Rashmi Pal - Academia.edu (original) (raw)

Papers by Rashmi Pal

Research paper thumbnail of Intrathecal Buprenorphine, Clonidine and Fentanyl as Adjuvants to 0.5% Hyperbaric Bupivacaine in Lower Abdominal and Lower Limb Surgeries: A Prospective, Randomized and Comparative Study

Journal of Evolution of Medical and Dental Sciences, 2015

BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha-2 agonist has the ability to alle... more BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha-2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written informed consent of patients. MATERIALS AND METHODS: Patients were randomly allocated into three groups (n=30) and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperbaric bupivacaine (3.0ml). The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in-group BC as compared to group BF and BB (P<.001). There was no significant difference in the onset time of sensory block in three groups (P>.05). Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intrathecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.

Research paper thumbnail of Predictors of Inpatient Treatment Completion and Non Completion in Patients with Alcohol Dependence from a Tertiary Care Centre in Central India

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Introduction: In India, millions of individuals are affected by alcohol dependence as evident by ... more Introduction: In India, millions of individuals are affected by alcohol dependence as evident by a recent national survey. Apart from the serious health consequences, the use of alcohol brings significant social and economic losses to individuals and society as well. The early treatment discontinuation for deaddiction of alcohol is a major challenge, therefore identification of predictors of treatment completion could be of use to reorganize treatment programs effectively. Aim: To study the predictors of inpatient treatment completion of subjects with alcohol dependence in the deaddiction ward of a tertiary care centre and to compare the socio-demographic and clinical variables among completers and non completers. Materials and Methods: The cross-sectional study was conducted at the Department of Psychiatry, MGM Medical College Indore, India. The purposive sample of 100 patients was recruited in a period of one year. Selected inpatients were assessed through semi-structured proforma...

Research paper thumbnail of α2-adrenoceptor agonist, Bupivacaine, Buprenorphine, Clonidine, Fentanyl

Research paper thumbnail of A Comparision of Two Different Doses of Butorphanol-Pretreatment to Establish A Minimum Effective Dose for Etomidate Induced Myoclonus-A Prospective Randomized Study

Introduction: Etomidate is often used for induction of general anaesthesia because of its very st... more Introduction: Etomidate is often used for induction of general anaesthesia because of its very stable hemodynamic profile. myoclonus is common problem with induction of anaesthesia with etomidate, which may be a problem in non fasting patients, open eye injury and epileptic patients. Incidence of myoclonus shown to be reduced by variety of opioid agents. Butorphanol is strong analgesic with both narcotic agonistic and antagonistic properties. This prospective randomized study was aimed to compare two different doses of butorphanol to establish minimum effective dose for prevention of myoclonus. Material and methods: A total of 90 patients,ASA I and II undergoing elective surgery were randomized into three groups comprising of 30 patients each. Group B and Group C received butorphanol 0.04 mg/kg and 0.02 mg/kg respectively and group A received normal saline. Two minutes after pretreatment patients received etomidate 0.3 mg /kg. Assessment of myoclonus after etomidate was done using f...

Research paper thumbnail of Anesthesia for electroconvulsive therapy: A Noble approach

International Journal of Medical Research & Health Sciences, 2015

Electroconvulsive therapy (ECT) has always proved to be an effective mode of therapy in the field... more Electroconvulsive therapy (ECT) has always proved to be an effective mode of therapy in the field of Psychiatry. Modified ECT is applied in the form of electrical stimulus to the central nervous system; it is associated with acute physiologic response leading to autonomic nervous system stimulation with an initial parasympathetic stimulation followed by a more prominent sympathetic response as well as post-ictal effects like confusion and delirium. The factors governing the efficacy of Modified ECT are the strength of electrical current applied and the duration of the seizure activity. Modified ECT requires the use of general anesthesia and many of the anesthetic drugs also have an effect on the duration of seizure and could adversely affect the efficacy of the Modified ECT treatments. Therefore, there has to be a delicate balance between achieving an adequate anesthetic state and optimal duration of seizure activity.

Research paper thumbnail of Colostomy in an ischiopagus, 3 rd PND conjoined twins with cross-circulation: Anaesthetic management

Indian Journal of Anaesthesia, 2014

et al. Clinical and hematologic features of 300 patients affected by hereditary spherocytosis gro... more et al. Clinical and hematologic features of 300 patients affected by hereditary spherocytosis grouped according to the type of the membrane protein defect.

Research paper thumbnail of Recannulation of a stenosed old tracheostomy wound in vocal-cord palsy: Anaesthetic management

Indian Journal of Anaesthesia, 2011

Tracheostomy still remains a life-saving procedure to secure a patent airway in emergency situati... more Tracheostomy still remains a life-saving procedure to secure a patent airway in emergency situations. Anaesthetic management of tracheostomy in paediatric patients with bilateral vocal cord immobility and acute respiratory distress in emergency has always been a great challenge to the anaesthesiologists. Administering general anaesthesia in a child for recannulation of tracheostomy in emergency is far more challenging. We report a case of a 4-year-old male child in whom tracheostomy tube was accidentally removed 2 months back and the wound got stenosed gradually leading to acute respiratory distress. Emergency dilatation and recannulation of tracheostomy wound was planned under general anaesthesia and the case was managed successfully.

Research paper thumbnail of Gabapentin provides effective postoperative analgesia whether administered pre-emptively or post-incision

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

We investigated the effects of pre-incision and postincision administration of gabapentin on post... more We investigated the effects of pre-incision and postincision administration of gabapentin on postoperative pain and fentanyl consumption associated with open donor nephrectomy. Methods: Sixty ASA I subjects were randomly allocated into three groups to receive gabapentin 600 mg two hours before surgery and placebo after surgical incision (pre-incision group), placebo two hours before surgery and gabapentin 600 mg after surgical incision (post-incision group), or placebo two hours before surgery and after surgical incision (placebo group). After surgery, pain was assessed using a visual analogue scale (VAS), (1-10 cm) at time points 0, 6, 12, 18, and 24 hr. Subjects received patient-controlled-analgesia (fentanyl 1.0 µg•kg-1 subject activated dose). Total fentanyl consumption in each group was recorded. Results: Subjects of pre-incision and post-incision groups had lower VAS scores at all time points (3.

Research paper thumbnail of Efficacy of Granisetron and Granisetron Plus Dexamethasone as Pre - Emptive Anti - Emetic Therapy for Ponv in Patients Undergoing General Anesthe Sia for Abdominal Surgery : A Controlled, Prospective & Randomized Study

Journal of Evolution of medical and Dental Sciences, 2015

BACKGROUND: Abdominal surgeries are associated with a very high rate of postoperative nausea and ... more BACKGROUND: Abdominal surgeries are associated with a very high rate of postoperative nausea and vomiting (PONV), which can lead to dehydration, electrolyte-imbalance, aspiration-pneumonitis and wound-dehiscence, thereby delaying patient’s recovery and prolonging hospital stay. OBJECTIVES: This study was designed to compare the effectiveness of granisetron alone and in combination with dexamethasone for prevention of PONV in patients undergoing general anesthesia for abdominal surgeries as well as recognizing the limitations of routine antiemetic prophylaxis with a multimodal approach to anti-emesis. MATERIALS & METHODS: In this prospective, randomized and controlled study 75 patients undergoing general anesthesia for abdominal surgeries were randomly allocated to one of the three groups of 25 patients each. Group G received granisetron 40μg/kg, group G+D received granisetron 40μg/kg+dexamethasone 0.1mg/kg and group C received normal saline intravenously, before induction of anesthe...

Research paper thumbnail of Intrathecal Buprenorphine, Clonidine and Fentanyl as Adjuvants to 0.5% Hyperbaric Bupivacaine in Lower Abdominal and Lower Limb Surgeries: A Prospective, Randomized and Comparative Study

Journal of Evolution of Medical and Dental Sciences, 2015

BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha-2 agonist has the ability to alle... more BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha-2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written informed consent of patients. MATERIALS AND METHODS: Patients were randomly allocated into three groups (n=30) and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperbaric bupivacaine (3.0ml). The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in-group BC as compared to group BF and BB (P<.001). There was no significant difference in the onset time of sensory block in three groups (P>.05). Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intrathecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.

Research paper thumbnail of Predictors of Inpatient Treatment Completion and Non Completion in Patients with Alcohol Dependence from a Tertiary Care Centre in Central India

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Introduction: In India, millions of individuals are affected by alcohol dependence as evident by ... more Introduction: In India, millions of individuals are affected by alcohol dependence as evident by a recent national survey. Apart from the serious health consequences, the use of alcohol brings significant social and economic losses to individuals and society as well. The early treatment discontinuation for deaddiction of alcohol is a major challenge, therefore identification of predictors of treatment completion could be of use to reorganize treatment programs effectively. Aim: To study the predictors of inpatient treatment completion of subjects with alcohol dependence in the deaddiction ward of a tertiary care centre and to compare the socio-demographic and clinical variables among completers and non completers. Materials and Methods: The cross-sectional study was conducted at the Department of Psychiatry, MGM Medical College Indore, India. The purposive sample of 100 patients was recruited in a period of one year. Selected inpatients were assessed through semi-structured proforma...

Research paper thumbnail of α2-adrenoceptor agonist, Bupivacaine, Buprenorphine, Clonidine, Fentanyl

Research paper thumbnail of A Comparision of Two Different Doses of Butorphanol-Pretreatment to Establish A Minimum Effective Dose for Etomidate Induced Myoclonus-A Prospective Randomized Study

Introduction: Etomidate is often used for induction of general anaesthesia because of its very st... more Introduction: Etomidate is often used for induction of general anaesthesia because of its very stable hemodynamic profile. myoclonus is common problem with induction of anaesthesia with etomidate, which may be a problem in non fasting patients, open eye injury and epileptic patients. Incidence of myoclonus shown to be reduced by variety of opioid agents. Butorphanol is strong analgesic with both narcotic agonistic and antagonistic properties. This prospective randomized study was aimed to compare two different doses of butorphanol to establish minimum effective dose for prevention of myoclonus. Material and methods: A total of 90 patients,ASA I and II undergoing elective surgery were randomized into three groups comprising of 30 patients each. Group B and Group C received butorphanol 0.04 mg/kg and 0.02 mg/kg respectively and group A received normal saline. Two minutes after pretreatment patients received etomidate 0.3 mg /kg. Assessment of myoclonus after etomidate was done using f...

Research paper thumbnail of Anesthesia for electroconvulsive therapy: A Noble approach

International Journal of Medical Research & Health Sciences, 2015

Electroconvulsive therapy (ECT) has always proved to be an effective mode of therapy in the field... more Electroconvulsive therapy (ECT) has always proved to be an effective mode of therapy in the field of Psychiatry. Modified ECT is applied in the form of electrical stimulus to the central nervous system; it is associated with acute physiologic response leading to autonomic nervous system stimulation with an initial parasympathetic stimulation followed by a more prominent sympathetic response as well as post-ictal effects like confusion and delirium. The factors governing the efficacy of Modified ECT are the strength of electrical current applied and the duration of the seizure activity. Modified ECT requires the use of general anesthesia and many of the anesthetic drugs also have an effect on the duration of seizure and could adversely affect the efficacy of the Modified ECT treatments. Therefore, there has to be a delicate balance between achieving an adequate anesthetic state and optimal duration of seizure activity.

Research paper thumbnail of Colostomy in an ischiopagus, 3 rd PND conjoined twins with cross-circulation: Anaesthetic management

Indian Journal of Anaesthesia, 2014

et al. Clinical and hematologic features of 300 patients affected by hereditary spherocytosis gro... more et al. Clinical and hematologic features of 300 patients affected by hereditary spherocytosis grouped according to the type of the membrane protein defect.

Research paper thumbnail of Recannulation of a stenosed old tracheostomy wound in vocal-cord palsy: Anaesthetic management

Indian Journal of Anaesthesia, 2011

Tracheostomy still remains a life-saving procedure to secure a patent airway in emergency situati... more Tracheostomy still remains a life-saving procedure to secure a patent airway in emergency situations. Anaesthetic management of tracheostomy in paediatric patients with bilateral vocal cord immobility and acute respiratory distress in emergency has always been a great challenge to the anaesthesiologists. Administering general anaesthesia in a child for recannulation of tracheostomy in emergency is far more challenging. We report a case of a 4-year-old male child in whom tracheostomy tube was accidentally removed 2 months back and the wound got stenosed gradually leading to acute respiratory distress. Emergency dilatation and recannulation of tracheostomy wound was planned under general anaesthesia and the case was managed successfully.

Research paper thumbnail of Gabapentin provides effective postoperative analgesia whether administered pre-emptively or post-incision

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2005

We investigated the effects of pre-incision and postincision administration of gabapentin on post... more We investigated the effects of pre-incision and postincision administration of gabapentin on postoperative pain and fentanyl consumption associated with open donor nephrectomy. Methods: Sixty ASA I subjects were randomly allocated into three groups to receive gabapentin 600 mg two hours before surgery and placebo after surgical incision (pre-incision group), placebo two hours before surgery and gabapentin 600 mg after surgical incision (post-incision group), or placebo two hours before surgery and after surgical incision (placebo group). After surgery, pain was assessed using a visual analogue scale (VAS), (1-10 cm) at time points 0, 6, 12, 18, and 24 hr. Subjects received patient-controlled-analgesia (fentanyl 1.0 µg•kg-1 subject activated dose). Total fentanyl consumption in each group was recorded. Results: Subjects of pre-incision and post-incision groups had lower VAS scores at all time points (3.

Research paper thumbnail of Efficacy of Granisetron and Granisetron Plus Dexamethasone as Pre - Emptive Anti - Emetic Therapy for Ponv in Patients Undergoing General Anesthe Sia for Abdominal Surgery : A Controlled, Prospective & Randomized Study

Journal of Evolution of medical and Dental Sciences, 2015

BACKGROUND: Abdominal surgeries are associated with a very high rate of postoperative nausea and ... more BACKGROUND: Abdominal surgeries are associated with a very high rate of postoperative nausea and vomiting (PONV), which can lead to dehydration, electrolyte-imbalance, aspiration-pneumonitis and wound-dehiscence, thereby delaying patient’s recovery and prolonging hospital stay. OBJECTIVES: This study was designed to compare the effectiveness of granisetron alone and in combination with dexamethasone for prevention of PONV in patients undergoing general anesthesia for abdominal surgeries as well as recognizing the limitations of routine antiemetic prophylaxis with a multimodal approach to anti-emesis. MATERIALS & METHODS: In this prospective, randomized and controlled study 75 patients undergoing general anesthesia for abdominal surgeries were randomly allocated to one of the three groups of 25 patients each. Group G received granisetron 40μg/kg, group G+D received granisetron 40μg/kg+dexamethasone 0.1mg/kg and group C received normal saline intravenously, before induction of anesthe...