LALIT GUPTA - Academia.edu (original) (raw)

Papers by LALIT GUPTA

Open Journal of Anesthesiology, 2012

The "i-gel" is a newer, non-inflatable supraglottic airway device for clinical use and also for r... more The "i-gel" is a newer, non-inflatable supraglottic airway device for clinical use and also for resuscitation purposes. It has also been found to be a useful ventilation and intubation device in anticipated/simulated difficult airway situations. However, its use in unanticipated difficult airway situations in emergency set up has not been explored. We describe a case of 24-year-old male posted for emergency laparotomy that turned out to have an unanticipated difficult airway. Attempts to intubation and ProSeal Laryngeal Mask Airway insertion failed. However, "i-gel" proved to be a very handy intubating conduit in this critical situation.

Archives of Anesthesiology, 2018

Calcium has an important role in large number of physiological actions that are essential for lif... more Calcium has an important role in large number of physiological actions that are essential for life. Abnormalities in serum calcium concentration may have profound effects on neurological, gastrointestinal, and renal function. Magnesium is the 4 th common cation in body after sodium, potassium and calcium. Intracellular, it is the second most common cation after potassium. Magnesium is widely distributed in plant and animal foods, particularly green vegetables, spices, nuts, soya flour and shellfish. Hypo-magnesemia is reported in up to 20% of patients in medical wards and in as many as 65% of patients in ICUs. In fact, magnesium depletion has been described as "the most underdiagnosed electrolyte abnormality in current medical practice". It is important therefore that the anaesthetist understands calcium and magnesium pathophysiology. Role of Calcium and Magnesium in Anesthesia and Critical Care

The following review article in brief describes the definition, pathophysiology, management, preo... more The following review article in brief describes the definition, pathophysiology, management, preoperative assessment and perioperative anesthesia management in a case of pheochromocytoma.

Journal of Patient Safety and Infection Control, 2020

Background: Avoidable surgical complications account for a large proportion of preventable medica... more Background: Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical safety checklist (SSCL) is evidence‑based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low and middle‑income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of World Health Organisation (WHO) checklist. Methods: This was a single centre e-survey to assess the knowledge, attitudes and beliefs about the WHO‑surgical checklist, in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Results: Majority believed that the use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre, yet there was no commitment for the use of SSCL. Although all theatre personnel support implementation and use of SSCL; however, hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co‑ordinator or leadership role and shortage of workforce can be impediment to effective use. Discussion: Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all operation theatre stakeholders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.

Reumatologia, 2017

Good biomarkers are important to guide decisions in the clinical management of rheumatoid arthrit... more Good biomarkers are important to guide decisions in the clinical management of rheumatoid arthritis (RA). RA patients harbor antibodies directed against carbamylated proteins which may predict joint damage. This study investigated whether antibodies against carbamylated proteins (anti-CarP) may serve as surrogate prognostic markers. Fifty-three patients with a diagnosis of rheumatoid arthritis according to ACR 1987 criteria were included. Blood samples were analyzed for CarP antibody levels using the ELISA method. Quality of life (QoL) was assessed by the WHO SF-36 questionnaire, and disease activity was assessed using the DAS28 calculator. Newly diagnosed patients were assessed at the first visit and at 12 weeks of treatment, while a single assessment was made for patients already on maintenance therapy. Out of 53 patients, 22 had titers of anti-CarP above the cut-off range and considered as positive for anti-CarP antibodies. Anti-CarP antibody serum level was significantly higher ...

Journal of the American College of Cardiology, 2017

Background: It is imperative that non-compliance to statins be identified and addressed to optimi... more Background: It is imperative that non-compliance to statins be identified and addressed to optimize the clinical benefit of statins. Patient self-reporting methods are convenient to apply in clinical practice but need to be validated. Objective: We studied the concordance of a patient self-report method, MMAS (Morisky eight item medication adherence scale) with pill count method in measuring adherence to statins and their correlation with extended lipid profile parameters and serum HMGCoA-R (hydroxymethylglutaryl coenzyme A reductase) enzyme levels. Methods: MMAS and pill count method were used to measure the adherence to statins in patients on statins for any duration. Patients were subjected to estimation of extended lipid profile and serum HMGCoA-R levels at the end of 3 months follow-up. Results: Out of a total of 200 patients included in the study, 117 patients had low adherence (score less than 6 on MMAS) whereas 65 and 18 patients had medium (score 6 to less than 8) and high adherence (score of 8) respectively. Majority of patients who had low adherence to statins by MMAS were nonadherent by pill count method yielding concordance of 96.5%. Medium or high adherence to statins by MMAS method had concordance of 89.1% with pill count method. The levels of total cholesterol, low density lipoprotein-cholesterol, apolipoprotein B and HMGCoA-R were significantly negatively correlated with compliance measured by pill count and MMAS with similar correlation coefficients. HMGCoA-R levels demonstrated a plateau phenomenon with levels being 9-10 ng/ml when compliance to statin therapy was greater than 60% by pill count and greater than 6 on Morisky scale. Conclusion: In conclusion, MMAS and pill count methods showed concordance in measuring adherence to statins. These methods need to be explored further for their interchangeability as surrogates for biomarker levels.

Indian Journal of Clinical Anaesthesia, 2020

Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with ... more Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with child physiology is a common error made. Circulation changes at birth from the foetal to adult type, but neonates are prone to revert to foetal circulation with disastrous effects. This phenomenon is known as flip flop or YoYo circulation. We report a case of a premature neonate, being operated for intestinal perforation, with Yo Yo circulation intraoperatively.

Indian Journal of Clinical Anaesthesia, 2020

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respi... more Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respiratory tract in which child presents with severe respiratory distress, pneumonitis or sepsis. Anesthetic management of such children is challenging owing to hyperinflation or rupture of cystic lesions or iatrogenic pneumothorax with positive pressure ventilation, sudden hemodynamic collapse during induction, excessive bleeding and situation becomes more challenging if child is presenting with sepsis. We report successful management of 42 days old infant with CCAM with pneumonitis and sepsis who underwent lobectomy and was successfully extubated on operating table with meticulous planning and optimum perioperative management. Early extubation is desirable to avoid iatrogenic ventilator induced bronchial stump dehiscence by positive pressure ventilation.

IP Innovative Publication, 2022

The exponential Growth of COVID 19 in few months have brought the mighty countries on their knees... more The exponential Growth of COVID 19 in few months
have brought the mighty countries on their knees in a very
short time span. The consequences are many fold, it has
not only affected the health system but also the people in
quarantine at their homes or in Covid care centres apart from
Hospitals

Journal of Anaesthesiology Clinical Pharmacology, 2013

Background: Transversus abdominis plane block is a safe, simple and effective technique of provid... more Background: Transversus abdominis plane block is a safe, simple and effective technique of providing analgesia for lower abdominal surgeries with easily identifiable landmarks. Aims: To compare the analgesic efficacy of transversus abdominis plane block with that of direct infiltration of local anesthetic into surgical incision in lower abdominal procedures. Settings and Design: Prospective randomized controlled trial in lower abdominal surgeries done under general anesthesia. Materials and Methods: 52 ASA I-II patients undergoing lower abdominal gynecological procedures under general anesthesia were divided randomly into two groups each after written informed consent. A bilateral TAP block was performed on Group T with 0.25% bupivacaine 0.6 ml/kg with half the volume on either side intra-operatively after skin closure before extubation using a short bevelled needle, whereas Group I received local infiltration intra-operatively after skin closure with the same amount of drug. The time taken for the first rescue analgesic and visual analog score (VAS) was noted, following which, the patient was administered intravenous morphine 0.1 mg/kg and connected to an intravenous patient controlled analgesia system with morphine for 24 hrs from the time of block administration. 24 h morphine requirement was noted. VAS and sedation scores were noted at 2, 4, 6 and 24 h postoperatively. Statistical Analysis Used: The results were analyzed with SPSS 16. A P value < 0.05 was considered significant. Duration of analgesia and 24 h morphine requirement was analysed by Student's t-test. VAS scores, with paired comparisons at each time interval, were performed using the t-test or Mann-Whitney U-test, as appropriate. Categorical data were analyzed using Chi square or Fisher's exact test. Results: In Group T, the time to rescue analgesic was significantly more and the VAS scores were lower (P = 0.001 and 0.003 respectively). The 24 hr morphine requirement and VAS at 2, 4, 6 and 24 h were less in the Group T (P = 0.001). Incidence of PONV was significant in Group I (P = 0.043), whereas Group T were less sedated at 2 and 4 h (P = 0.001 and 0.014). Conclusions: Transversus abdominis plane block proved to be an effective means of analgesia for lower abdominal surgeries with minimal side-effects.

Indian Journal of Clinical Anaesthesia, 2020

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a ... more Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts were successful. The ease of fibreoptic intubation was graded to be excellent in a significantly greater number of patients in the nasal group as compared to the oral group. Hemodynamic variability though present was not clinically relevent, this might have been secondary to use of adequate sedation. Conclusion: The ease of fibreoptic intubation in simulated cervical spine injury, under conscious sedation was found to be significantly better in the nasotracheal group. Hemodynamic stability was demonstrated in both the groups in our study.

Indian Journal of Clinical Anaesthesia, 2020

Adult-onset Still ’s disease (AOSD), is a chronic systemic inflammatory disorder rarely encounter... more Adult-onset Still ’s disease (AOSD), is a chronic systemic inflammatory disorder rarely encountered in clinical practice, described by Sir George Frederick Still in 1897. AOSD is of unknown aetiology with the incidence estimated to be 0.16 per 100,000 persons with articular and extra-articular or systemic manifestations. AOSD has a more acute course than compared to rheumatoid arthritis in adults, often affecting many parts of the body before settling in the various joints. Its diagnosis is made by exclusion. Securing airway mainly tracheal intubation may be difficult due to involvement of cervical spine, temporomandibular joint and laryngeal involvement (crico-arytenoid arthritis). In addition, intermittent disease flare-ups with laryngeal involvement may cause delayed extubation. This case highlights the anaesthetic concerns involved with the Still’s disease.

Research and Practice in Anesthesiology – Open Journal, 2019

Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many... more Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it's also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling.

Indian Journal of Clinical Anaesthesia, 2019

Introduction: Spinal myoclonus under regional anaesthesia necessitates awareness about its manife... more Introduction: Spinal myoclonus under regional anaesthesia necessitates awareness about its manifestation with a framework for immediate plan of action. Case: A 52 year old male patient posted for open reduction and internal fixation with Interlocking nail for both bone leg fracture lower limbs. Combined spinal and epidural anesthesia (CSE) was administered. He developed abnormal movements in lower limb after 2hrs of subarachnoid block. These uncoordinated movements initially thought to be due to weaning of the effect of spinal anesthesia were later found to be spinal myoclonus which resolved over a period of three hours after giving GABA agonists. Conclusion: Spinal myoclonus, a rare disorder requires high clinical suspicion of the entity for diagnosis and can be managed successfully with GABA agonist drugs.

Korean journal of anesthesiology, 2018

Open Journal of Anesthesiology, 2013

Paragangliomas are tumours which arise in extra adrenal autonomic paraganglia and have the abilit... more Paragangliomas are tumours which arise in extra adrenal autonomic paraganglia and have the ability to secrete catecholamines. Their anaesthetic management is the same as that of a case of pheochromocytoma, but in an undiagnosed case like our patient, unexpected eventful encounter in the operating theatre may lead to life threatening complications during surgical resection warranting immediate management and thus posing a real challenge to the skill of an anaesthesiologist.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2010

In patients with traumatic injury of an upper limb it is often necessary to both secure intraveno... more In patients with traumatic injury of an upper limb it is often necessary to both secure intravenous (IV) access and record blood pressure noninvasively in the other upper limb. This may cause intermittent obstruction to the flow of IV fluids during cuff inflation. Also backflow of blood into the IV tubing when the cuff is inflated and the temporary stasis which occurs predisposes to clotting of blood in the IV tubing/catheter. Overenthusiastic efforts to push IV fluids without disconnection and flushing of IV line may pose a possible risk of embolizing the clotted blood thrombus into circulation. We describe a simple technique to prevent backflow of blood into the IV tubing when both intravenous fluid infusion and non-invasive blood pressure cuff are in the same limb. This may prevent clot formation and eliminate the risk of an iatrogenic thrombo-embolism.

Indian Journal of Medical Microbiology, 2009

Indian Journal of Clinical Anaesthesia, 2020

Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, r... more Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, randomized study was conducted in 90 patients (ASA-I & II) posted for various surgeries under general anaesthesia with endotracheal intubation to evaluate differences in glottic view, attempts and duration of laryngoscopy and intubation attempts along with hemodynamic variability associated with the three blades-Macintosh, McCoy and Miller laryngoscope blade. Patients were randomly allocated in three groups. In first group laryngoscopy was done with Macintosh blade, in second group with Miller blade, in third group with McCoy blade. In this study it was found that McCoy laryngoscope is distinctly superior to the Macintosh and Miller with less hemodynamic changes and better glottic visualization. Degree of difficulty in intubation was more with Miller blade in comparison to Macintosh and McCoy blade which is statistically significant (p value < 0.001).

IP Innovative Publication Pvt. Ltd., 2018

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a ... more Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts ...

Open Journal of Anesthesiology, 2012

The "i-gel" is a newer, non-inflatable supraglottic airway device for clinical use and also for r... more The "i-gel" is a newer, non-inflatable supraglottic airway device for clinical use and also for resuscitation purposes. It has also been found to be a useful ventilation and intubation device in anticipated/simulated difficult airway situations. However, its use in unanticipated difficult airway situations in emergency set up has not been explored. We describe a case of 24-year-old male posted for emergency laparotomy that turned out to have an unanticipated difficult airway. Attempts to intubation and ProSeal Laryngeal Mask Airway insertion failed. However, "i-gel" proved to be a very handy intubating conduit in this critical situation.

Archives of Anesthesiology, 2018

Calcium has an important role in large number of physiological actions that are essential for lif... more Calcium has an important role in large number of physiological actions that are essential for life. Abnormalities in serum calcium concentration may have profound effects on neurological, gastrointestinal, and renal function. Magnesium is the 4 th common cation in body after sodium, potassium and calcium. Intracellular, it is the second most common cation after potassium. Magnesium is widely distributed in plant and animal foods, particularly green vegetables, spices, nuts, soya flour and shellfish. Hypo-magnesemia is reported in up to 20% of patients in medical wards and in as many as 65% of patients in ICUs. In fact, magnesium depletion has been described as "the most underdiagnosed electrolyte abnormality in current medical practice". It is important therefore that the anaesthetist understands calcium and magnesium pathophysiology. Role of Calcium and Magnesium in Anesthesia and Critical Care

The following review article in brief describes the definition, pathophysiology, management, preo... more The following review article in brief describes the definition, pathophysiology, management, preoperative assessment and perioperative anesthesia management in a case of pheochromocytoma.

Journal of Patient Safety and Infection Control, 2020

Background: Avoidable surgical complications account for a large proportion of preventable medica... more Background: Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical safety checklist (SSCL) is evidence‑based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low and middle‑income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of World Health Organisation (WHO) checklist. Methods: This was a single centre e-survey to assess the knowledge, attitudes and beliefs about the WHO‑surgical checklist, in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Results: Majority believed that the use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre, yet there was no commitment for the use of SSCL. Although all theatre personnel support implementation and use of SSCL; however, hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co‑ordinator or leadership role and shortage of workforce can be impediment to effective use. Discussion: Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all operation theatre stakeholders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.

Reumatologia, 2017

Good biomarkers are important to guide decisions in the clinical management of rheumatoid arthrit... more Good biomarkers are important to guide decisions in the clinical management of rheumatoid arthritis (RA). RA patients harbor antibodies directed against carbamylated proteins which may predict joint damage. This study investigated whether antibodies against carbamylated proteins (anti-CarP) may serve as surrogate prognostic markers. Fifty-three patients with a diagnosis of rheumatoid arthritis according to ACR 1987 criteria were included. Blood samples were analyzed for CarP antibody levels using the ELISA method. Quality of life (QoL) was assessed by the WHO SF-36 questionnaire, and disease activity was assessed using the DAS28 calculator. Newly diagnosed patients were assessed at the first visit and at 12 weeks of treatment, while a single assessment was made for patients already on maintenance therapy. Out of 53 patients, 22 had titers of anti-CarP above the cut-off range and considered as positive for anti-CarP antibodies. Anti-CarP antibody serum level was significantly higher ...

Journal of the American College of Cardiology, 2017

Background: It is imperative that non-compliance to statins be identified and addressed to optimi... more Background: It is imperative that non-compliance to statins be identified and addressed to optimize the clinical benefit of statins. Patient self-reporting methods are convenient to apply in clinical practice but need to be validated. Objective: We studied the concordance of a patient self-report method, MMAS (Morisky eight item medication adherence scale) with pill count method in measuring adherence to statins and their correlation with extended lipid profile parameters and serum HMGCoA-R (hydroxymethylglutaryl coenzyme A reductase) enzyme levels. Methods: MMAS and pill count method were used to measure the adherence to statins in patients on statins for any duration. Patients were subjected to estimation of extended lipid profile and serum HMGCoA-R levels at the end of 3 months follow-up. Results: Out of a total of 200 patients included in the study, 117 patients had low adherence (score less than 6 on MMAS) whereas 65 and 18 patients had medium (score 6 to less than 8) and high adherence (score of 8) respectively. Majority of patients who had low adherence to statins by MMAS were nonadherent by pill count method yielding concordance of 96.5%. Medium or high adherence to statins by MMAS method had concordance of 89.1% with pill count method. The levels of total cholesterol, low density lipoprotein-cholesterol, apolipoprotein B and HMGCoA-R were significantly negatively correlated with compliance measured by pill count and MMAS with similar correlation coefficients. HMGCoA-R levels demonstrated a plateau phenomenon with levels being 9-10 ng/ml when compliance to statin therapy was greater than 60% by pill count and greater than 6 on Morisky scale. Conclusion: In conclusion, MMAS and pill count methods showed concordance in measuring adherence to statins. These methods need to be explored further for their interchangeability as surrogates for biomarker levels.

Indian Journal of Clinical Anaesthesia, 2020

Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with ... more Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with child physiology is a common error made. Circulation changes at birth from the foetal to adult type, but neonates are prone to revert to foetal circulation with disastrous effects. This phenomenon is known as flip flop or YoYo circulation. We report a case of a premature neonate, being operated for intestinal perforation, with Yo Yo circulation intraoperatively.

Indian Journal of Clinical Anaesthesia, 2020

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respi... more Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respiratory tract in which child presents with severe respiratory distress, pneumonitis or sepsis. Anesthetic management of such children is challenging owing to hyperinflation or rupture of cystic lesions or iatrogenic pneumothorax with positive pressure ventilation, sudden hemodynamic collapse during induction, excessive bleeding and situation becomes more challenging if child is presenting with sepsis. We report successful management of 42 days old infant with CCAM with pneumonitis and sepsis who underwent lobectomy and was successfully extubated on operating table with meticulous planning and optimum perioperative management. Early extubation is desirable to avoid iatrogenic ventilator induced bronchial stump dehiscence by positive pressure ventilation.

IP Innovative Publication, 2022

The exponential Growth of COVID 19 in few months have brought the mighty countries on their knees... more The exponential Growth of COVID 19 in few months
have brought the mighty countries on their knees in a very
short time span. The consequences are many fold, it has
not only affected the health system but also the people in
quarantine at their homes or in Covid care centres apart from
Hospitals

Journal of Anaesthesiology Clinical Pharmacology, 2013

Background: Transversus abdominis plane block is a safe, simple and effective technique of provid... more Background: Transversus abdominis plane block is a safe, simple and effective technique of providing analgesia for lower abdominal surgeries with easily identifiable landmarks. Aims: To compare the analgesic efficacy of transversus abdominis plane block with that of direct infiltration of local anesthetic into surgical incision in lower abdominal procedures. Settings and Design: Prospective randomized controlled trial in lower abdominal surgeries done under general anesthesia. Materials and Methods: 52 ASA I-II patients undergoing lower abdominal gynecological procedures under general anesthesia were divided randomly into two groups each after written informed consent. A bilateral TAP block was performed on Group T with 0.25% bupivacaine 0.6 ml/kg with half the volume on either side intra-operatively after skin closure before extubation using a short bevelled needle, whereas Group I received local infiltration intra-operatively after skin closure with the same amount of drug. The time taken for the first rescue analgesic and visual analog score (VAS) was noted, following which, the patient was administered intravenous morphine 0.1 mg/kg and connected to an intravenous patient controlled analgesia system with morphine for 24 hrs from the time of block administration. 24 h morphine requirement was noted. VAS and sedation scores were noted at 2, 4, 6 and 24 h postoperatively. Statistical Analysis Used: The results were analyzed with SPSS 16. A P value < 0.05 was considered significant. Duration of analgesia and 24 h morphine requirement was analysed by Student's t-test. VAS scores, with paired comparisons at each time interval, were performed using the t-test or Mann-Whitney U-test, as appropriate. Categorical data were analyzed using Chi square or Fisher's exact test. Results: In Group T, the time to rescue analgesic was significantly more and the VAS scores were lower (P = 0.001 and 0.003 respectively). The 24 hr morphine requirement and VAS at 2, 4, 6 and 24 h were less in the Group T (P = 0.001). Incidence of PONV was significant in Group I (P = 0.043), whereas Group T were less sedated at 2 and 4 h (P = 0.001 and 0.014). Conclusions: Transversus abdominis plane block proved to be an effective means of analgesia for lower abdominal surgeries with minimal side-effects.

Indian Journal of Clinical Anaesthesia, 2020

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a ... more Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts were successful. The ease of fibreoptic intubation was graded to be excellent in a significantly greater number of patients in the nasal group as compared to the oral group. Hemodynamic variability though present was not clinically relevent, this might have been secondary to use of adequate sedation. Conclusion: The ease of fibreoptic intubation in simulated cervical spine injury, under conscious sedation was found to be significantly better in the nasotracheal group. Hemodynamic stability was demonstrated in both the groups in our study.

Indian Journal of Clinical Anaesthesia, 2020

Adult-onset Still ’s disease (AOSD), is a chronic systemic inflammatory disorder rarely encounter... more Adult-onset Still ’s disease (AOSD), is a chronic systemic inflammatory disorder rarely encountered in clinical practice, described by Sir George Frederick Still in 1897. AOSD is of unknown aetiology with the incidence estimated to be 0.16 per 100,000 persons with articular and extra-articular or systemic manifestations. AOSD has a more acute course than compared to rheumatoid arthritis in adults, often affecting many parts of the body before settling in the various joints. Its diagnosis is made by exclusion. Securing airway mainly tracheal intubation may be difficult due to involvement of cervical spine, temporomandibular joint and laryngeal involvement (crico-arytenoid arthritis). In addition, intermittent disease flare-ups with laryngeal involvement may cause delayed extubation. This case highlights the anaesthetic concerns involved with the Still’s disease.

Research and Practice in Anesthesiology – Open Journal, 2019

Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many... more Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it's also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling.

Indian Journal of Clinical Anaesthesia, 2019

Introduction: Spinal myoclonus under regional anaesthesia necessitates awareness about its manife... more Introduction: Spinal myoclonus under regional anaesthesia necessitates awareness about its manifestation with a framework for immediate plan of action. Case: A 52 year old male patient posted for open reduction and internal fixation with Interlocking nail for both bone leg fracture lower limbs. Combined spinal and epidural anesthesia (CSE) was administered. He developed abnormal movements in lower limb after 2hrs of subarachnoid block. These uncoordinated movements initially thought to be due to weaning of the effect of spinal anesthesia were later found to be spinal myoclonus which resolved over a period of three hours after giving GABA agonists. Conclusion: Spinal myoclonus, a rare disorder requires high clinical suspicion of the entity for diagnosis and can be managed successfully with GABA agonist drugs.

Korean journal of anesthesiology, 2018

Open Journal of Anesthesiology, 2013

Paragangliomas are tumours which arise in extra adrenal autonomic paraganglia and have the abilit... more Paragangliomas are tumours which arise in extra adrenal autonomic paraganglia and have the ability to secrete catecholamines. Their anaesthetic management is the same as that of a case of pheochromocytoma, but in an undiagnosed case like our patient, unexpected eventful encounter in the operating theatre may lead to life threatening complications during surgical resection warranting immediate management and thus posing a real challenge to the skill of an anaesthesiologist.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2010

In patients with traumatic injury of an upper limb it is often necessary to both secure intraveno... more In patients with traumatic injury of an upper limb it is often necessary to both secure intravenous (IV) access and record blood pressure noninvasively in the other upper limb. This may cause intermittent obstruction to the flow of IV fluids during cuff inflation. Also backflow of blood into the IV tubing when the cuff is inflated and the temporary stasis which occurs predisposes to clotting of blood in the IV tubing/catheter. Overenthusiastic efforts to push IV fluids without disconnection and flushing of IV line may pose a possible risk of embolizing the clotted blood thrombus into circulation. We describe a simple technique to prevent backflow of blood into the IV tubing when both intravenous fluid infusion and non-invasive blood pressure cuff are in the same limb. This may prevent clot formation and eliminate the risk of an iatrogenic thrombo-embolism.

Indian Journal of Medical Microbiology, 2009

Indian Journal of Clinical Anaesthesia, 2020

Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, r... more Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, randomized study was conducted in 90 patients (ASA-I & II) posted for various surgeries under general anaesthesia with endotracheal intubation to evaluate differences in glottic view, attempts and duration of laryngoscopy and intubation attempts along with hemodynamic variability associated with the three blades-Macintosh, McCoy and Miller laryngoscope blade. Patients were randomly allocated in three groups. In first group laryngoscopy was done with Macintosh blade, in second group with Miller blade, in third group with McCoy blade. In this study it was found that McCoy laryngoscope is distinctly superior to the Macintosh and Miller with less hemodynamic changes and better glottic visualization. Degree of difficulty in intubation was more with Miller blade in comparison to Macintosh and McCoy blade which is statistically significant (p value < 0.001).

IP Innovative Publication Pvt. Ltd., 2018

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a ... more Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts ...