a policy for its maintenance. Materials & Methods: The study was conducted in all the patient care areas of the super specialty hospital. Resuscitation cart policy and checklist were developed by seeking inputs from all the stakeholders and validating the same using the available literature. A training program was conducted and a total of 13 resuscitation carts were inspected against the approved checklist for checking its contents in both pre and post intervention periods. Results: Resuscitation cart policy and checklist were prepared, validated by the domain experts and implemented. The compliance of all 13 resuscitation cart in terms of their contents increased from 77.82% to 97.87% with p value of <0.05 which is statistically signi cant. Conclusion: Maintaining resuscitation carts as per the checklist is a continuous process which will contribute to patient safety.

Journal of patient safety and infection control, 2018

Introduction: Central venous catheters are vital in critical care which can be associated with in... more Introduction: Central venous catheters are vital in critical care which can be associated with infectious and non-infectious adverse events. Materials and Methods: This case–control study was conducted over 1 year in trauma centre of India. All patients admitted in intensive care units (ICUs) having central line inserted during the study period (November 2013–October 2014) were included as cases. Historical controls with non-antibiotic-impregnated dressings were used as controls (November 2012–October 2013). Standard central line insertion and maintenance checklist was followed. Results: A total of 2034 patients were admitted in ICUs during study period, and the central line-associated bloodstream infection (CLABSI) rate was 2.89/1000 catheter days. During the year 2012–2013, 2100 patients were admitted and CLABSI rate was 3.04/1000 catheter days. The mean central line insertion bundle compliance rate was 76.8% in 2012–2013 and 78.37% in 2013–2014. The compliance with scrubbing the access port was minimum 34% while that with change in dressing was the maximum 79%. Discussion: Since CLABSI rate reduction was not statistically significant, the use of biopatch in our setting could not be justified and its use was not found to be cost-effective. In maintenance bundle, compliance with scrubbing the hub was least only 35%. Thus, the use of effective maintenance bundle parameters could easily reduce CLABSI rate.

Journal of Hospital Infection, 2016

Elizabethkingia meningoseptica is an infrequent cause of hospital-acquired infections. The clinic... more Elizabethkingia meningoseptica is an infrequent cause of hospital-acquired infections. The clinical and microbiological profiles of infections due to E. meningoseptica over a seven-year period at a Level I trauma centre are reported in this study. Medical records of patients from whose clinical samples E. meningoseptica was isolated on at least two occasions were reviewed. A total of 21 cases were observed during the study, 16 (76.2%) of which exhibited multidrug resistance. The observed in-hospital mortality rate was 47.6%. A high index of clinical suspicion and effective detection of E. meningoseptica in clinical samples are requisite for improved clinical outcome.

Brain Tumor Pathology, Jul 1, 2018

Diffuse leptomeningeal glioneuronal tumor (DL-GNT) is a newly introduced tumor entity of uncertai... more Diffuse leptomeningeal glioneuronal tumor (DL-GNT) is a newly introduced tumor entity of uncertain prognosis characterised by a primary diffuse leptomeningeal growth pattern, oligodendroglial-like morphology and dual glial/neuronal differentiation. Predominantly occurring in children, these tumors present as chronic meningitis and mimic infectious/inflammatory diseases. They are surgically challenging tumors with a high incidence of delayed morbidity and mortality despite low-grade histology. Their molecular genetic profile is not fully elucidated and few reports have identified chromosome 1p and 19q deletions, and BRAF alterations. We present a rare instance of a DL-GNT in a 13-year-old female who presented with slowly progressive and sequential neurological deficits over a 12-month duration. Imaging showed leptomeningeal thickening and spinal lesions. Biopsy from the spinal mass showed histomorphological features characteristic of DL-GNT. Further molecular analysis revealed 1p and 19q co-deletion and H3K27M mutation, while no mutation were identified in IDH, TERT, or BRAF genes. Patient died 4 months after diagnosis. Only one previous case of DL-GNT has been reported to harbour H3K27M mutation. Although H3K27M mutations have been described in rare examples of low-grade glial and glioneuronal tumors, whether DL-GNTs with H3K27M represent a rare growth pattern of the aggressive H3K27M-mutant diffuse midline gliomas needs further clarification.

Springer eBooks, 2021

Objectives/Hypothesis: To study rates of respiratory complications/interventions among inpatient ... more Objectives/Hypothesis: To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events. Study Design: Retrospective database review. Methods: Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ 2 test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant. Results: The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3-1.6) and less common among white children (OR: 0.8, 95% CI: 0.8-0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection. Conclusions: Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.

Saudi Journal of Anaesthesia, Nov 16, 2018

Patients with permanent pacemaker posted for cervical spine instrumentation pose special challeng... more Patients with permanent pacemaker posted for cervical spine instrumentation pose special challenges for modern-day anesthesiologist since the field of surgery is in proximity to the pacing apparatus. The important considerations in this regard are pacemaker dependency, prior reprogramming to asynchronous mode, perioperative interference with pacemaker function due to electrolyte, acid-base disturbances, and electromagnetic interference leading to pacemaker failure and hemodynamic compromise. We report successful anesthetic management of a patient of postlaminectomy kyphosis with compressive myelopathy with permanent pacemaker in situ who underwent C5–C6 corpectomy and instrumentation under general anesthesia.

Indian Journal of Surgery, Apr 1, 2023

The National Medical Journal of India, Oct 22, 2021

Background All medical graduates must know how to stabilize and manage critically ill patients. A... more Background All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. Methods We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. Results The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. Conclusions Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton's feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.

Nigerian medical journal : journal of the Nigeria Medical Association, 2013

incite trigeminal cardiac reflex (TCR) and may produce similar symptoms such as hypotension and b... more incite trigeminal cardiac reflex (TCR) and may produce similar symptoms such as hypotension and bradycardia but manifestation of wide array of arrhythmias point towards reverse herniation. 5 In addition, dural stretch can produce TCR; however, very late haemodynamic changes in this patient rule out TCR as a probable diagnosis. The reversal of haemodynamic disturbances after removal of negative suction also suggests our hypothesis. In conclusion, although the role of V.A.C dressing is proven to effective for wound healing in many areas of body but certainly the head region imposes greatest risks of haemodynamic instability, hence, need greater caution for its use and with vigilant haemodynamic monitoring.

The National Medical Journal of India, 2021

Background. Effective patient–doctor communication is a key component of patient-centred care, wh... more Background. Effective patient–doctor communication is a key component of patient-centred care, which is one of the six pillars of quality healthcare delivery. Structured and effective communication skills training for healthcare providers is the need of hour in medical education. We assessed the efficacy of role play and simulation in developing communication skills. Methods. As a key component of an acute critical care course (ACCC), communication skills are taught using role play models and simulation. Live feedback is critical in learning during this course as per the principles of adult learning (andragogy). Quantitative and qualitative data were collected to assess the efficacy of ACCC. Results. The 19th ACCC was introduced to interns at the All India Institute of Medical Sciences, New Delhi in December 2018. The teaching methodology and objective-oriented structured training in ACCC were much appreciated for training in human factors with emphasis on communication. A positive response was obtained from the candidates 3 weeks after they completed the course to assess whether interns are able to make use of this training in their day-to-day clinical practice amounting to a reliable evidence level of Kirkpatrick's ‘return of investment’. Conclusion. The use of ‘role play’ to teach communication skills is effective and superior to lecture-based teaching. Further structured and interactive programmes in communication skills training will improve patient care, relatives’ satisfaction and the image of medical profession.

The trigeminocardiac reflex (TCR) is a potent brain stem reflex that manifests as sudden bradycar... more The trigeminocardiac reflex (TCR) is a potent brain stem reflex that manifests as sudden bradycardia, hypotension, and asystole. This unique reflex is evoked during the stimulation of any sensory branch of the trigeminal nerve. Literature related to the TCR has reported mainly on its appearance during the intraoperative period; thus, it is important for anesthesiologists to know about the reflex in order for them to prevent and manage its potentially catastrophic effects. Moreover, the literature suggests that certain type of drugs, including narcotics and beta-blockers, as well as a light plane of anesthesia, play some role in inciting the TCR; therefore, what is required is a thorough understanding of anesthesia-related occurrences of the TCR. This chapter highlights anesthesia-related aspects of the reflex, including drug-related risk factors, the role of depth of anesthesia, and related mechanisms.

Saudi Journal of Anaesthesia, 2012

Journal of Anaesthesiology Clinical Pharmacology, 2013

International journal of engineering research and technology, Oct 6, 2013

In the modern era there is rapid increment in the use of video on demand system. Video on demand ... more In the modern era there is rapid increment in the use of video on demand system. Video on demand system is the one of most popular application over internet and it is also a broad research area. In the video on demand System many challenges occur in the process of designing video on demand system that is how to reduce the client waiting time required bandwidth and client buffer space. In this Survey provide the details of existing technology of Video on Demand in Mobile Ad Hoc Network, Challenges and problems occurs during the design Process.

International journal of engineering research and technology, Apr 6, 2013

Mobile Ad hoc Network is a collection of mobile nodes that make use of transmission range for com... more Mobile Ad hoc Network is a collection of mobile nodes that make use of transmission range for communication. When source node wishes to send the packet to a node that is not in its transmission range, it has to rely on the intermediate nodes for communication. Routing is required to forward the packets to the intermediate/destination node. Due to the frequent change in topology and other constraints like limited bandwidth, limited resources, routing in MANETs is a very challenging task. Routing mechanism must provide security and privacy. It also should take care of various qualities of service parameters. This survey presents a state of art overview of the different categories of protocols and their advantages and disadvantages in tabular form.

Paroxysmal sympathetic hyperactivity develops following acute brain insult from diverse pathologi... more Paroxysmal sympathetic hyperactivity develops following acute brain insult from diverse pathological conditions. The episodic sympathetic hyperactivity results in hypertension, tachycardia, tachypnea, rise in body temperature, excessive diaphoresis, and dystonia. Its prevalence is more common in males, and is generally identified during patient’s liberation from mechanical ventilator and withdrawal of sedation/muscle relaxant. The episode may follow various stimuli, including nonnoxious stimuli such as touch or even sound. Its onset is usually after a week of acute brain insult and may last up to 1 year. There are no specific signs on magnetic resonance imaging (MRI) of brain but it is suspected that patients of diffuse axonal injury on MRI are more prone to get this syndrome. Its definite etiology remains elusive. The most popular theory of excitatory–inhibitory ratio model tends to explain the sympathetic over-reactive nature of response of these patients even to nonallodynic stimuli. Its management is symptomatic and supportive; the mainstay of management relies on morphine and propranolol. Typically, beta-blockers are used to minimize the frequency of the spells, whereas morphine is administered to abort the episodes. Many second-line agents have also been used in refractory cases with variable success rate. Patients who suffer from this entity have higher incidence of various systemic complications. Early recognition is highly essential to avoid unnecessary, costly investigations and for proper management.

Saudi Journal of Anaesthesia, 2011

During one lung ventilation (OLV) hypoxemia may occur due to ventilation-perfusion mismatch. It c... more During one lung ventilation (OLV) hypoxemia may occur due to ventilation-perfusion mismatch. It can be prevented with application of ventilation strategy that prevents atelectasis while minimally impairing perfusion of the dependant lung. Here, two cases are reported who required OLV and in whom hypoxemia could be prevented with the application of continuous positive airway pressure to the deflated or non-dependant lung, using an indigenous technique. We suggest use of this technique which is easy to be employed during the intraoperative period.