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Papers by Pankaj Kundra

Research paper thumbnail of Ebstein’s anomaly during pregnancy: experience from a tertiary care centre – a case series and review of literature

Journal of Obstetrics and Gynaecology, Aug 18, 2021

Pregnancy complicated with uncorrected Ebstein's anomaly is uncommon and may pose a serious t... more Pregnancy complicated with uncorrected Ebstein's anomaly is uncommon and may pose a serious threat to maternal and foetal life in the clinical setting of altered hemodynamics of pregnancy. Data of eight pregnancies in four women with Ebstein's anomaly who delivered in a tertiary care institute was analysed. Among the four women, one had associated atrial septal defect, one had pulmonary hypertension and three had right bundle branch block. There were two miscarriages and six successful pregnancies resulting in live births. Three of the pregnancies were delivered by caesarean section. There was one pregnancy complicated by severe preeclampsia, no preterm births or maternal cardiac complications. There was one neonate with congenital ostium secundum atrial septal defect. All patients were managed by a multidisciplinary team involving Obstetrician, Cardiologist, Anaesthesiologist and Neonatologist.IMPACT STATEMENTWhat is already known on this subject? Ebstein's anomaly is a rare congenital anomaly with apical displacement of the septal tricuspid leaflet in association with leaflet dysplasia. It may cause varied presentation in pregnancy depending on the severity of the lesion.What do the results of this study add? Ebstein's anomaly may become symptomatic for the first-time during pregnancy. Patients with NYHA class II symptoms and no cyanosis generally tolerate pregnancy well. Miscarriages and intrauterine growth restriction may occur in the presence of this condition. Vaginal delivery is advised and caesarean is done only for obstetric indications.What are the implications of these findings for clinical practise and/or future research? The management of pregnancy with uncorrected Ebstein's anomaly is highly challenging especially in a low resource setting and requires tertiary centre care. Multidisciplinary team involvement can help to improve the outcomes in such pregnancies.

Research paper thumbnail of Maternal and perinatal outcomes of pregnant women with tetralogy of Fallot: a tertiary center experience from south-India

Journal of Maternal-fetal & Neonatal Medicine, Sep 20, 2020

BACKGROUND Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse... more BACKGROUND Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse maternal and perinatal outcomes. METHOD We reviewed the maternal complications and pregnancy outcomes of women with tetralogy of Fallot (ToF), having corrected or uncorrected lesion during the period from 2011 to 2019 attending a south-Indian tertiary care center. Data regarding demographics, clinical course, and medications received and echocardiographic diagnosis regarding ToF, labor and delivery details, and postpartum follow-up was collected from the records. For each case, four women matched for age (±2 years), without a diagnosis of heart disease, were included as controls. We compared the outcomes in pregnant women with ToF and controls as well between those who have undergone repair with those without repair and also with the controls. RESULTS There were 27 pregnancies in 19 patients with ToF, including eight pregnancies in seven women with uncorrected lesions. There was no maternal death or occurrence of infective endocarditis. Women with uncorrected lesion had significantly higher rates of fetal growth restriction (37.5% vs 6.7%), preterm birth (50% vs. 13.3%) resulting in lower birth weight (1907.5 g vs. 2607.3 g)) compared to those with a corrected lesion. Women with corrected lesion had similar outcomes to the controls (p > .5). CONCLUSION Women with uncorrected ToF are at increased risk of perinatal complications compared to those with corrected lesion and require care under a multidisciplinary team, with an individualized plan for delivery to optimize the outcomes.

Research paper thumbnail of Predictive models for fentanyl dose requirement and postoperative pain using clinical and genetic factors in patients undergoing major breast surgery

Research paper thumbnail of Ultrasound in Anesthesia Practice

Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2015

Research paper thumbnail of Advances in vaporisation: A narrative review

Indian Journal of Anaesthesia, 2020

A thorough literature search was done from inception till March 2019 using databases/search engin... more A thorough literature search was done from inception till March 2019 using databases/search engines (Medline, Embase, Scopus, PubMed and Google Scholar). The articles were manually searched by the authors for cross-referencing. All the articles published in English were searched. We used the following keywords '

Research paper thumbnail of Airway management in children

Indian Journal of Anaesthesia, Jul 1, 2005

Paediatric airway management remains the most daunting task before the anaesthesiologist. However... more Paediatric airway management remains the most daunting task before the anaesthesiologist. However, the laryngeal structures are so soft and pliable that external laryngeal manipulation of the airway makes the task much easier than expected. Often in ...

Research paper thumbnail of Unusual Foreign Body Airway Obstruction After Laryngeal Mask Airway Insertion

Anesthesia & Analgesia, Jul 1, 2005

Airway obstruction during general anesthesia is fairly common. Foreign body causing obstruction o... more Airway obstruction during general anesthesia is fairly common. Foreign body causing obstruction of the laryngeal mask airway is uncommon but can confuse the anesthesiologist trying to troubleshoot the cause of inability to ventilate. We present a case of complete airway obstruction with a nematode caught in the vertical bars of the laryngeal mask airway after its insertion.

Research paper thumbnail of Evaluation of pelvic wedge for gynaecological laparoscopy

Anaesthesia, Oct 1, 2008

Seventy-eight ASA 1 and 2 women scheduled for elective diagnostic laparoscopy under general anaes... more Seventy-eight ASA 1 and 2 women scheduled for elective diagnostic laparoscopy under general anaesthesia were randomly allocated into two groups. Patients were either positioned with a 20 degrees Trendelenberg tilt (group T) or with a wedge placed under the pelvis (group W). A standard general anaesthetic technique was used in all patients. The endoscopic view of pelvic organs was graded on a four-point scale by the operating surgeon. Heart rate (HR), mean arterial pressure (MAP), S(p)O(2), and peak airway pressure (Paw) were continuously measured. Significantly more patients (77%) in group W had grade 1 view (clear view of pelvic organs without additional manoeuvres) when compared with group T (46%). Mean Paw increased significantly in group T when compared with group W. The use of a pelvic wedge provides a better view of pelvic viscera than 20 degrees Trendelenberg tilt during gynaecological laparoscopy.

Research paper thumbnail of Activity of third generation cephalosporins against Pseudomonas aeruginosa in high risk hospital units

PubMed, Jul 1, 1996

Ceftazidime and Cefoperazone are the two third generation cephalosporins with anti-pseudomonal ac... more Ceftazidime and Cefoperazone are the two third generation cephalosporins with anti-pseudomonal activity. They have been frequently used in the I.C.U.s. in the developed countries but their use in the Indian hospitals has begun relatively recently. We studied the in-vitro susceptibility of 139 Pseudomonas aeruginosa isolates that were multiple drug resistant from the Resuscitation Unit/I.C.U. (61 strains), Burns Unit (48 strains), Surgical Post-operative unit (24 strains), Nephrology unit (6 strains) of our hospital to these two cephalosporine over a period of about 18 months. Antibiotic susceptibility was studied using Kirby Bauer's disc dibusion method. Out of a total of 139 strains of multiple drug resistant Pseudomonas aeruginosa tested, 17.9% were found resistant each to Ceftazidime and Cefoperazone separately and 10% were found resistant to both antibiotics.

Research paper thumbnail of COVID-19 cardiopulmonary resuscitation: Guidelines and modifications

Journal of Anaesthesiology Clinical Pharmacology, 2020

International societies like the International Liaison Committee on Resuscitation (ILCOR), Americ... more International societies like the International Liaison Committee on Resuscitation (ILCOR), American Heart Association (AHA), and UK Resuscitation Council have suggested modified guidelines for resuscitation during coronavirus disease (COVID-19) pandemic. Though there is consensus in most of the recommendations there are also disparities. Considering the rapidly evolving COVID-19 pandemic and our better understanding of the spread of the disease, there is an urgent need to suggest modifications to the existing guidelines. These modifications should allay the fear of health care workers regarding their safety and reluctance to provide cardiopulmonary resuscitation (CPR) but should also address the serious concerns where an opportunity is lost to revive patients who may not be COVID positive as suspected.

Research paper thumbnail of Role of Renin Angiotensin System in Cardiovascular Homeostasis

Research paper thumbnail of Does non-medical grade power cord compromise the safety of medical equipment?

Indian Journal of Anaesthesia, 2015

A tertiary care 1000 bedded hospital contains more than 10,000 pieces of equipment worth approxim... more A tertiary care 1000 bedded hospital contains more than 10,000 pieces of equipment worth approximately 41 million USD, while the power cords supplied along with the imported equipment do not comply with country-specific norms. Moreover, the local vendors procure power cords with type D/M plug to complete installation and also on-site electrical safety test is not performed. Hence, this project was undertaken to evaluate the electrical safety of all life-saving equipment purchased in the year 2013, referring to the guidelines of International Electrotechnical Commission 62353, the Association for the Advancement of Medical Instrumentation (AAMI) and National Fire Protection Association (NFPA)-99 hospital standard for the analysis of protective earth resistance and chassis leakage current. This study was done with a measuring device namely electrical safety analyser 612 model from Fluke Biomedical.

Research paper thumbnail of Endothelial glycocalyx: Role in body fluid homeostasis and fluid management

Indian Journal of Anaesthesia, 2019

Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an e... more Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an essential role in maintaining the normal fluid homeostasis of the body. This highly fragile layer can be damaged by a number of pathophysiological conditions and interventions. Disease state management should be directed to maintain EGL integrity to improve patient's outcome. When intravenous (IV) fluids are used, appropriate type, rate and amount of fluid should be determined by the pathophysiology of the condition and measures to maintain the integrity of the EGL. This review depicts the structure and function of the EGL, its alteration in common pathological states and the rationale of IV fluid management to preserve EGL in such conditions.

Research paper thumbnail of Loss of resistance technique

Acta Anaesthesiologica Scandinavica, May 1, 2006

Sir, Thank you for giving us the opportunity to respond to the issues raised by Gallart and Aguil... more Sir, Thank you for giving us the opportunity to respond to the issues raised by Gallart and Aguilera about our article (1). The loss of resistance technique is a well-established method of ascertaining the entry of a needle into a space. The technique is widely practised to detect the epidural space and is safe if practised in the following manner. A saline-filled glass syringe is attached to a Touhey needle through a three-way stopcock. A deliberate attempt is made to contact the upper border of the rib, which helps to gauge the actual depth of the intercostal space. The interpleural space is another 1-2 cm from here. The needle is then walked off the upper border of the rib. A constant pressure is applied to the plunger of the syringe and 'this force' is utilized to advance the needle forwards. Once the bevel enters a potential space, the pressure on the plunger injects saline into the space and deters the needle from moving forwards. Care must be taken not to use any other force except that on the plunger to advance the needle while identifying the space. To avoid accidental lung injury, positive-pressure mechanical ventilation is interrupted or synchronized to avoid lung inflation during needle advancement while the interpleural space is being identified. Intraparenchymal or intrabronchial placement of the catheter seems to be a remote possibility for the cause of bronchospasm,

Research paper thumbnail of ERAS protocol with respiratory prehabilitation versus conventional perioperative protocol in elective gastrectomy– a randomized controlled trial

International Journal of Surgery, Sep 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in children

Acta Anaesthesiologica Scandinavica, May 1, 2006

Background: Three different sites of needle insertion have been proposed for ilioinguinal‐iliohy... more Background: Three different sites of needle insertion have been proposed for ilioinguinal‐iliohypogastric (ILIH) nerve block. This double‐blind study was designed to assess the quality of analgesia produced from these different sites.Methods: One hundred and thirty‐two children of ASA grade I and II were randomly allocated into four groups to receive no nerve block (control group, n = 30) or ILIH block at 1 cm inferio‐medial to the anterior superior iliac spine (ASIS) in group IM (n = 34), 1–2 cm medial to the ASIS in group M (n = 34) and 2 cm superio‐medial to the ASIS in group SM (n = 34) with 0.25 ml/kg of 0.25% bupivacaine after induction of anaesthesia. Pain was assessed using the All India Institute of Medical Sciences (AIIMS) pain discomfort scale (APDS) score. The amount and pattern of fentanyl consumed over the ensuing 24‐h period was noted.Results: APDS score and fentanyl requirement were similar in all the study groups but significantly higher until 8 h after surgery in the control group, P < 0.05. Twenty‐two out of 102 children in the study groups and all patients in the control group received additional fentanyl during the post‐operative period. Only 6 out of 22 children required additional fentanyl supplementation beyond the 30‐min interval. Overall failure rate of ILIH nerve block was 6%.Conclusion: ILIH block can be successfully accomplished from any point if the needle bevel lies between the two muscle planes above and below the internal oblique.

Research paper thumbnail of Ultrasound imaging of the airway and its applications

Airway, 2018

Airway ultrasound (US) provides a dynamic assessment of the airway. In conjunction with other ima... more Airway ultrasound (US) provides a dynamic assessment of the airway. In conjunction with other imaging techniques such as computerised tomographic (CT) scan and magnetic resonance imaging (MRI), ultrasonography of the airway can influence airway management decisions. There is some evidence to support its use in the prediction of difficult airway by measuring pre-tracheal soft-tissue thickness and pre-epiglottis space thickness. However, the dynamic scan of vocal cord movements may replace direct visualisation techniques in the future. In addition, measurements of the subglottic diameter by US have been shown to predict endotracheal tube size as accurately as MRI or CT scan. US-assisted or US-guided front of the neck procedures such as percutaneous dilatational tracheostomy is safer and more accurate with decreased rate of complications. Localisation of cricothyroid membrane with US in difficult necks may become a life-saving procedure when complete ventilation failure is encountered. The use of US to overcome airway challenges is growing at a rapid pace adding newer dimensions to its use.

Research paper thumbnail of Securing of supraglottic airway devices during position change and in prone position

Indian Journal of Anaesthesia, 2018

© 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow Supraglottic airway de... more © 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow Supraglottic airway devices (SADs) are now routinely used for elective airway management. Like regional anaesthesia, anaesthesiologists rule out contraindications for SAD use rather than seek an indication. The flexible laryngeal mask airway (LMA) found its popularity in oral surgeries as the incidence of adverse events were reduced during removal of SAD when compared to endotracheal tube extubation.[1] Recently, the LMA has been used for airway management in cervical tracheal resection and reconstruction.[2] However, despite the expanding horizons in the use of SADs, their use in the prone position still happens to raise a few concerns. Eight retrospective case series and six prospective studies that involved 1600 patients were identified on Medline search where SADs were electively used for airway management in the prone position. Investigators were able to successfully ventilate all patients and the reported adverse events were managed successfully.[3] In a study published in this issue of the Indian Journal of Anaesthesia, Hegde et al. demonstrated that Streamlined Liner of the Pharynx AirwayTM (SLIPA) and LMA-ProSeal (ProsealTM) can be safely used in prone position in adults, but the endotracheal tube was the most efficacious.[4] Use of SADs in the prone position is a challenge, and there is a possibility of airway dislodgement, obstruction, desaturation or hypercapnoea. Nevertheless, with the advent of new third-generation SAD (Baska mask) the use of SADs will be even more common, and the airway will be better secured than with the older generation SADs.[5]

Research paper thumbnail of COVID-19 mask: A modified anatomical face mask

Indian Journal of Anaesthesia, 2020

The COVID-19 outbreak was declared a Public Health Emergency of international concern on 30 Janua... more The COVID-19 outbreak was declared a Public Health Emergency of international concern on 30 January 2020 by World Health Organization (WHO). Subsequently, on March 11 2020, WHO declared the outbreak as a pandemic and till date, it continues to spread globally into new countries.[1] Leading the fight against this deadly disease are the health care workers (HCW) who are at the frontline. Amongst all the shortcomings they are facing, the most striking concern which has emerged is the lack of sufficient number of N95 mask/respirators. Even countries like United States of America and Italy which have a health care system that is far better than India are struggling to meet the demand of N95 masks for their health care workers. These numbers explain why China is the world’s largest producer of them, with a reported daily capacity of 20 million pieces, but by the estimate of its manufacturers, the domestic demand alone is around 50-60 million per day.[2]

Research paper thumbnail of Ultrasonography as a novel airway assessment tool for preoperative dynamic airway evaluation in an anticipated difficult airway

Indian Journal of Anaesthesia, 2017

Declaration of patient consent The authors certify that they have obtained all appropriate patien... more Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/ her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Research paper thumbnail of Ebstein’s anomaly during pregnancy: experience from a tertiary care centre – a case series and review of literature

Journal of Obstetrics and Gynaecology, Aug 18, 2021

Pregnancy complicated with uncorrected Ebstein's anomaly is uncommon and may pose a serious t... more Pregnancy complicated with uncorrected Ebstein's anomaly is uncommon and may pose a serious threat to maternal and foetal life in the clinical setting of altered hemodynamics of pregnancy. Data of eight pregnancies in four women with Ebstein's anomaly who delivered in a tertiary care institute was analysed. Among the four women, one had associated atrial septal defect, one had pulmonary hypertension and three had right bundle branch block. There were two miscarriages and six successful pregnancies resulting in live births. Three of the pregnancies were delivered by caesarean section. There was one pregnancy complicated by severe preeclampsia, no preterm births or maternal cardiac complications. There was one neonate with congenital ostium secundum atrial septal defect. All patients were managed by a multidisciplinary team involving Obstetrician, Cardiologist, Anaesthesiologist and Neonatologist.IMPACT STATEMENTWhat is already known on this subject? Ebstein's anomaly is a rare congenital anomaly with apical displacement of the septal tricuspid leaflet in association with leaflet dysplasia. It may cause varied presentation in pregnancy depending on the severity of the lesion.What do the results of this study add? Ebstein's anomaly may become symptomatic for the first-time during pregnancy. Patients with NYHA class II symptoms and no cyanosis generally tolerate pregnancy well. Miscarriages and intrauterine growth restriction may occur in the presence of this condition. Vaginal delivery is advised and caesarean is done only for obstetric indications.What are the implications of these findings for clinical practise and/or future research? The management of pregnancy with uncorrected Ebstein's anomaly is highly challenging especially in a low resource setting and requires tertiary centre care. Multidisciplinary team involvement can help to improve the outcomes in such pregnancies.

Research paper thumbnail of Maternal and perinatal outcomes of pregnant women with tetralogy of Fallot: a tertiary center experience from south-India

Journal of Maternal-fetal & Neonatal Medicine, Sep 20, 2020

BACKGROUND Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse... more BACKGROUND Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse maternal and perinatal outcomes. METHOD We reviewed the maternal complications and pregnancy outcomes of women with tetralogy of Fallot (ToF), having corrected or uncorrected lesion during the period from 2011 to 2019 attending a south-Indian tertiary care center. Data regarding demographics, clinical course, and medications received and echocardiographic diagnosis regarding ToF, labor and delivery details, and postpartum follow-up was collected from the records. For each case, four women matched for age (±2 years), without a diagnosis of heart disease, were included as controls. We compared the outcomes in pregnant women with ToF and controls as well between those who have undergone repair with those without repair and also with the controls. RESULTS There were 27 pregnancies in 19 patients with ToF, including eight pregnancies in seven women with uncorrected lesions. There was no maternal death or occurrence of infective endocarditis. Women with uncorrected lesion had significantly higher rates of fetal growth restriction (37.5% vs 6.7%), preterm birth (50% vs. 13.3%) resulting in lower birth weight (1907.5 g vs. 2607.3 g)) compared to those with a corrected lesion. Women with corrected lesion had similar outcomes to the controls (p > .5). CONCLUSION Women with uncorrected ToF are at increased risk of perinatal complications compared to those with corrected lesion and require care under a multidisciplinary team, with an individualized plan for delivery to optimize the outcomes.

Research paper thumbnail of Predictive models for fentanyl dose requirement and postoperative pain using clinical and genetic factors in patients undergoing major breast surgery

Research paper thumbnail of Ultrasound in Anesthesia Practice

Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2015

Research paper thumbnail of Advances in vaporisation: A narrative review

Indian Journal of Anaesthesia, 2020

A thorough literature search was done from inception till March 2019 using databases/search engin... more A thorough literature search was done from inception till March 2019 using databases/search engines (Medline, Embase, Scopus, PubMed and Google Scholar). The articles were manually searched by the authors for cross-referencing. All the articles published in English were searched. We used the following keywords '

Research paper thumbnail of Airway management in children

Indian Journal of Anaesthesia, Jul 1, 2005

Paediatric airway management remains the most daunting task before the anaesthesiologist. However... more Paediatric airway management remains the most daunting task before the anaesthesiologist. However, the laryngeal structures are so soft and pliable that external laryngeal manipulation of the airway makes the task much easier than expected. Often in ...

Research paper thumbnail of Unusual Foreign Body Airway Obstruction After Laryngeal Mask Airway Insertion

Anesthesia & Analgesia, Jul 1, 2005

Airway obstruction during general anesthesia is fairly common. Foreign body causing obstruction o... more Airway obstruction during general anesthesia is fairly common. Foreign body causing obstruction of the laryngeal mask airway is uncommon but can confuse the anesthesiologist trying to troubleshoot the cause of inability to ventilate. We present a case of complete airway obstruction with a nematode caught in the vertical bars of the laryngeal mask airway after its insertion.

Research paper thumbnail of Evaluation of pelvic wedge for gynaecological laparoscopy

Anaesthesia, Oct 1, 2008

Seventy-eight ASA 1 and 2 women scheduled for elective diagnostic laparoscopy under general anaes... more Seventy-eight ASA 1 and 2 women scheduled for elective diagnostic laparoscopy under general anaesthesia were randomly allocated into two groups. Patients were either positioned with a 20 degrees Trendelenberg tilt (group T) or with a wedge placed under the pelvis (group W). A standard general anaesthetic technique was used in all patients. The endoscopic view of pelvic organs was graded on a four-point scale by the operating surgeon. Heart rate (HR), mean arterial pressure (MAP), S(p)O(2), and peak airway pressure (Paw) were continuously measured. Significantly more patients (77%) in group W had grade 1 view (clear view of pelvic organs without additional manoeuvres) when compared with group T (46%). Mean Paw increased significantly in group T when compared with group W. The use of a pelvic wedge provides a better view of pelvic viscera than 20 degrees Trendelenberg tilt during gynaecological laparoscopy.

Research paper thumbnail of Activity of third generation cephalosporins against Pseudomonas aeruginosa in high risk hospital units

PubMed, Jul 1, 1996

Ceftazidime and Cefoperazone are the two third generation cephalosporins with anti-pseudomonal ac... more Ceftazidime and Cefoperazone are the two third generation cephalosporins with anti-pseudomonal activity. They have been frequently used in the I.C.U.s. in the developed countries but their use in the Indian hospitals has begun relatively recently. We studied the in-vitro susceptibility of 139 Pseudomonas aeruginosa isolates that were multiple drug resistant from the Resuscitation Unit/I.C.U. (61 strains), Burns Unit (48 strains), Surgical Post-operative unit (24 strains), Nephrology unit (6 strains) of our hospital to these two cephalosporine over a period of about 18 months. Antibiotic susceptibility was studied using Kirby Bauer's disc dibusion method. Out of a total of 139 strains of multiple drug resistant Pseudomonas aeruginosa tested, 17.9% were found resistant each to Ceftazidime and Cefoperazone separately and 10% were found resistant to both antibiotics.

Research paper thumbnail of COVID-19 cardiopulmonary resuscitation: Guidelines and modifications

Journal of Anaesthesiology Clinical Pharmacology, 2020

International societies like the International Liaison Committee on Resuscitation (ILCOR), Americ... more International societies like the International Liaison Committee on Resuscitation (ILCOR), American Heart Association (AHA), and UK Resuscitation Council have suggested modified guidelines for resuscitation during coronavirus disease (COVID-19) pandemic. Though there is consensus in most of the recommendations there are also disparities. Considering the rapidly evolving COVID-19 pandemic and our better understanding of the spread of the disease, there is an urgent need to suggest modifications to the existing guidelines. These modifications should allay the fear of health care workers regarding their safety and reluctance to provide cardiopulmonary resuscitation (CPR) but should also address the serious concerns where an opportunity is lost to revive patients who may not be COVID positive as suspected.

Research paper thumbnail of Role of Renin Angiotensin System in Cardiovascular Homeostasis

Research paper thumbnail of Does non-medical grade power cord compromise the safety of medical equipment?

Indian Journal of Anaesthesia, 2015

A tertiary care 1000 bedded hospital contains more than 10,000 pieces of equipment worth approxim... more A tertiary care 1000 bedded hospital contains more than 10,000 pieces of equipment worth approximately 41 million USD, while the power cords supplied along with the imported equipment do not comply with country-specific norms. Moreover, the local vendors procure power cords with type D/M plug to complete installation and also on-site electrical safety test is not performed. Hence, this project was undertaken to evaluate the electrical safety of all life-saving equipment purchased in the year 2013, referring to the guidelines of International Electrotechnical Commission 62353, the Association for the Advancement of Medical Instrumentation (AAMI) and National Fire Protection Association (NFPA)-99 hospital standard for the analysis of protective earth resistance and chassis leakage current. This study was done with a measuring device namely electrical safety analyser 612 model from Fluke Biomedical.

Research paper thumbnail of Endothelial glycocalyx: Role in body fluid homeostasis and fluid management

Indian Journal of Anaesthesia, 2019

Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an e... more Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an essential role in maintaining the normal fluid homeostasis of the body. This highly fragile layer can be damaged by a number of pathophysiological conditions and interventions. Disease state management should be directed to maintain EGL integrity to improve patient's outcome. When intravenous (IV) fluids are used, appropriate type, rate and amount of fluid should be determined by the pathophysiology of the condition and measures to maintain the integrity of the EGL. This review depicts the structure and function of the EGL, its alteration in common pathological states and the rationale of IV fluid management to preserve EGL in such conditions.

Research paper thumbnail of Loss of resistance technique

Acta Anaesthesiologica Scandinavica, May 1, 2006

Sir, Thank you for giving us the opportunity to respond to the issues raised by Gallart and Aguil... more Sir, Thank you for giving us the opportunity to respond to the issues raised by Gallart and Aguilera about our article (1). The loss of resistance technique is a well-established method of ascertaining the entry of a needle into a space. The technique is widely practised to detect the epidural space and is safe if practised in the following manner. A saline-filled glass syringe is attached to a Touhey needle through a three-way stopcock. A deliberate attempt is made to contact the upper border of the rib, which helps to gauge the actual depth of the intercostal space. The interpleural space is another 1-2 cm from here. The needle is then walked off the upper border of the rib. A constant pressure is applied to the plunger of the syringe and 'this force' is utilized to advance the needle forwards. Once the bevel enters a potential space, the pressure on the plunger injects saline into the space and deters the needle from moving forwards. Care must be taken not to use any other force except that on the plunger to advance the needle while identifying the space. To avoid accidental lung injury, positive-pressure mechanical ventilation is interrupted or synchronized to avoid lung inflation during needle advancement while the interpleural space is being identified. Intraparenchymal or intrabronchial placement of the catheter seems to be a remote possibility for the cause of bronchospasm,

Research paper thumbnail of ERAS protocol with respiratory prehabilitation versus conventional perioperative protocol in elective gastrectomy– a randomized controlled trial

International Journal of Surgery, Sep 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in children

Acta Anaesthesiologica Scandinavica, May 1, 2006

Background: Three different sites of needle insertion have been proposed for ilioinguinal‐iliohy... more Background: Three different sites of needle insertion have been proposed for ilioinguinal‐iliohypogastric (ILIH) nerve block. This double‐blind study was designed to assess the quality of analgesia produced from these different sites.Methods: One hundred and thirty‐two children of ASA grade I and II were randomly allocated into four groups to receive no nerve block (control group, n = 30) or ILIH block at 1 cm inferio‐medial to the anterior superior iliac spine (ASIS) in group IM (n = 34), 1–2 cm medial to the ASIS in group M (n = 34) and 2 cm superio‐medial to the ASIS in group SM (n = 34) with 0.25 ml/kg of 0.25% bupivacaine after induction of anaesthesia. Pain was assessed using the All India Institute of Medical Sciences (AIIMS) pain discomfort scale (APDS) score. The amount and pattern of fentanyl consumed over the ensuing 24‐h period was noted.Results: APDS score and fentanyl requirement were similar in all the study groups but significantly higher until 8 h after surgery in the control group, P < 0.05. Twenty‐two out of 102 children in the study groups and all patients in the control group received additional fentanyl during the post‐operative period. Only 6 out of 22 children required additional fentanyl supplementation beyond the 30‐min interval. Overall failure rate of ILIH nerve block was 6%.Conclusion: ILIH block can be successfully accomplished from any point if the needle bevel lies between the two muscle planes above and below the internal oblique.

Research paper thumbnail of Ultrasound imaging of the airway and its applications

Airway, 2018

Airway ultrasound (US) provides a dynamic assessment of the airway. In conjunction with other ima... more Airway ultrasound (US) provides a dynamic assessment of the airway. In conjunction with other imaging techniques such as computerised tomographic (CT) scan and magnetic resonance imaging (MRI), ultrasonography of the airway can influence airway management decisions. There is some evidence to support its use in the prediction of difficult airway by measuring pre-tracheal soft-tissue thickness and pre-epiglottis space thickness. However, the dynamic scan of vocal cord movements may replace direct visualisation techniques in the future. In addition, measurements of the subglottic diameter by US have been shown to predict endotracheal tube size as accurately as MRI or CT scan. US-assisted or US-guided front of the neck procedures such as percutaneous dilatational tracheostomy is safer and more accurate with decreased rate of complications. Localisation of cricothyroid membrane with US in difficult necks may become a life-saving procedure when complete ventilation failure is encountered. The use of US to overcome airway challenges is growing at a rapid pace adding newer dimensions to its use.

Research paper thumbnail of Securing of supraglottic airway devices during position change and in prone position

Indian Journal of Anaesthesia, 2018

© 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow Supraglottic airway de... more © 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow Supraglottic airway devices (SADs) are now routinely used for elective airway management. Like regional anaesthesia, anaesthesiologists rule out contraindications for SAD use rather than seek an indication. The flexible laryngeal mask airway (LMA) found its popularity in oral surgeries as the incidence of adverse events were reduced during removal of SAD when compared to endotracheal tube extubation.[1] Recently, the LMA has been used for airway management in cervical tracheal resection and reconstruction.[2] However, despite the expanding horizons in the use of SADs, their use in the prone position still happens to raise a few concerns. Eight retrospective case series and six prospective studies that involved 1600 patients were identified on Medline search where SADs were electively used for airway management in the prone position. Investigators were able to successfully ventilate all patients and the reported adverse events were managed successfully.[3] In a study published in this issue of the Indian Journal of Anaesthesia, Hegde et al. demonstrated that Streamlined Liner of the Pharynx AirwayTM (SLIPA) and LMA-ProSeal (ProsealTM) can be safely used in prone position in adults, but the endotracheal tube was the most efficacious.[4] Use of SADs in the prone position is a challenge, and there is a possibility of airway dislodgement, obstruction, desaturation or hypercapnoea. Nevertheless, with the advent of new third-generation SAD (Baska mask) the use of SADs will be even more common, and the airway will be better secured than with the older generation SADs.[5]

Research paper thumbnail of COVID-19 mask: A modified anatomical face mask

Indian Journal of Anaesthesia, 2020

The COVID-19 outbreak was declared a Public Health Emergency of international concern on 30 Janua... more The COVID-19 outbreak was declared a Public Health Emergency of international concern on 30 January 2020 by World Health Organization (WHO). Subsequently, on March 11 2020, WHO declared the outbreak as a pandemic and till date, it continues to spread globally into new countries.[1] Leading the fight against this deadly disease are the health care workers (HCW) who are at the frontline. Amongst all the shortcomings they are facing, the most striking concern which has emerged is the lack of sufficient number of N95 mask/respirators. Even countries like United States of America and Italy which have a health care system that is far better than India are struggling to meet the demand of N95 masks for their health care workers. These numbers explain why China is the world’s largest producer of them, with a reported daily capacity of 20 million pieces, but by the estimate of its manufacturers, the domestic demand alone is around 50-60 million per day.[2]

Research paper thumbnail of Ultrasonography as a novel airway assessment tool for preoperative dynamic airway evaluation in an anticipated difficult airway

Indian Journal of Anaesthesia, 2017

Declaration of patient consent The authors certify that they have obtained all appropriate patien... more Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/ her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.