Nagendra Vemuri - Academia.edu (original) (raw)

Papers by Nagendra Vemuri

BJA: British Journal of Anaesthesia, 2013

analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br... more analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 2009; 96: 331-41 3 Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right.

Background Assessment of Stroke volume variation (SVV) using minimally invasive devices in mechan... more Background Assessment of Stroke volume variation (SVV) using minimally invasive devices in mechanically ventilated patients has been in use for several years to guide fluid administration. This study was designed to assess the utility of SVV derived from arterial pulse contour analysis, using FloTrac/Vigileo system to predict fluid status in patients scheduled for brain surgery. Method We studied 60 adult patients undergoing brain surgery. After a 5min period of stable hemodynamic parameters post-intubation, each patient received successive volume loading steps(VLS), of 200ml lactated Ringer's solution (LR), until the increase in SV(stroke volume) was <10%. Blood pressure(BP), Heart rate(HR), SV and SVV were measured before and after each VLS. We measured the optimal preload augmentation required for each patient by the number of VLS after which SV increase was<10%. Results There was a statistically significant difference in base line BP and SVV but not in HR between resp...

International Journal of Research, 2015

Introduction: Efforts to find a better adjuvant in regional anesthesia are underway since long. M... more Introduction: Efforts to find a better adjuvant in regional anesthesia are underway since long. Many agents were proved to be effective in providing a same pharmacological benefit by different mechanisms of action. In this study we sought to investigate the effect of Alpha-2 adrenergic agonists added to a local anesthetic in epidural space. Objective: To evaluate the efficacy of Dexmedetomidine as an adjuvant to Lidocaine in epidural anesthesia. Methodology: Sixty patients scheduled for lower limb trauma orthopaedic surgeries under epidural anesthesia were divided into two groups D and C with 30 in each. Patients in group D received 12.5ml of 2% Lidocaine + Dexmedetomidine 0.5mcg/kg in 1.5ml solution making a total volume of 14ml. Patients in group C received 12.5ml of 2% Lidocaine + 1.5ml Normal saline making a total volume of 14ml. Onset, time for peak sensory level, time for two segment regression and the total Mephentermine consumed to maintain the hemodynamics were recorded, ta...

Anesthesia, essays and researches

Internal jugular catheterization is associated with arterial puncture in 6.3-9.4% of cases and su... more Internal jugular catheterization is associated with arterial puncture in 6.3-9.4% of cases and subclavian artery (SCA) injuries are probably under-reported. Several complications like hemothorax, delayed presentation of hemomediastinum due to SCA injury have been reported. We report a case of critical upper limb ischemia due to SCA thrombosis developing a few hours after a difficult right internal jugular vein cannulation without any evidence of initial arterial injury with the finder or introducer needle and which was successfully treated by surgical thrombectomy. Arterial trauma should be kept in mind during subsequent manipulations and at all stages, particularly if a technical difficulty arises during the procedure. Although the ultrasound (US) was not used in this case, US should be used not just to identify the vein, but also to verify guide-wire and catheter insertion. High index of suspicion is necessary for detection of postprocedure thrombosis of SCA. Close monitoring for ...

Anesthesia: Essays and Researches, 2015

A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was pos... more A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was posted for an emergency laparotomy for hollow viscus perforation. His history was not suggestive of any systemic disorders. An echocardiography revealed left ventricular dysfunction with an ejection fraction of 47% without any valvular or chamber abnormality. Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed. Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge. Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

Anesthesia: Essays and Researches, 2014

Context: Laryngoscopy and tracheal intubation produce sympathetic overdrive by catecholamine rele... more Context: Laryngoscopy and tracheal intubation produce sympathetic overdrive by catecholamine release resulting in hypertension and tachycardia. Various agents are being tried to combat the intubation response over years. Aims: This study is aimed at comparing dexmedetomidine which is a highly selective alpha-2 agonist with an ultra-short acting beta blocker, esmolol to see which among the two is better in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. Settings and Design: This was a prospective randomized double-blind control study. Subjects and Methods: Sixty patients scheduled for general anesthesia were divided into two groups, D and E with 30 patients in each group. Group-D patients received dexmedetomidine 0.5 mcg/kg and Group-E patients received esmolol 0.5 mg/kg as intravenous premedication over 5 min before a rapid sequence induction and tracheal intubation. Systolic, diastolic and mean arterial pressures along with heart rate were measured using invasive arterial line at various time points. The percentage change of hemodynamic parameters at those time points from the baseline was compared between the groups. Statistical Analysis Used: Descriptive and inferential statistical methods were used to analyze the data. Results: The percentage change of all hemodynamic parameters from base line were less in the dexmedetomidine group than in esmolol group at all-time points of measurement. However, a statistically significant difference was observed often at the time points within 1 min after tracheal intubation. Conclusions: Dexmedetomidine is superior to esmolol in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

International Journal of Perioperative Ultrasound and Applied Technologies, 2012

Anaesthesia for percutaneous nephrolithotomy using supracostal access for complex calculus proble... more Anaesthesia for percutaneous nephrolithotomy using supracostal access for complex calculus problems poses unique challenges in terms of pulmonary injuries, haemorrhage, fluid absorption, dilutional anaemia and hypothermia.

Anesthesia: Essays and Researches, 2014

Tetany a syndrome of sharp flexion of the wrist and ankle joints (carpopedal spasm), muscle twitc... more Tetany a syndrome of sharp flexion of the wrist and ankle joints (carpopedal spasm), muscle twitching, cramps and convulsions, sometimes with an attack of stridor, is due to hyperexcitability of nerves and muscles caused by decreased extracellular ionized calcium. Hyperventilation secondary to anxiety can result in tetany. We report a case of hyperventilation induced tetany 2 h following spinal anesthesia for inguinal hernia repair.

International Journal of Perioperative Ultrasound and Applied Technologies, 2012

Transurethral resection of prostate is currently the gold standard therapy for benign prostatic h... more Transurethral resection of prostate is currently the gold standard therapy for benign prostatic hyperplasia. However, open prostatectomy remains the procedure of choice for massive glands.

Chemical Ecology, 2016

International audienc

Les odeurs font partie de notre vie quotidienne... La majorite des especes, y compris les hommes,... more Les odeurs font partie de notre vie quotidienne... La majorite des especes, y compris les hommes, echangent entre elles a l'aide de molecules et de signaux chimiques. Reproduction, alimentation, defense... Dans toutes ces fonctions, la communication chimique est de tres loin le mode de communication le plus utilise dans le monde vivant ! Ce livre fascinant permet de decouvrir les secrets de cette science qui etudie, selon une approche interdisciplinaire (chimie, biologie, ethologie, genomique, etc.), les interactions entre les organismes entre eux et avec leur environnement, via des molecules complexes d'une grande diversite. Une cinquantaine de specialistes, issus de laboratoires CNRS ou associes, presentent dans cet ouvrage les differentes facettes de cette " chimio-diversite ". Ils nous aident ainsi a interpreter ce langage de la nature qui faconne les interactions indispensables au fonctionnement et a la preservation des ecosystemes terrestres ou aquatiques.

International Journal of Biomedical and Advance Research, 2014

Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamin... more Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamine release resulting in hypertension and tachycardia. This is usually tolerated by healthy individuals but susceptible patients are likely to succumb to the hemodynamic fluctuations. Various agents are being tried to combat the intubation response over years. This study is aimed at evaluating the efficacy of Esmolol in attenuating the rise in rate-pressure product secondary to laryngoscopy and tracheal intubation. Methodology: 60 patients scheduled for general anesthesia were divided into two groups, E and C with 30 patients in each group. Hypertension, diabetes mellitus, thyroid disease, treatment with beta blockers and difficult airway constituted the exclusion criteria. Group-E patients received Esmolol 0.5mg/kg and group-C patients received normal saline [placebo] as intravenous premedication over 5min before a rapid sequence induction and tracheal intubation. Blood pressure and heart rate were measured using invasive arterial line and rate pressure product[RPP] was calculated at various time points including baseline, before induction, before intubation, at every 5sec after intuba tion up to 1min and at 5, 10 and 15min. Mean change in RPPs from the baseline were compared between the groups at the said time poi nts. Results: Mean fall in RPP in Esmolol group was significantly more than that in control group at almost all the time points of measurement. Conclusion: Esmolol is effective in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

Anesthesia: Essays and Researches, 2014

Positioning has always been a special and important concern for any regional anesthetic technique... more Positioning has always been a special and important concern for any regional anesthetic technique. The standard positions recommended for epidural anesthesia include lateral decubitus, sitting and prone. We report a special situation where we employed the standing position for placing epidural catheter. A 40-year-old man presented with severe ischemic pain of right lower limb due to near total thrombosis of right common iliac artery. He was scheduled for peripheral angiogram and referred to us for pain management as his pain was not permitting him to sit or lie down. Epidural analgesia was planned for managing the pain in the catheterization laboratory and for any other possible management intervention later. As the patient was not tolerating any position other than standing because of severe pain, we placed the lumbar epidural catheter in the standing position and quickly activated the analgesia in the supine position. Patient had good pain relief immediately and an infusion was commenced. Safety and comfort are the major issues to be addressed, while positioning for any procedure. Standing position was chosen for this particular case as it was the only comfortable position for the patient and the safety was not compromised.

Anesthesia: Essays and Researches, 2015

Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of t... more Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED95) of R and V. The study was carried out in 60 adult American Society of Anesthesiologists physical status 1-2 patients of age 20-60 years. The patients were divided into two groups of 30 each and received either 0.9 mg/kg of R (Group R) or 0.168 mg/kg of V (Group V) to facilitate endotracheal intubation. Neuromuscular blockade was assessed at corrugator supercilii and adductor pollicis muscles to evaluate onset time and duration of neuromuscular block, respectively. The mean onset time was significantly rapid in Group R as compared to Group V (P -0.011). Overall intubating conditions were excellent in 100% of patients in Group R as compared to 70% in Group V. The mean duration of action did not show a significant variation between the groups. At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.

Anesthesia: Essays and Researches

Background: Ultrasound guidance has dramatically improved the accuracy of nerve localization, and... more Background: Ultrasound guidance has dramatically improved the accuracy of nerve localization, and various adjuvants prolong the block and extend analgesia. Aims: This study aimed to evaluate the effects of dexmedetomidine added to 0.5% bupivacaine on the onset and duration of motor and sensory blockade and the duration of analgesia. Settings and Design: This is a prospective, randomized double-blind, study. Materials and Methods: Sixty adult patients aged 20–60 years of either sex undergoing orthopedic procedures on the forearm were randomly allocated into two groups of thirty each: Group BS (bupivacaine + saline) and Group BD (bupivacaine + dexmedetomidine). All patients were administered subclavian perivascular brachial plexus block under ultrasound guidance. Group BS: Patients in this group were administered 20-mL 0.5% bupivacaine + 0.75-mL saline. Group BD: Patients in this group were administered 20-mL 0.5% bupivacaine + 0.75-mL dexmedetomidine (75 μg). Statistical Analysis: Statistical analysis was performed with IBM SPSS software Version 21.0. Quantitative data were expressed as mean ± standard deviation. Independent sample t-test was used for comparisons between the two groups. P < 0.05 was considered statistically significant. Results: Demographic data and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were statistically significantly shorter in Group BD compared to Group BS (P < 0.01), whereas the duration of blocks and analgesia were statistically significantly longer (P < 0.01) in Group BD. Conclusion: The addition of dexmedetomidine to 0.5% bupivacaine for supraclavicular brachial plexus block shortens the onset time and prolongs both the duration of the block and analgesia.

Anesthesia: Essays and Researches

Background: Direct laryngoscopy used for tracheal intubation requires aligning the pharyngeal, la... more Background: Direct laryngoscopy used for tracheal intubation requires aligning the pharyngeal, laryngeal and oral axes to achieve a line of sight. Video laryngoscopy provides a better view of the glottis without the need for aligning the three axes. Aims: To evaluate the effectiveness of King vision laryngoscope over Macintosh laryngoscope in visualizing the glottis and intubating the trachea, when used on a same patient as in a cross over manner. Settings and Design: Department of Anaesthesia, Mediciti Institute of Medical Sciences, prospective crossover study conducted over a period of six months. Subjects and Methods: Sixty adult patients belonging to ASA physical status class I-II, requiring tracheal intubation were randomly assigned to intubation by King vision or Macintosh laryngoscope. Improvement, if any, in the Cormack-Lehane grading using the King vision scope, following initial grading with the Macintosh blade in the same patient was analyzed. Statistical Analysis: Mean and Standard deviation were calculated for different parameters under the study. Where appropriate, results were analyzed using the Mc Nemar χ2 test. A ‘p’ value less than 0.05 was considered statistically significant. Results: In the King Vision group, Cormack and Lehane grade improved in the majority (9/12) of patients in whom the initial Cormack and Lehane grade was >1 using the Macintosh blade. Conclusions: The use of the King vision blade significantly improved the laryngoscopic view over the Macintosh blade but the time for intubation was prolonged.

Ain-Shams Journal of Anaesthesiology, 2016

Context Efforts to find a better adjuvant in regional anesthesia have been underway since long. D... more Context Efforts to find a better adjuvant in regional anesthesia have been underway since long. Dexmedetomidine and sodium bicarbonate have been proven to be effective in providing the same pharmacological benefit through two different mechanisms of action. In this study, we sought to investigate which is superior between the two. Aims The aim of the study was to compare the efficacy of dexmedetomidine and sodium bicarbonate as adjuvants to lidocaine in epidural anesthesia. Settings and design This was a prospective, randomized, double-blind study. Materials and methods Sixty patients scheduled for lower-limb trauma orthopedic surgeries under epidural anesthesia were divided into two groups group D and group S, with 30 patients in each. Patients in group D received 12.5 ml of 2% lidocaine+dexmedetomidine 0.5 mg/kg in 1.5 ml solution, making a total volume of 14 ml. Patients in group S received 12.5 ml of 2% lidocaine+1.5 ml of 7.5% sodium bicarbonate, making a total volume of 14 ml. Onset, time for peak sensory level, time for two-segment regression, and the total mephentermine consumed to maintain the hemodynamics were recorded, tabulated, and statistically analyzed. Results The onset of sensory block was quicker in group D. The time for attaining peak sensory level and the mephentermine consumption was nearly the same in both groups. The time for two-segment regression was more in group D than in group S. Conclusion Dexmedetomidine is more effective than sodium bicarbonate in hastening the onset and prolonging the duration of blockade when used as an adjuvant to epidural lidocaine.

Anesthesia: Essays and Researches, 2015

Context: Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which fa... more Context: Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which facilitates easy visualization of glottis through a matrix of sequentially arranged lenses and mirrors. In this observatory study, we sought to compare the ease of tracheal intubation with Airtraq™ and Macintosh laryngoscope when performed by 2nd year postgraduate residents of Anesthesiology in NRI Medical College, Mangalagiri. Aims: To compare the ease of tracheal intubation by Airtraq™ laryngoscope with that by Macintosh laryngoscope among the 2nd year postgraduate residents of anesthesiology in terms of time taken for intubation and the rise of rate-pressure product (RPP) with intubation. Settings and Design: Prospective randomized observational study. Subjects and Methods: Eighty adult and healthy patients with an easy airway, scheduled for general anesthesia were allocated into two groups A, and M. Patients in Group A were intubated with Airtraq™ laryngoscope and those in Group M were intubated with Macintosh laryngoscope by the 2nd year postgraduate residents of anesthesiology. The time taken for intubation, the RPPs at baseline, after induction of general anesthesia, postintubation, at 3 and 5 min after intubation, the rise of RPP to intubation and the occurrence of a sore throat were compared between the two groups. Statistical Analysis Used: Descriptive and inferential statistical methods were used to analyze the data. Results: The mean time for intubation in Macintosh group was 28.18 s and was 40.98 s in Airtraq group. The mean rise of RPP to intubation was 4644.83 in Airtraq group and 2829.27 in Macintosh group. The incidence of a sore throat was equal in both the groups. Conclusions: The time for intubation and the sympathetic response to airway instrumentation were more with Airtraq™ laryngoscope than with Macintosh laryngoscope.

Objective: T o describe the use of the Glidescope in comparison with direct laryngoscopy for elec... more Objective: T o describe the use of the Glidescope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods :Two hundred patients, ASA In scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features (Mallampati oropharyngeal scale, thyromenta distance and mouth opening). In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn. and the views of the glottis at laryngoscopy (Cormack and 1-ehane scores) were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or Glidescope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results : There were 200 patients including 107 males and 93 females, with mean age being 521t13 years, height 164. S i l l. 3 cm, weight 64. O k l l .

BJA: British Journal of Anaesthesia, 2013

analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br... more analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 2009; 96: 331-41 3 Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right.

Background Assessment of Stroke volume variation (SVV) using minimally invasive devices in mechan... more Background Assessment of Stroke volume variation (SVV) using minimally invasive devices in mechanically ventilated patients has been in use for several years to guide fluid administration. This study was designed to assess the utility of SVV derived from arterial pulse contour analysis, using FloTrac/Vigileo system to predict fluid status in patients scheduled for brain surgery. Method We studied 60 adult patients undergoing brain surgery. After a 5min period of stable hemodynamic parameters post-intubation, each patient received successive volume loading steps(VLS), of 200ml lactated Ringer's solution (LR), until the increase in SV(stroke volume) was <10%. Blood pressure(BP), Heart rate(HR), SV and SVV were measured before and after each VLS. We measured the optimal preload augmentation required for each patient by the number of VLS after which SV increase was<10%. Results There was a statistically significant difference in base line BP and SVV but not in HR between resp...

International Journal of Research, 2015

Introduction: Efforts to find a better adjuvant in regional anesthesia are underway since long. M... more Introduction: Efforts to find a better adjuvant in regional anesthesia are underway since long. Many agents were proved to be effective in providing a same pharmacological benefit by different mechanisms of action. In this study we sought to investigate the effect of Alpha-2 adrenergic agonists added to a local anesthetic in epidural space. Objective: To evaluate the efficacy of Dexmedetomidine as an adjuvant to Lidocaine in epidural anesthesia. Methodology: Sixty patients scheduled for lower limb trauma orthopaedic surgeries under epidural anesthesia were divided into two groups D and C with 30 in each. Patients in group D received 12.5ml of 2% Lidocaine + Dexmedetomidine 0.5mcg/kg in 1.5ml solution making a total volume of 14ml. Patients in group C received 12.5ml of 2% Lidocaine + 1.5ml Normal saline making a total volume of 14ml. Onset, time for peak sensory level, time for two segment regression and the total Mephentermine consumed to maintain the hemodynamics were recorded, ta...

Anesthesia, essays and researches

Internal jugular catheterization is associated with arterial puncture in 6.3-9.4% of cases and su... more Internal jugular catheterization is associated with arterial puncture in 6.3-9.4% of cases and subclavian artery (SCA) injuries are probably under-reported. Several complications like hemothorax, delayed presentation of hemomediastinum due to SCA injury have been reported. We report a case of critical upper limb ischemia due to SCA thrombosis developing a few hours after a difficult right internal jugular vein cannulation without any evidence of initial arterial injury with the finder or introducer needle and which was successfully treated by surgical thrombectomy. Arterial trauma should be kept in mind during subsequent manipulations and at all stages, particularly if a technical difficulty arises during the procedure. Although the ultrasound (US) was not used in this case, US should be used not just to identify the vein, but also to verify guide-wire and catheter insertion. High index of suspicion is necessary for detection of postprocedure thrombosis of SCA. Close monitoring for ...

Anesthesia: Essays and Researches, 2015

A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was pos... more A 45-year-old male patient with an irregularly irregular rhythm and fast ventricular rate was posted for an emergency laparotomy for hollow viscus perforation. His history was not suggestive of any systemic disorders. An echocardiography revealed left ventricular dysfunction with an ejection fraction of 47% without any valvular or chamber abnormality. Thyromegaly noticed during placement of central venous catheter was suspected to be the etiology for his cardiovascular status and was successfully managed. Thyroid crisis in an undiagnosed case of hyperthyroidism poses a diagnostic and therapeutic challenge. Timely and aggressive management is essential to correct the homeostatic decompensation characteristic of thyroid storm.

Anesthesia: Essays and Researches, 2014

Context: Laryngoscopy and tracheal intubation produce sympathetic overdrive by catecholamine rele... more Context: Laryngoscopy and tracheal intubation produce sympathetic overdrive by catecholamine release resulting in hypertension and tachycardia. Various agents are being tried to combat the intubation response over years. Aims: This study is aimed at comparing dexmedetomidine which is a highly selective alpha-2 agonist with an ultra-short acting beta blocker, esmolol to see which among the two is better in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. Settings and Design: This was a prospective randomized double-blind control study. Subjects and Methods: Sixty patients scheduled for general anesthesia were divided into two groups, D and E with 30 patients in each group. Group-D patients received dexmedetomidine 0.5 mcg/kg and Group-E patients received esmolol 0.5 mg/kg as intravenous premedication over 5 min before a rapid sequence induction and tracheal intubation. Systolic, diastolic and mean arterial pressures along with heart rate were measured using invasive arterial line at various time points. The percentage change of hemodynamic parameters at those time points from the baseline was compared between the groups. Statistical Analysis Used: Descriptive and inferential statistical methods were used to analyze the data. Results: The percentage change of all hemodynamic parameters from base line were less in the dexmedetomidine group than in esmolol group at all-time points of measurement. However, a statistically significant difference was observed often at the time points within 1 min after tracheal intubation. Conclusions: Dexmedetomidine is superior to esmolol in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

International Journal of Perioperative Ultrasound and Applied Technologies, 2012

Anaesthesia for percutaneous nephrolithotomy using supracostal access for complex calculus proble... more Anaesthesia for percutaneous nephrolithotomy using supracostal access for complex calculus problems poses unique challenges in terms of pulmonary injuries, haemorrhage, fluid absorption, dilutional anaemia and hypothermia.

Anesthesia: Essays and Researches, 2014

Tetany a syndrome of sharp flexion of the wrist and ankle joints (carpopedal spasm), muscle twitc... more Tetany a syndrome of sharp flexion of the wrist and ankle joints (carpopedal spasm), muscle twitching, cramps and convulsions, sometimes with an attack of stridor, is due to hyperexcitability of nerves and muscles caused by decreased extracellular ionized calcium. Hyperventilation secondary to anxiety can result in tetany. We report a case of hyperventilation induced tetany 2 h following spinal anesthesia for inguinal hernia repair.

International Journal of Perioperative Ultrasound and Applied Technologies, 2012

Transurethral resection of prostate is currently the gold standard therapy for benign prostatic h... more Transurethral resection of prostate is currently the gold standard therapy for benign prostatic hyperplasia. However, open prostatectomy remains the procedure of choice for massive glands.

Chemical Ecology, 2016

International audienc

Les odeurs font partie de notre vie quotidienne... La majorite des especes, y compris les hommes,... more Les odeurs font partie de notre vie quotidienne... La majorite des especes, y compris les hommes, echangent entre elles a l'aide de molecules et de signaux chimiques. Reproduction, alimentation, defense... Dans toutes ces fonctions, la communication chimique est de tres loin le mode de communication le plus utilise dans le monde vivant ! Ce livre fascinant permet de decouvrir les secrets de cette science qui etudie, selon une approche interdisciplinaire (chimie, biologie, ethologie, genomique, etc.), les interactions entre les organismes entre eux et avec leur environnement, via des molecules complexes d'une grande diversite. Une cinquantaine de specialistes, issus de laboratoires CNRS ou associes, presentent dans cet ouvrage les differentes facettes de cette " chimio-diversite ". Ils nous aident ainsi a interpreter ce langage de la nature qui faconne les interactions indispensables au fonctionnement et a la preservation des ecosystemes terrestres ou aquatiques.

International Journal of Biomedical and Advance Research, 2014

Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamin... more Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamine release resulting in hypertension and tachycardia. This is usually tolerated by healthy individuals but susceptible patients are likely to succumb to the hemodynamic fluctuations. Various agents are being tried to combat the intubation response over years. This study is aimed at evaluating the efficacy of Esmolol in attenuating the rise in rate-pressure product secondary to laryngoscopy and tracheal intubation. Methodology: 60 patients scheduled for general anesthesia were divided into two groups, E and C with 30 patients in each group. Hypertension, diabetes mellitus, thyroid disease, treatment with beta blockers and difficult airway constituted the exclusion criteria. Group-E patients received Esmolol 0.5mg/kg and group-C patients received normal saline [placebo] as intravenous premedication over 5min before a rapid sequence induction and tracheal intubation. Blood pressure and heart rate were measured using invasive arterial line and rate pressure product[RPP] was calculated at various time points including baseline, before induction, before intubation, at every 5sec after intuba tion up to 1min and at 5, 10 and 15min. Mean change in RPPs from the baseline were compared between the groups at the said time poi nts. Results: Mean fall in RPP in Esmolol group was significantly more than that in control group at almost all the time points of measurement. Conclusion: Esmolol is effective in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.

Anesthesia: Essays and Researches, 2014

Positioning has always been a special and important concern for any regional anesthetic technique... more Positioning has always been a special and important concern for any regional anesthetic technique. The standard positions recommended for epidural anesthesia include lateral decubitus, sitting and prone. We report a special situation where we employed the standing position for placing epidural catheter. A 40-year-old man presented with severe ischemic pain of right lower limb due to near total thrombosis of right common iliac artery. He was scheduled for peripheral angiogram and referred to us for pain management as his pain was not permitting him to sit or lie down. Epidural analgesia was planned for managing the pain in the catheterization laboratory and for any other possible management intervention later. As the patient was not tolerating any position other than standing because of severe pain, we placed the lumbar epidural catheter in the standing position and quickly activated the analgesia in the supine position. Patient had good pain relief immediately and an infusion was commenced. Safety and comfort are the major issues to be addressed, while positioning for any procedure. Standing position was chosen for this particular case as it was the only comfortable position for the patient and the safety was not compromised.

Anesthesia: Essays and Researches, 2015

Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of t... more Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED95) of R and V. The study was carried out in 60 adult American Society of Anesthesiologists physical status 1-2 patients of age 20-60 years. The patients were divided into two groups of 30 each and received either 0.9 mg/kg of R (Group R) or 0.168 mg/kg of V (Group V) to facilitate endotracheal intubation. Neuromuscular blockade was assessed at corrugator supercilii and adductor pollicis muscles to evaluate onset time and duration of neuromuscular block, respectively. The mean onset time was significantly rapid in Group R as compared to Group V (P -0.011). Overall intubating conditions were excellent in 100% of patients in Group R as compared to 70% in Group V. The mean duration of action did not show a significant variation between the groups. At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.

Anesthesia: Essays and Researches

Background: Ultrasound guidance has dramatically improved the accuracy of nerve localization, and... more Background: Ultrasound guidance has dramatically improved the accuracy of nerve localization, and various adjuvants prolong the block and extend analgesia. Aims: This study aimed to evaluate the effects of dexmedetomidine added to 0.5% bupivacaine on the onset and duration of motor and sensory blockade and the duration of analgesia. Settings and Design: This is a prospective, randomized double-blind, study. Materials and Methods: Sixty adult patients aged 20–60 years of either sex undergoing orthopedic procedures on the forearm were randomly allocated into two groups of thirty each: Group BS (bupivacaine + saline) and Group BD (bupivacaine + dexmedetomidine). All patients were administered subclavian perivascular brachial plexus block under ultrasound guidance. Group BS: Patients in this group were administered 20-mL 0.5% bupivacaine + 0.75-mL saline. Group BD: Patients in this group were administered 20-mL 0.5% bupivacaine + 0.75-mL dexmedetomidine (75 μg). Statistical Analysis: Statistical analysis was performed with IBM SPSS software Version 21.0. Quantitative data were expressed as mean ± standard deviation. Independent sample t-test was used for comparisons between the two groups. P < 0.05 was considered statistically significant. Results: Demographic data and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were statistically significantly shorter in Group BD compared to Group BS (P < 0.01), whereas the duration of blocks and analgesia were statistically significantly longer (P < 0.01) in Group BD. Conclusion: The addition of dexmedetomidine to 0.5% bupivacaine for supraclavicular brachial plexus block shortens the onset time and prolongs both the duration of the block and analgesia.

Anesthesia: Essays and Researches

Background: Direct laryngoscopy used for tracheal intubation requires aligning the pharyngeal, la... more Background: Direct laryngoscopy used for tracheal intubation requires aligning the pharyngeal, laryngeal and oral axes to achieve a line of sight. Video laryngoscopy provides a better view of the glottis without the need for aligning the three axes. Aims: To evaluate the effectiveness of King vision laryngoscope over Macintosh laryngoscope in visualizing the glottis and intubating the trachea, when used on a same patient as in a cross over manner. Settings and Design: Department of Anaesthesia, Mediciti Institute of Medical Sciences, prospective crossover study conducted over a period of six months. Subjects and Methods: Sixty adult patients belonging to ASA physical status class I-II, requiring tracheal intubation were randomly assigned to intubation by King vision or Macintosh laryngoscope. Improvement, if any, in the Cormack-Lehane grading using the King vision scope, following initial grading with the Macintosh blade in the same patient was analyzed. Statistical Analysis: Mean and Standard deviation were calculated for different parameters under the study. Where appropriate, results were analyzed using the Mc Nemar χ2 test. A ‘p’ value less than 0.05 was considered statistically significant. Results: In the King Vision group, Cormack and Lehane grade improved in the majority (9/12) of patients in whom the initial Cormack and Lehane grade was >1 using the Macintosh blade. Conclusions: The use of the King vision blade significantly improved the laryngoscopic view over the Macintosh blade but the time for intubation was prolonged.

Ain-Shams Journal of Anaesthesiology, 2016

Context Efforts to find a better adjuvant in regional anesthesia have been underway since long. D... more Context Efforts to find a better adjuvant in regional anesthesia have been underway since long. Dexmedetomidine and sodium bicarbonate have been proven to be effective in providing the same pharmacological benefit through two different mechanisms of action. In this study, we sought to investigate which is superior between the two. Aims The aim of the study was to compare the efficacy of dexmedetomidine and sodium bicarbonate as adjuvants to lidocaine in epidural anesthesia. Settings and design This was a prospective, randomized, double-blind study. Materials and methods Sixty patients scheduled for lower-limb trauma orthopedic surgeries under epidural anesthesia were divided into two groups group D and group S, with 30 patients in each. Patients in group D received 12.5 ml of 2% lidocaine+dexmedetomidine 0.5 mg/kg in 1.5 ml solution, making a total volume of 14 ml. Patients in group S received 12.5 ml of 2% lidocaine+1.5 ml of 7.5% sodium bicarbonate, making a total volume of 14 ml. Onset, time for peak sensory level, time for two-segment regression, and the total mephentermine consumed to maintain the hemodynamics were recorded, tabulated, and statistically analyzed. Results The onset of sensory block was quicker in group D. The time for attaining peak sensory level and the mephentermine consumption was nearly the same in both groups. The time for two-segment regression was more in group D than in group S. Conclusion Dexmedetomidine is more effective than sodium bicarbonate in hastening the onset and prolonging the duration of blockade when used as an adjuvant to epidural lidocaine.

Anesthesia: Essays and Researches, 2015

Context: Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which fa... more Context: Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which facilitates easy visualization of glottis through a matrix of sequentially arranged lenses and mirrors. In this observatory study, we sought to compare the ease of tracheal intubation with Airtraq™ and Macintosh laryngoscope when performed by 2nd year postgraduate residents of Anesthesiology in NRI Medical College, Mangalagiri. Aims: To compare the ease of tracheal intubation by Airtraq™ laryngoscope with that by Macintosh laryngoscope among the 2nd year postgraduate residents of anesthesiology in terms of time taken for intubation and the rise of rate-pressure product (RPP) with intubation. Settings and Design: Prospective randomized observational study. Subjects and Methods: Eighty adult and healthy patients with an easy airway, scheduled for general anesthesia were allocated into two groups A, and M. Patients in Group A were intubated with Airtraq™ laryngoscope and those in Group M were intubated with Macintosh laryngoscope by the 2nd year postgraduate residents of anesthesiology. The time taken for intubation, the RPPs at baseline, after induction of general anesthesia, postintubation, at 3 and 5 min after intubation, the rise of RPP to intubation and the occurrence of a sore throat were compared between the two groups. Statistical Analysis Used: Descriptive and inferential statistical methods were used to analyze the data. Results: The mean time for intubation in Macintosh group was 28.18 s and was 40.98 s in Airtraq group. The mean rise of RPP to intubation was 4644.83 in Airtraq group and 2829.27 in Macintosh group. The incidence of a sore throat was equal in both the groups. Conclusions: The time for intubation and the sympathetic response to airway instrumentation were more with Airtraq™ laryngoscope than with Macintosh laryngoscope.

Objective: T o describe the use of the Glidescope in comparison with direct laryngoscopy for elec... more Objective: T o describe the use of the Glidescope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods :Two hundred patients, ASA In scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features (Mallampati oropharyngeal scale, thyromenta distance and mouth opening). In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn. and the views of the glottis at laryngoscopy (Cormack and 1-ehane scores) were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or Glidescope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results : There were 200 patients including 107 males and 93 females, with mean age being 521t13 years, height 164. S i l l. 3 cm, weight 64. O k l l .