Saipriya Tewari - Academia.edu (original) (raw)

Papers by Saipriya Tewari

Research paper thumbnail of In Response to Font et Al

Pain Physician, May 1, 2016

Research paper thumbnail of Serratus Anterior Plane Block: A New Analgesic Technique for Post-Thoracotomy Pain

May 2015, 2015

Pain following thoracotomy is of moderate to severe nature. Management of thoracotomy pain is a c... more Pain following thoracotomy is of moderate to severe nature. Management of thoracotomy pain is a challenging task. Post thoracotomy pain has acute effects in the post operative period by affecting respiratory mechanics, which increases the morbidity. Poorly controlled thoracotomy pain in the acute phase may also lead to the development of a chronic pain syndrome. A young male patient underwent esophagectomy and esophago-gastric anastomosis for corrosive stricture of the esophagus. Epidural analgesia is standard of care for patients undergoing thoracotomy. Due to hypotension and fluid losses following surgery, he was maintained on intravenous sedatoanalgesia during postoperative mechanical ventilation. The thoracic epidural catheter which was placed pre-operatively, had developed blockage during the hospital stay. However, during weaning from ventilation and sedation, he indicated severe pain in the thoracotomy incision. The pain was severe enough to impair tidal breathing. We wanted ...

Research paper thumbnail of Collusion: The Facade and its Implications on Total Pain Management in Palliative Care

Indian Journal of Palliative Care, 2021

Collusion is an unharmonious bond between the doctor and a patient or between patients and caregi... more Collusion is an unharmonious bond between the doctor and a patient or between patients and caregivers. This case report exemplifies one such experience and highlights the hurdles we face when dealing with collusion. A 31-year-old woman was diagnosed with rectal carcinoma during her pregnancy and underwent diversion colostomy (for intestinal obstruction) followed by neoadjuvant chemoradiation after delivery. Later, she was diagnosed with metastatic disease and was under palliative care. The family always had a negative association with cancer and chose to withhold information from the patient throughout the treatment trajectory. Collusion and lack of information can be a factor for persisting total pain. While caregivers desire to protect the patient from the distress of a life-limiting diagnosis, invariably it causes more anguish than comfort. Oncology professionals need to consider collusion as part of our sociocultural fabric and develop a strategy to negotiate and improve the care.

Research paper thumbnail of Near total airway obstruction due to tracheal granulations: an anesthesiologist’s nightmare

A 17 year old boy, post tracheoplasty, presented to emergency in respiratory distress with presen... more A 17 year old boy, post tracheoplasty, presented to emergency in respiratory distress with presence of stridor at rest. Flexible bronchoscopy revealed granulations at tracheal graft site causing airway stenosis. The presence of graft perculded use of invasive surgical approaches due to risk of damage.The anesthetic management options in this case carried inherent risks of causing total airway obstruction and impairing surgical access. We decided to perform the electrocauterization of tracheal granulations using subglottic jet ventilation while placing the catheter above the stenotic trachea.

Research paper thumbnail of Fluoroscopy-Guided Iliopsoas Injection: A Modified Approach

Pain Practice, 2016

To the Editor: Myofascial pain in the iliopsoas is a common cause of low back and pelvic pain. In... more To the Editor: Myofascial pain in the iliopsoas is a common cause of low back and pelvic pain. Injection of the iliopsoas muscle is a well-known procedure for relieving myofascial pain arising secondary to its involvement. Iliopsoas is a deep muscle, which offers core support to the spine among other musculature. It is composed of the iliacus and psoas muscles. The psoas takes its origin from the T12 vertebra and runs downward, getting muscle fibers from the first 4 lumbar vertebrae, to insert into the lesser trochanter of femur. The iliacus arises from the iliac bone, to attach into the lesser trochanter. The commonly described fluoroscopic technique of injecting the iliopsoas mandates placement of needle at the level of L3 vertebra, 5 cm lateral to the spinous process.

Research paper thumbnail of Integrating psycho-oncology services in cancer care in India

Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocia... more Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocial issues would enhance treatment compliance, physician–patient relationship, treatment efficacy and quality of life. This article emphasizes the importance of integrating psycho-oncology services in cancer care and attempts to define the various roles that a psycho-oncologist can play across the entire trajectory. It also highlights the indispensable role played by the oncologists' referrals in maximizing the benefits of psycho-oncology services received by patients and their caregivers.

Research paper thumbnail of Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele

Annals of Cardiac Anaesthesia

Large posterior mediastinal masses may lead threatening complications such as critical tracheobro... more Large posterior mediastinal masses may lead threatening complications such as critical tracheobronchial compression. Airway management in these individuals is a challenge and being a lower airway obstruction; rescue strategies are limited. We encountered one such case of a large esophageal mucocele causing extrinsic tracheobronchial compression. We have described the anesthetic management of this case using awake fiber-optic assessment followed by intubation. Close communication with the surgical team, meticulous planning of airway management, and early drainage of the mucocele are the cornerstones of management in such patients.

Research paper thumbnail of Painful trigeminal neuropathy in patients with invasive fungal sinusitis post COVID‐19 infection

Research paper thumbnail of A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Anesthesia: Essays and Researches

Research paper thumbnail of Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature

Indian Journal of Anaesthesia

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumour... more Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.

Research paper thumbnail of Role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pain

Indian Journal of Clinical Anaesthesia

To evaluate the role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pa... more To evaluate the role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pain Introduction: Radiofrequency neurotomy of the genicular nerves is a novel technique for the alleviation of knee pain in patients with advanced osteoarthritis (OA). The efficacy of radiofrequency neurotomy may be enhanced by prior positive diagnostic genicular block. To date, genicular nerve injections have been performed under fluoroscopic guidance, in which needle is placed with reference to bony landmarks. Ultrasound-guided genicular nerve injections have recently been shown to be accurate. In the present study, we have evaluated the role of ultrasound (US) to achieve successful diagnostic genicular nerve block. Materials and Methods: 20 patients (age 50-80 years) with advanced knee osteoarthritis pain (kellgran Lawrence grade 3-4) who failed conservative treatment underwent ultrasound guided genicular nerve block. The genicular nerve block was performed on a total of 24 knees. Visual analogue scale (VAS) of pain of each was assessed before and 2 hours after the procedure. Results: VAS scores were found to reduce from 75.23±12.89 mm to 29.52± 10.71 mm post-procedure (P<0.05). 22 out of 24 knees (91.7%) got >50% pain relief. Conclusion: Ultrasound is a valuable tool for performing the diagnostic genicular block of the knee.

Research paper thumbnail of Ultrasound as a point-of-care tool for early detection of potential complications like pneumothorax associated with the pectoralis block

Indian Journal of Anaesthesia, 2017

Research paper thumbnail of Ultrasound as a point-of-care tool for early detection of potential complications like pneumothorax associated with the pectoralis block

Indian journal of anaesthesia, 2017

Research paper thumbnail of Intercostal Neuralgia Occurring as a Complication of Splanchnic Nerve Radiofrequency Ablation in a Patient with Chronic Pancreatitis

Pain physician, 2017

Our intent is to report a case of intercostal neuralgia occuring as a complication of splanchnic ... more Our intent is to report a case of intercostal neuralgia occuring as a complication of splanchnic radiofreqency ablation (RFA), due to a breach in the integrity of the insulating sheath of the RFA needle.A 48-year-old man presented to our pain clinic with upper abdominal pain due to chronic pancreatitis, recalcitrant to medical management. We decided to perform bilateral splanchnic nerve RFA in this patient. After confirmation of bilateral correct needle placement under fluoroscopic guidance and sensorimotor testing, RFA was performed on the right side uneventfully. However, during RFA on the left side, the patient experienced severe pain in the epigastric region. A bolus of fentanyl 50 µg was given intravenously in order to minimise discomfort, and RFA was performed. In the post-procedure period, the patient described severe pain in the left subcostal and epigastric region, with features suggestive of intercostal neuralgia of the left 11th intercostal nerve. We went back and analyse...

Research paper thumbnail of Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature

Indian Journal of Anaesthesia

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumour... more Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.

Research paper thumbnail of Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele

Annals of Cardiac Anaesthesia

Large posterior mediastinal masses may lead threatening complications such as critical tracheobro... more Large posterior mediastinal masses may lead threatening complications such as critical tracheobronchial compression. Airway management in these individuals is a challenge and being a lower airway obstruction; rescue strategies are limited. We encountered one such case of a large esophageal mucocele causing extrinsic tracheobronchial compression. We have described the anesthetic management of this case using awake fiber-optic assessment followed by intubation. Close communication with the surgical team, meticulous planning of airway management, and early drainage of the mucocele are the cornerstones of management in such patients.

Research paper thumbnail of A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Anesthesia: Essays and Researches

Research paper thumbnail of Entropy vs standard clinical monitoring using total intravenous anesthesia during transvaginal oocyte retrieval in patients for in vitro fertilization

Journal of clinical anesthesia, 2016

Day care surgery is an important arena for monitors of anesthetic depth where minimizing drug use... more Day care surgery is an important arena for monitors of anesthetic depth where minimizing drug use is essential for rapid turnover. Underdosage, on the other hand, carries the risks of intraoperative awareness and pain. Transvaginal oocyte retrieval (TVOR), often performed under total intravenous anesthesia using propofol and fentanyl in Indian patients, is a procedure of special interest because, in addition to the above concerns, toxic effects of propofol on oocytes have been described. We have studied the role of entropy monitor, a depth of anesthesia monitor, in optomising drug titration and facilitating distinction between analgesic and hypnotic components of anesthesia. Prospective randomized controlled study. Operating theater and postoperative recovery area. One hundred twenty American Society of Anesthesiologists class I and II female patients coming to the IVF centre for TVOR under total intravenous anesthesia using propofol and fentanyl. They were randomly allocated into 2...

Research paper thumbnail of Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome

The Korean Journal of Pain, 2016

Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction path... more Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire-9 (PHQ-9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology.

Research paper thumbnail of Airway management in Hurler's syndrome: A persistent challenge for anaesthesiologists

Indian journal of anaesthesia, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Research paper thumbnail of In Response to Font et Al

Pain Physician, May 1, 2016

Research paper thumbnail of Serratus Anterior Plane Block: A New Analgesic Technique for Post-Thoracotomy Pain

May 2015, 2015

Pain following thoracotomy is of moderate to severe nature. Management of thoracotomy pain is a c... more Pain following thoracotomy is of moderate to severe nature. Management of thoracotomy pain is a challenging task. Post thoracotomy pain has acute effects in the post operative period by affecting respiratory mechanics, which increases the morbidity. Poorly controlled thoracotomy pain in the acute phase may also lead to the development of a chronic pain syndrome. A young male patient underwent esophagectomy and esophago-gastric anastomosis for corrosive stricture of the esophagus. Epidural analgesia is standard of care for patients undergoing thoracotomy. Due to hypotension and fluid losses following surgery, he was maintained on intravenous sedatoanalgesia during postoperative mechanical ventilation. The thoracic epidural catheter which was placed pre-operatively, had developed blockage during the hospital stay. However, during weaning from ventilation and sedation, he indicated severe pain in the thoracotomy incision. The pain was severe enough to impair tidal breathing. We wanted ...

Research paper thumbnail of Collusion: The Facade and its Implications on Total Pain Management in Palliative Care

Indian Journal of Palliative Care, 2021

Collusion is an unharmonious bond between the doctor and a patient or between patients and caregi... more Collusion is an unharmonious bond between the doctor and a patient or between patients and caregivers. This case report exemplifies one such experience and highlights the hurdles we face when dealing with collusion. A 31-year-old woman was diagnosed with rectal carcinoma during her pregnancy and underwent diversion colostomy (for intestinal obstruction) followed by neoadjuvant chemoradiation after delivery. Later, she was diagnosed with metastatic disease and was under palliative care. The family always had a negative association with cancer and chose to withhold information from the patient throughout the treatment trajectory. Collusion and lack of information can be a factor for persisting total pain. While caregivers desire to protect the patient from the distress of a life-limiting diagnosis, invariably it causes more anguish than comfort. Oncology professionals need to consider collusion as part of our sociocultural fabric and develop a strategy to negotiate and improve the care.

Research paper thumbnail of Near total airway obstruction due to tracheal granulations: an anesthesiologist’s nightmare

A 17 year old boy, post tracheoplasty, presented to emergency in respiratory distress with presen... more A 17 year old boy, post tracheoplasty, presented to emergency in respiratory distress with presence of stridor at rest. Flexible bronchoscopy revealed granulations at tracheal graft site causing airway stenosis. The presence of graft perculded use of invasive surgical approaches due to risk of damage.The anesthetic management options in this case carried inherent risks of causing total airway obstruction and impairing surgical access. We decided to perform the electrocauterization of tracheal granulations using subglottic jet ventilation while placing the catheter above the stenotic trachea.

Research paper thumbnail of Fluoroscopy-Guided Iliopsoas Injection: A Modified Approach

Pain Practice, 2016

To the Editor: Myofascial pain in the iliopsoas is a common cause of low back and pelvic pain. In... more To the Editor: Myofascial pain in the iliopsoas is a common cause of low back and pelvic pain. Injection of the iliopsoas muscle is a well-known procedure for relieving myofascial pain arising secondary to its involvement. Iliopsoas is a deep muscle, which offers core support to the spine among other musculature. It is composed of the iliacus and psoas muscles. The psoas takes its origin from the T12 vertebra and runs downward, getting muscle fibers from the first 4 lumbar vertebrae, to insert into the lesser trochanter of femur. The iliacus arises from the iliac bone, to attach into the lesser trochanter. The commonly described fluoroscopic technique of injecting the iliopsoas mandates placement of needle at the level of L3 vertebra, 5 cm lateral to the spinous process.

Research paper thumbnail of Integrating psycho-oncology services in cancer care in India

Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocia... more Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocial issues would enhance treatment compliance, physician–patient relationship, treatment efficacy and quality of life. This article emphasizes the importance of integrating psycho-oncology services in cancer care and attempts to define the various roles that a psycho-oncologist can play across the entire trajectory. It also highlights the indispensable role played by the oncologists' referrals in maximizing the benefits of psycho-oncology services received by patients and their caregivers.

Research paper thumbnail of Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele

Annals of Cardiac Anaesthesia

Large posterior mediastinal masses may lead threatening complications such as critical tracheobro... more Large posterior mediastinal masses may lead threatening complications such as critical tracheobronchial compression. Airway management in these individuals is a challenge and being a lower airway obstruction; rescue strategies are limited. We encountered one such case of a large esophageal mucocele causing extrinsic tracheobronchial compression. We have described the anesthetic management of this case using awake fiber-optic assessment followed by intubation. Close communication with the surgical team, meticulous planning of airway management, and early drainage of the mucocele are the cornerstones of management in such patients.

Research paper thumbnail of Painful trigeminal neuropathy in patients with invasive fungal sinusitis post COVID‐19 infection

Research paper thumbnail of A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Anesthesia: Essays and Researches

Research paper thumbnail of Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature

Indian Journal of Anaesthesia

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumour... more Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.

Research paper thumbnail of Role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pain

Indian Journal of Clinical Anaesthesia

To evaluate the role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pa... more To evaluate the role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pain Introduction: Radiofrequency neurotomy of the genicular nerves is a novel technique for the alleviation of knee pain in patients with advanced osteoarthritis (OA). The efficacy of radiofrequency neurotomy may be enhanced by prior positive diagnostic genicular block. To date, genicular nerve injections have been performed under fluoroscopic guidance, in which needle is placed with reference to bony landmarks. Ultrasound-guided genicular nerve injections have recently been shown to be accurate. In the present study, we have evaluated the role of ultrasound (US) to achieve successful diagnostic genicular nerve block. Materials and Methods: 20 patients (age 50-80 years) with advanced knee osteoarthritis pain (kellgran Lawrence grade 3-4) who failed conservative treatment underwent ultrasound guided genicular nerve block. The genicular nerve block was performed on a total of 24 knees. Visual analogue scale (VAS) of pain of each was assessed before and 2 hours after the procedure. Results: VAS scores were found to reduce from 75.23±12.89 mm to 29.52± 10.71 mm post-procedure (P<0.05). 22 out of 24 knees (91.7%) got >50% pain relief. Conclusion: Ultrasound is a valuable tool for performing the diagnostic genicular block of the knee.

Research paper thumbnail of Ultrasound as a point-of-care tool for early detection of potential complications like pneumothorax associated with the pectoralis block

Indian Journal of Anaesthesia, 2017

Research paper thumbnail of Ultrasound as a point-of-care tool for early detection of potential complications like pneumothorax associated with the pectoralis block

Indian journal of anaesthesia, 2017

Research paper thumbnail of Intercostal Neuralgia Occurring as a Complication of Splanchnic Nerve Radiofrequency Ablation in a Patient with Chronic Pancreatitis

Pain physician, 2017

Our intent is to report a case of intercostal neuralgia occuring as a complication of splanchnic ... more Our intent is to report a case of intercostal neuralgia occuring as a complication of splanchnic radiofreqency ablation (RFA), due to a breach in the integrity of the insulating sheath of the RFA needle.A 48-year-old man presented to our pain clinic with upper abdominal pain due to chronic pancreatitis, recalcitrant to medical management. We decided to perform bilateral splanchnic nerve RFA in this patient. After confirmation of bilateral correct needle placement under fluoroscopic guidance and sensorimotor testing, RFA was performed on the right side uneventfully. However, during RFA on the left side, the patient experienced severe pain in the epigastric region. A bolus of fentanyl 50 µg was given intravenously in order to minimise discomfort, and RFA was performed. In the post-procedure period, the patient described severe pain in the left subcostal and epigastric region, with features suggestive of intercostal neuralgia of the left 11th intercostal nerve. We went back and analyse...

Research paper thumbnail of Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature

Indian Journal of Anaesthesia

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumour... more Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.

Research paper thumbnail of Anesthetic challenges of extrinsic trachea-bronchial compression due to posterior mediastinal mass: Our experience with a large esophageal mucocele

Annals of Cardiac Anaesthesia

Large posterior mediastinal masses may lead threatening complications such as critical tracheobro... more Large posterior mediastinal masses may lead threatening complications such as critical tracheobronchial compression. Airway management in these individuals is a challenge and being a lower airway obstruction; rescue strategies are limited. We encountered one such case of a large esophageal mucocele causing extrinsic tracheobronchial compression. We have described the anesthetic management of this case using awake fiber-optic assessment followed by intubation. Close communication with the surgical team, meticulous planning of airway management, and early drainage of the mucocele are the cornerstones of management in such patients.

Research paper thumbnail of A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Anesthesia: Essays and Researches

Research paper thumbnail of Entropy vs standard clinical monitoring using total intravenous anesthesia during transvaginal oocyte retrieval in patients for in vitro fertilization

Journal of clinical anesthesia, 2016

Day care surgery is an important arena for monitors of anesthetic depth where minimizing drug use... more Day care surgery is an important arena for monitors of anesthetic depth where minimizing drug use is essential for rapid turnover. Underdosage, on the other hand, carries the risks of intraoperative awareness and pain. Transvaginal oocyte retrieval (TVOR), often performed under total intravenous anesthesia using propofol and fentanyl in Indian patients, is a procedure of special interest because, in addition to the above concerns, toxic effects of propofol on oocytes have been described. We have studied the role of entropy monitor, a depth of anesthesia monitor, in optomising drug titration and facilitating distinction between analgesic and hypnotic components of anesthesia. Prospective randomized controlled study. Operating theater and postoperative recovery area. One hundred twenty American Society of Anesthesiologists class I and II female patients coming to the IVF centre for TVOR under total intravenous anesthesia using propofol and fentanyl. They were randomly allocated into 2...

Research paper thumbnail of Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome

The Korean Journal of Pain, 2016

Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction path... more Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire-9 (PHQ-9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology.

Research paper thumbnail of Airway management in Hurler's syndrome: A persistent challenge for anaesthesiologists

Indian journal of anaesthesia, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.