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Papers by Marutheesh Mallappa
Journal of Acute Care, Dec 31, 2022
Background: Although there has been great progress in the field of medicine, mortality associated... more Background: Although there has been great progress in the field of medicine, mortality associated with the age-old problem of sepsis still remains high. One of the newer modalities to treat sepsis is the hydrocortisone, ascorbic acid (AA), and thiamine (HAT) therapy, using HAT, which is proposed to reduce organ failure and mortality by restoring dysregulated host immune response and mitochondrial function as well as neutralizing reactive oxygen species (ROS). Studies evaluating the treatment of severe sepsis, burns, and trauma with vitamin C administration have shown inconsistent results. Several studies have also shown the detrimental effect of a positive fluid balance on patients with sepsis, including an increased risk of mortality. This study aims to evaluate the effect of vitamin C with thiamine on improving the outcome of septic shock. Materials and methods: This prospective cohort study was conducted at a tertiary care intensive care unit (ICU) and enrolled adult septic shock patients admitted over a 6-month period between April and September 2018. They formed an intervention group that received intravenous (IV) vitamin C 1.5 gm every 6 hours and thiamine 200 mg every 12 hours in addition to antibiotics. This was compared with a retrospective cohort of patients admitted between July to December 2017, which received only antibiotics. Both vitamin C and thiamine were initiated within 6 hours of admission and given for a period of 4 days. Hydrocortisone, as an infusion of 200 mg over 24 hours, was used in all patients on vasopressor support. The primary outcome evaluated was ICU mortality and secondary outcomes, ICU length of stay (LOS), hospital LOS, mechanical ventilation-free days (MVFDs), vasopressor-free days (VFDs), and cumulative fluid balance after 4 days. Results: A total of 30 patients fulfilled the inclusion criteria and formed the intervention group. This was compared with a retrospective group which was equally matched in their baseline characteristics and acute physiology and chronic health evaluation (APACHE) II scores (20 vs 21), as well as antibiotics, are given. ICU mortality was 19% in the intervention group and 34.1% in the retrospective group (p = 0.115). ICU LOS was higher in the intervention group (5 vs 4 days, p = 0.014). There was no difference in the other secondary outcome parameters, namely, hospital LOS (10 vs 8 days, p = 0.141), MVFDs (5 vs 6, p = 0.493), VFDs (4 vs 6, p = 0.415), and cumulative fluid balance (+583 mL vs +450 mL, p = 0.209). Conclusion: Intravenous (IV) administration of vitamin C and thiamine may not be beneficial in improving the outcome in patients with septic shock.
Objectives: Transdermal nitroglycerin patch is being used as an adjuvant to neostigmine for posto... more Objectives: Transdermal nitroglycerin patch is being used as an adjuvant to neostigmine for postoperative analgesia, besides its vasodilator effects on cardiovascular system. We aimed to evaluate the transdermal nitroglycerin for its capability to enhance analgesia when used as an adjuvant to intrathecal neostigmine and bupivacaine in elective lower abdominal surgeries. Methodology: We enrolled 60 adult ASA-1 and 2 patients undergoing lower abdominal surgeries under spinal anesthesia. In this double blind randomized study, patients were assigned into two groups, Group NT received transdermal nitroglycerin patch (5 mg/24 h) and Group NE received placebo patch along with 5 μg of neostigmine and 15 mg of 0.5% hyperbaric bupivacaine. Spinal anesthesia was performed at L3-L4 level, with 25 gauge spinal needle and 3.5 ml of the drug solution was injected intrathecally per the group allocation. Sensory block was checked using pin prick method and motor block was assessed by modified Bromag...
Turkish Journal of Anesthesia and Reanimation, 2019
Objective: Minor surgical procedures under general anaesthesia require a patent airway without th... more Objective: Minor surgical procedures under general anaesthesia require a patent airway without the use of muscle relaxant. Supraglottic airway devices have been widely used for airway management. A study was undertaken to compare first-time insertion success rate, insertion time, sealing pressure and complications between the Baska ® mask and I-gel. Methods: After approval from the institutional ethical committee, a randomised single-blinded study was conducted on 50 American Society of Anesthesiologists' physical status I and II female patients aged 18-40 years who underwent minor surgical procedures under general anaesthesia. Patients were randomly categorized into two groups of 25 each; group Baska ® mask and group I-gel, and the first-time success rate, mean insertion time and sealing pressure were measured. The results were analysed using unpaired t-test, Mann-Whitney U test, Chi-square test and ANOVA. A p value <0.05 was considered to be statistically significant. Results: The first-time insertion success rate of the Baska ® mask was 21/24 (88%) when compared with the I-gel, which was 23/25 (92%) (p=0.585). The insertion time of the Baska ® mask was 14.9±6.2 s, whereas that of the I-gel was 14.7±4.4 s (p=0.877). The mean sealing pressure of the Baska ® mask was significantly higher when compared with the I-gel (28.9±3.5 vs. 25.9±2.5 cmH 2 O) (p=0.001). Conclusion: The Baska ® mask had a similar first-time insertion success rate and insertion time as the I-gel. The sealing pressure of the Baska ® mask was significantly greater than that of the I-gel. Both devices had complications that were comparable.
Anesthesia, essays and researches
Epidural administrations of α2 agonists are being used as adjuvants as they lead to anxiolysis, s... more Epidural administrations of α2 agonists are being used as adjuvants as they lead to anxiolysis, sedation, analgesia, and hypnosis. This study aims to evaluate the analgesic effects of epidural α2 agonists-dexmedetomidine and clonidine in conjunction with intrathecal levobupivacaine in combined spinal epidural anesthesia (CSEA). A prospective, randomized controlled study was done to assess and compare the efficacy and clinical profile of two α2 adrenergic agonists, clonidine, and dexmedetomidine administered epidurally in combination with intrathecal levobupivacaine in CSEA. The study was conducted for 1 year. Sixty adult patients physical status Class I and II undergoing below umbilical surgeries under CSEA were included in the study after a valid consent. Patients were randomly assigned into two groups, to receive either epidural dexmedetomidine (1.5 μg/kg) or clonidine (2 μg/kg) in 10 ml normal saline along with 0.5% isobaric levobupivacaine 15 mg (3 ml). Block characteristics, ab...
Journal of Acute Care, Dec 31, 2022
Background: Although there has been great progress in the field of medicine, mortality associated... more Background: Although there has been great progress in the field of medicine, mortality associated with the age-old problem of sepsis still remains high. One of the newer modalities to treat sepsis is the hydrocortisone, ascorbic acid (AA), and thiamine (HAT) therapy, using HAT, which is proposed to reduce organ failure and mortality by restoring dysregulated host immune response and mitochondrial function as well as neutralizing reactive oxygen species (ROS). Studies evaluating the treatment of severe sepsis, burns, and trauma with vitamin C administration have shown inconsistent results. Several studies have also shown the detrimental effect of a positive fluid balance on patients with sepsis, including an increased risk of mortality. This study aims to evaluate the effect of vitamin C with thiamine on improving the outcome of septic shock. Materials and methods: This prospective cohort study was conducted at a tertiary care intensive care unit (ICU) and enrolled adult septic shock patients admitted over a 6-month period between April and September 2018. They formed an intervention group that received intravenous (IV) vitamin C 1.5 gm every 6 hours and thiamine 200 mg every 12 hours in addition to antibiotics. This was compared with a retrospective cohort of patients admitted between July to December 2017, which received only antibiotics. Both vitamin C and thiamine were initiated within 6 hours of admission and given for a period of 4 days. Hydrocortisone, as an infusion of 200 mg over 24 hours, was used in all patients on vasopressor support. The primary outcome evaluated was ICU mortality and secondary outcomes, ICU length of stay (LOS), hospital LOS, mechanical ventilation-free days (MVFDs), vasopressor-free days (VFDs), and cumulative fluid balance after 4 days. Results: A total of 30 patients fulfilled the inclusion criteria and formed the intervention group. This was compared with a retrospective group which was equally matched in their baseline characteristics and acute physiology and chronic health evaluation (APACHE) II scores (20 vs 21), as well as antibiotics, are given. ICU mortality was 19% in the intervention group and 34.1% in the retrospective group (p = 0.115). ICU LOS was higher in the intervention group (5 vs 4 days, p = 0.014). There was no difference in the other secondary outcome parameters, namely, hospital LOS (10 vs 8 days, p = 0.141), MVFDs (5 vs 6, p = 0.493), VFDs (4 vs 6, p = 0.415), and cumulative fluid balance (+583 mL vs +450 mL, p = 0.209). Conclusion: Intravenous (IV) administration of vitamin C and thiamine may not be beneficial in improving the outcome in patients with septic shock.
Objectives: Transdermal nitroglycerin patch is being used as an adjuvant to neostigmine for posto... more Objectives: Transdermal nitroglycerin patch is being used as an adjuvant to neostigmine for postoperative analgesia, besides its vasodilator effects on cardiovascular system. We aimed to evaluate the transdermal nitroglycerin for its capability to enhance analgesia when used as an adjuvant to intrathecal neostigmine and bupivacaine in elective lower abdominal surgeries. Methodology: We enrolled 60 adult ASA-1 and 2 patients undergoing lower abdominal surgeries under spinal anesthesia. In this double blind randomized study, patients were assigned into two groups, Group NT received transdermal nitroglycerin patch (5 mg/24 h) and Group NE received placebo patch along with 5 μg of neostigmine and 15 mg of 0.5% hyperbaric bupivacaine. Spinal anesthesia was performed at L3-L4 level, with 25 gauge spinal needle and 3.5 ml of the drug solution was injected intrathecally per the group allocation. Sensory block was checked using pin prick method and motor block was assessed by modified Bromag...
Turkish Journal of Anesthesia and Reanimation, 2019
Objective: Minor surgical procedures under general anaesthesia require a patent airway without th... more Objective: Minor surgical procedures under general anaesthesia require a patent airway without the use of muscle relaxant. Supraglottic airway devices have been widely used for airway management. A study was undertaken to compare first-time insertion success rate, insertion time, sealing pressure and complications between the Baska ® mask and I-gel. Methods: After approval from the institutional ethical committee, a randomised single-blinded study was conducted on 50 American Society of Anesthesiologists' physical status I and II female patients aged 18-40 years who underwent minor surgical procedures under general anaesthesia. Patients were randomly categorized into two groups of 25 each; group Baska ® mask and group I-gel, and the first-time success rate, mean insertion time and sealing pressure were measured. The results were analysed using unpaired t-test, Mann-Whitney U test, Chi-square test and ANOVA. A p value <0.05 was considered to be statistically significant. Results: The first-time insertion success rate of the Baska ® mask was 21/24 (88%) when compared with the I-gel, which was 23/25 (92%) (p=0.585). The insertion time of the Baska ® mask was 14.9±6.2 s, whereas that of the I-gel was 14.7±4.4 s (p=0.877). The mean sealing pressure of the Baska ® mask was significantly higher when compared with the I-gel (28.9±3.5 vs. 25.9±2.5 cmH 2 O) (p=0.001). Conclusion: The Baska ® mask had a similar first-time insertion success rate and insertion time as the I-gel. The sealing pressure of the Baska ® mask was significantly greater than that of the I-gel. Both devices had complications that were comparable.
Anesthesia, essays and researches
Epidural administrations of α2 agonists are being used as adjuvants as they lead to anxiolysis, s... more Epidural administrations of α2 agonists are being used as adjuvants as they lead to anxiolysis, sedation, analgesia, and hypnosis. This study aims to evaluate the analgesic effects of epidural α2 agonists-dexmedetomidine and clonidine in conjunction with intrathecal levobupivacaine in combined spinal epidural anesthesia (CSEA). A prospective, randomized controlled study was done to assess and compare the efficacy and clinical profile of two α2 adrenergic agonists, clonidine, and dexmedetomidine administered epidurally in combination with intrathecal levobupivacaine in CSEA. The study was conducted for 1 year. Sixty adult patients physical status Class I and II undergoing below umbilical surgeries under CSEA were included in the study after a valid consent. Patients were randomly assigned into two groups, to receive either epidural dexmedetomidine (1.5 μg/kg) or clonidine (2 μg/kg) in 10 ml normal saline along with 0.5% isobaric levobupivacaine 15 mg (3 ml). Block characteristics, ab...