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Papers by Sonia Bansal

Journal of Neuroanaesthesiology and Critical Care, 2021

Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in ps... more Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders pr...

Journal of Neurosciences in Rural Practice

Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraope... more Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS). Methods This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure. Results A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The I...

Introduction: The Surgical Apgar Score (SAS) was developed as a tool to predict morbidity and mor... more Introduction: The Surgical Apgar Score (SAS) was developed as a tool to predict morbidity and mortality after surgery, incorporating three intraoperative variables [heart rate, mean arterial blood pressure (MAP), and estimated blood loss (EBL)] to identify patients at the highest risk of postoperative complications and death. We conducted this study to determine the usefulness of SAS in predicting postoperative complications in patients undergoing elective cranial neurosurgical procedures. Materials & Methods: In this retrospective study, data of 150 adult patients (aged above 18) undergoing elective neurosurgical procedures was retrieved. The primary endpoint of our study was the occurrence of major complications or mortality within 30 days of the index surgery. Results: The patients’ mean age was 42 years (± 14.8) and 44.7% of those patients were females. The overall mortality rate for the cohort was 3.33% (five out of 150) and 105 patients (70%) had developed one or more complica...

Journal of Neuroanaesthesiology and Critical Care, Apr 13, 2020

Vasoconstrictors are commonly administered with local anesthetics (LAs) to decrease intraoperativ... more Vasoconstrictors are commonly administered with local anesthetics (LAs) to decrease intraoperative bleeding. However, inadvertent systemic absorption of adrenaline is not uncommon and is associated with significant hemodynamic consequences and arrhythmias, which are usually inconsequential. We report a case of suspected intravascular adrenaline absorption in a 1-year-old girl with craniosynostosis, which led to subarachnoid hemorrhage, herniation, and death.

20th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care (ISNACC)

Materials and Methods: Perioperative data of infants and children who had undergone craniosynosto... more Materials and Methods: Perioperative data of infants and children who had undergone craniosynostosis correction surgery by a single surgical team over a period of 10 years were retrospectively collected after IRB approval. Results: There were 22 patients, of whom 9 (40.9%) were females; Mean age-21.4 months; weight of 8.6 kg. The most common suture involved was coronal in 18 (81.8%), followed by sagittal 13 (59.1%), metopic in 12 (54.6%), and lambdoid in 11 (50%). Seven (31.8%) infants had all four-suture involvement, two had three sutures, seven had two sutures, and six had single-suture involvement. Of these, 13 (59.1%) were syndromic (Crouzon's, Apert's, and Down's syndromes). Sevoflurane induction was performed in 17 (77.3%), and rest had intravenous induction. Anesthesia was maintained with inhalational in 18 (81.8%), and 4 (18.2%) had combination of IV and inhalational agents. Eighteen (81.8%) had an anticipated difficult airway; of these, 5 had CL grade of 3, most of them (4/5) were syndromic. Average blood loss was 40.9 mL/kg; syndromic group had higher loss 51.2 mL/kg vs. 25.9 mL/kg (p = 0.049). Three out of 22 patients did not receive tranexamic acid, these children had increased blood loss 68.3 vs. 36.5 mL/kg (p = 0.09). Hypofibrinogenemia was the most common coagulation abnormality. Those who had intraoperative coagulation abnormality had higher blood loss, 58.0 mL/kg vs. 29.7 mL/kg (p = 0.004). 14/22 (64%) had intraoperative hypotension requiring nor-adrenaline infusion. Few (2/22) had both noradrenaline and adrenaline. Children who had intraoperative ABG (15/22), six (40%) had lactate of > 2 mmol/L. Hyperchloremia (45.4%) was the most commonly observed electrolyte abnormality, followed by hypocalcemia. Average duration of anesthesia was 352 minutes. There was no correlation between the number of sutures involved and the duration of surgery (p = 0.418) nor with the blood loss (p = 0.331). Four (18%) out of 22 children had postoperative ventilation. The mean ICU and hospital stays were 1.7 and 5 days, respectively. Seven out of 22 had postoperative coagulation profile, of whom 1 had both low levels of fibrinogen and a prolonged APTT and 4 had purely hypofibrinogenemia; 1 had thrombocytopenia. No postoperative complication or death noted in these series. Conclusions: Anticipation, adequate preparation for airway and blood loss, administration of titrated anesthetic, maintenance of hemodynamics, and timely administration of tranexamic acid and blood and blood products reduced the complication in these children.

Journal of Neuroanaesthesiology and Critical Care

Background: Coagulopathy in isolated traumatic brain injury (TBI) is well-known, and studies have... more Background: Coagulopathy in isolated traumatic brain injury (TBI) is well-known, and studies have found an association between coagulopathy and unfavourable outcomes. This study was conducted to determine the incidence and causes of coagulopathy in patients with TBI undergoing craniotomy and its effect on post-operative outcome. Materials and Methods: The data collected was demographics, computed tomography diagnosis, post-resuscitation Glasgow Coma Scale (GCS) score, pre- and post-operative platelet count, liver function tests, intraoperative blood loss and transfusion, fluids infused and incidence of redo surgery. Point of care (Coaguchek XS) monitor was used to obtain prothrombin time and international normalised ratio (INR) at 24 h and 72 h of injury. Coagulopathy was defined as INR ≥1.3 and thrombocytopenia as platelet count ≤100,000/mcL. Outcome measures assessed were the length of hospital stay, GCS at discharge and in-hospital mortality. Results: In 166 patients, the average...

15th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care

Asian Journal of Psychiatry

OBJECTIVE To examine the differences in whole brain topology and connectivity in 17 children of t... more OBJECTIVE To examine the differences in whole brain topology and connectivity in 17 children of the ages 3-8 years across severity of ASD, we performed resting state fMRI using a 3T MRI scanner and graph theoretical analysis of networks. METHOD Patients were partitioned into two cohorts based on the severity of ASD, determined using the Childhood Autism Rating Scale (CARS) scores (Mild, 30-36; Severe, 37+). Standard preprocessing pipeline was used, followed by independent component analysis (ICA) to identify regions of interest (ROIs) to construct subject-specific Z-correlation matrices representing the whole brain network. Following which, graph theory measures were calculated in the range of sparsity 6%-35% and statistically analyzed, and corrected for significance (FDR corrected, p < 0.05). Regional clustering coefficient that revealed significant between-group (mild vs. severe) differences were correlated against clinical scores (CARS). RESULTS Children with severe ASD revealed significantly increased clustering coefficient and small-worldness compared to those with mild or moderate ASD. Region of interest analysis revealed altered clustering in the Heschl's gyrus that significantly correlated with CARS scores. CONCLUSION The findings from the current study provide early stage evidence of aberrant brain connectivity appearing in severe ASD, prior to the effect of environmental bias and pruning mechanisms. The clustering of the Heschl's gyrus correlated to the severity of ASD symptoms and agrees with current literature on ASD-associated cortical changes, reflecting early changes to language processing regions.

Journal of Neurosurgical Anesthesiology

Supplemental Digital Content is available in the text. Background: There is paucity of literature... more Supplemental Digital Content is available in the text. Background: There is paucity of literature on the prognostic value of tissue oxygen saturation (StO2) and regional cerebral oxygen saturation (rSO2) in neurological patients with sepsis. In this preliminary study, we investigated the prognostic value of StO2 and rSO2 in a group of neurological patients and correlated StO2 and rSO2 with hemodynamic and metabolic parameters. Materials and Methods: This preliminary, prospective observational study was conducted in 45 adult neurological patients admitted to intensive care unit. Once a diagnosis of sepsis or septic shock was established, parameters of oxygenation (StO2, rSO2, central venous oxygen saturation [ScvO2]), serum lactate, illness severity scores (Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, Glasgow Coma Scale) were recorded at 0, 6, 12, 24, 36, and 48 hours, and once daily thereafter. Outcomes were in-hospital mortality attributable to sepsis and the Glasgow outcome score at hospital discharge. Results: There was a moderately positive correlation between StO2 and rSO2 at baseline (r=0.599; P=0.001). StO2, illness severity scores and serum lactate, but not rSO2, were significantly different between survivors (n=29) and nonsurvivors (n=16) at baseline and during the first 48 hours. An rSO2 of 62.5% had a sensitivity of 83% and specificity of 67% to differentiate survivors and nonsurvivors of septic shock at 48 hours. StO2 had a higher correlation with ScvO2 and serum lactate than rSO2. Conclusions: StO2 prognosticates survival and favorable/unfavorable outcomes in neurological patients with sepsis. The role of rSO2 in predicting survival in milder form of sepsis is doubtful.

Journal of neurosurgical anesthesiology, Jan 5, 2017

Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nocic... more Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nociception Index (ANI) monitor based on the high frequency component of heart rate variability has been launched into clinical practice. We monitored analgesia during craniotomy using ANI monitor and compared it with cardiovascular parameters and response entropy (RE) of entropy monitor. In 21 patients undergoing a craniotomy for a supratentorial lesion, we monitored ANI, heart rate (HR), mean arterial pressure (MAP), state entropy, and RE throughout the surgery. Also, ANI, hemodynamic variables and spectral entropy values were noted at the times of maximal stimulation, such as induction, intubation, head pin fixation, skin incision, craniotomy, durotomy, and skin closure. We also compared ANI with RE during administration of bolus doses of fentanyl. There was an inverse correlation between ANI values and the hemodynamic changes. When the HR and MAP increased, ANI decreased suggesting a good...

Journal of Neuroanaesthesiology and Critical Care

Background: Illness severity scoring systems (SSs) are increasingly being used to provide informa... more Background: Illness severity scoring systems (SSs) are increasingly being used to provide information about patients’ severity of illness and outcome in terms of mortality or length of Intensive care Unit (ICU) and hospital stay. In this retrospective study, we compared the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE) II and IV, Simplified Acute Physiology Score (SAPS), Mortality Prediction Model at 24 h and Glasgow Coma Scale (GCS) with actual in-hospital 28 day mortality in patients admitted to neuro-ICU over a period of 6 months. Methods: The data required for calculation of above scores was retrieved from medical records. The 28-day post-admission outcome including in-hospital mortality was measured by Glasgow Outcome Scale (GOS). Logistic regression was used to determine the mortality prediction power of each SS. Results: A total of 197 adult patients with varied neurological diagnosis were included in this study. The in-hospital 28-day mortality ...

Journal of Neurosurgical Anesthesiology, 2017

ETCO2, such as inadequate ventilation, increase in dead space, and increased metabolism such as f... more ETCO2, such as inadequate ventilation, increase in dead space, and increased metabolism such as fever, partial muscle relaxation, and exhausted soda lime causing partial rebreathing were all ruled out in our case. We postulate that in presence of raised ICP, to maintain a constant cerebral blood flow, the body reacts by increasing the systemic vascular resistance (SVR).1,2 This increase in SVR diverts the systemic splanchnic blood to pulmonary circulation, thereby increasing the cardiac output to maintain a constant cerebral perfusion pressure. This increase in pulmonary blood flow will increase the ETCO2 and decreases the pulmonary compliance.3–5 In our case, the increase in ETCO2 despite an adequate ventilatory setting could be due to the above-mentioned effect. After the ventricular tapping, a transient decrease in blood pressure and an improvement in ventilation (ETCO2 decrease) could be explained by a decrease in SVR and causing decrease in pulmonary blood flow. From this case, we wanted to highlight that aggressive ventilation to maintain a normal ETCO2 can dangerously increase the ICP by increasing the airway pressure, especially in neonates with poor intracranial compliance. One limitation of this report is that we did not perform a blood gas test to determine the correlation between the arterial CO2 and ETCO2.

Indian Journal of Neurotrauma, 2016

Journal of Anaesthesiology Clinical Pharmacology, 2015

Background and Aims: Electroconvulsive therapy (ECT) is an established modality of treatment for ... more Background and Aims: Electroconvulsive therapy (ECT) is an established modality of treatment for severe psychiatric illnesses. Among the various complications associated with ECT, oxygen desaturation is often under reported. None of the previous studies has evaluated the predictive factors for oxygen desaturation during ECT. The objective of this study was to evaluate the incidence of oxygen desaturation during recovery from anesthesia for modified ECT and evaluate its risk factors in a large sample. Materials and Methods: All patients aged above 15 years who were prescribed a modified ECT for their psychiatric illness over 1 year were prospectively included in this observational study. The association between age, body mass index (BMI), doses of thiopentone and suxamethonium, stimulus current, ECT session number, pre-and post-ECT heart rate and mean arterial pressure, seizure duration, and pre-and post ECT oxygen saturation, was systematically studied. Results: The incidence of oxygen desaturation was 29% (93/316 patients). Seizure duration and BMI were found to be significantly correlated with post ECT desaturation. Conclusion: In this prospective observational study, the incidence of oxygen desaturation during recovery from anesthesia for ECT was high. The study identified obesity and duration of seizure as the independent predictors of this complication. This knowledge is likely to help in identifying and optimizing such patients before subsequent ECT sessions.

The Indian Journal of Neurotrauma, 2014

ABSTRACT Post-traumatic acute subdural hematoma (ASDH) requires immediate surgical evacuation in ... more ABSTRACT Post-traumatic acute subdural hematoma (ASDH) requires immediate surgical evacuation in most cases. We present two cases of ASDH which resolved spontaneously. The first patient had 9 mm thick ASDH in left fronto-temporo-parietal region with initial GCS of E1V1M3 which improved to E2VtM4 within 7 h. Repeat CT of the brain showed a decrease in the size of ASDH. Hence, patient was conservatively managed with anti-edema measures and elective ventilation. The patient improved and ASDH also resolved completely. The second patient also had 8 mm thick ASDH in the right fronto-temporo-parietal region with GCS of E1V2M5 which 5 h later improved to E3V4M5. With conservative measures, there was clinical and radiological improvement. Based on previous reports, certain characteristic features have been shown to favor spontaneous resolution of ASDH; absence of underlying contusion and the presence of a low-density band between the skull and the hematoma on imaging were features common to our patients also.

Journal of Neurosurgical Anesthesiology, 2012

The requirement of anesthetic drugs in a patient with an intracranial space-occupying lesion is o... more The requirement of anesthetic drugs in a patient with an intracranial space-occupying lesion is of relevance to the neuroanesthetist. The requirement is often presumed to have reduced or at least altered. However, not much research has focused on this issue. Hence, we conducted this study to examine whether intracranial tumors reduce the induction dose of propofol in patients undergoing craniotomy based on plasma and effect site concentrations (Ce) of propofol and the effect of additional fentanyl. A total of 80 patients were recruited into the study. The study group included patients with supratentorial tumors undergoing craniotomy, and the control group consisted of patients undergoing spinal surgeries. Patients in each group were randomized further to receive propofol alone or propofol preceded by fentanyl for induction of anesthesia. They were divided into the following groups: patients with supratentorial tumor receiving only propofol (group T1), or fentanyl and propofol (group T2); patients who were undergoing spinal surgery and receiving only propofol (group S1) or fentanyl and propofol (group S2). Anesthesia was induced with infusion of propofol through a Target Controlled Infusion pump. At the point of loss of verbal contact, plasma concentration (Cp) and Ce of propofol, time taken for loss of consciousness, and the total dose of propofol required were noted. Hemodynamic variables were recorded before and after induction of anesthesia. There were 19, 21, 19, and 21 patients in groups TI, T2, S1, and S2, respectively. In group T2 the Cp, Ce, time to loss of verbal contact, and dose required for induction were all significantly lower compared with the other groups. There were no significant differences in the study parameters between T1 and S1, whereas the differences were significant between T2 and S2 (Cp: 3.9±1.1 vs. 4.9±1.2 μg/mL; Ce: 2.6±1.0 vs. 3.7±1.2 μg/mL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Propofol dose for induction of anesthesia was significantly reduced when administered after fentanyl in patients with supratentorial tumors. Tumors per se without fentanyl coadministration do not decrease the propofol requirement for induction of anesthesia.

Journal of Neurosurgical Anesthesiology, 2014

To JNA Readers: A 60-year-old man presented with history of a fall 6 months back after which he d... more To JNA Readers: A 60-year-old man presented with history of a fall 6 months back after which he developed neck pain, lower limb weakness, and urinary retention. There were no respiratory complaints. Medical history was not significant. Hypertonia was present in both the lower limbs with power of 3/5. The lungs were clear on auscultation. Magnetic resonance imaging of the spine revealed cord compression at the cervical (C3-C5) and thoracic (T10) levels. Laminectomy at T10T11 and excision of T10-T12 ossified ligamentum flavum were planned. X-ray reports of the chest showed bilateral upper-zone focal abnormalities with fibrotic bands and emphysematous changes. Computed tomography scan of the chest showed bilateral gross pleural thickening, upper-zone lesions with fibrotic strands, and calcified mediastinal lymph nodes (Fig. 1A). On the right side, multiple large emphysematous bullae were seen (Fig. 1B). Radiologic findings were suggestive of pulmonary tuberculosis. Pulmonary function test revealed severe restriction. In view of emphysematous bullae, general anesthesia (GA) with spontaneous respiration was planned to avoid positive pressure ventilation (PPV). Patient was premedicated with 0.2mg of glycopyrrolate and 1mg of midazolam intravenously. Airway was anesthetized with 4% lignocaine nebulization, topical 10% spray, and transtracheal block. A dosage of 50mg of propofol and a dosage of 40mg IV fentanyl were given to facilitate intubation. Anesthesia was maintained using 1% to 2% sevoflurane and O2 with air (35:75). Analgesia was provided with fentanyl boluses. Throughout the procedure, spontaneous respiration was maintained (respiratory rate 8 to 12/min, end tidal carbon dioxide 40 to 42mm Hg). Airway pressures and systemic parameters were monitored carefully to diagnose the occurrence of pneumothorax at the earliest. Postoperatively, patient was breathing comfortably with no new complications. Bulla is a pathologic entity caused by a confluence of 2 or more terminal elements of bronchial tree. It may get infected or enlarge progressively and may lead to pneumothorax. It exists frequently in conditions like tuberculosis. Various anesthetic techniques have been tried in patients with bullae presenting for extrathoracic surgery such as GA with double-lumen tube,1 inhalational anesthetics and spontaneous ventilation,2 and awake craniotomy using dexmedetomidine sedation. Iwakura et al used spontaneous ventilation, although initially succinylcholine was used to facilitate intubation. Because of preoperative paraparesis, we avoided succinylcholine. To blunt airway reflexes, we used topical anesthesia and airway blocks. In another case report, authors have used laryngeal mask airway with epidural catheter in a spontaneously breathing patient. We did not consider regional anesthesia, despite being a good option in patients with lung bulla, in view of preoperative limb weakness. Placing a patient in prone position presents significant challenges to the anesthetist. A decrease in the mean arterial pressure, stroke volume, and the cardiac index can occur. Abdominal compression can worsen the obstruction to inferior vena cava leading to an increased surgical-site bleeding. Accidental extubation and endotracheal tube obstruction are other feared complications. Prone position increases functional residual capacity and improves oxygenation by reducing the ventilation perfusion mismatch. Spontaneous breathing can have synergistic effect with prone position. Active

Acta Neurochirurgica, 2015

The Glasgow Coma Scale (GCS) is considered the gold standard for assessment of unconsciousness in... more The Glasgow Coma Scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury (TBI) against which other scales are compared. To overcome the disadvantages of GCS, the Full Outline Of Unresponsiveness (FOUR) score was proposed. We aimed to compare the predictability of FOUR score and GCS for early mortality, after moderate and severe TBI. This is a prospective observational study of patients with moderate and severe TBI. Both FOUR and GCS scores were determined at admission. The primary outcome was mortality at the end of 2 weeks of injury. A total of 138 (117 males) patients were included in the study. Out of these, 17 (12.3 %) patients died within 2 weeks of injury. The mean GCS and FOUR scores were 9.5 (range, 3-13) and 11 (0-16), respectively. The total GCS and FOUR scores were significantly lower in patients who did not survive. At a cut-off score of 7 for FOUR score, the AUC was 0.97, with sensitivity of 97.5 and specificity of 88.2 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). For GCS score, AUC was 0.95, with sensitivity of 98.3 % and specificity of 82.4 % with cut-off score of 6 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The correlation coefficient was 0.753 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) between the GCS and FOUR scores. The predictive value of the FOUR score on admission of patients with TBI is no better than the GCS score.

Journal of Neurosurgical Anesthesiology, 2016

In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general ... more In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general anesthesia (GA) and local anesthesia with or without sedation are used for the surgical treatment of CSDH. Sedation with dexmedetomidine has been safely used for various diagnostic and therapeutic procedures. However, its effectiveness against GA has not been evaluated for surgical treatment of CSDH. We tried to compare dexmedetomidine sedation technique with the GA technique for surgical treatment of CSDH. In this prospective-randomized study, 76 patients undergoing surgery for CSDH were divided into 2 groups using computer-generated randomized tables; Dex group ([n=38]; received IV bolus of dexmedetomidine 1 mcg/kg over 10 min followed by maintenance infusion 0.5 mcg/kg/h) and GA group ([n=38; of which 4 patients were dropped out]; received endotracheal intubation with balanced anesthesia). Both anesthesia techniques (Dex group; n=35/38 [92.1%] and GA group; n=34/34 [100%]) were successfully used for surgical treatment of CSDH. Significantly less time for anesthesia onset (14.2±4.2 vs. 20.5±3.4 min, P=0.001), total duration of surgery (77.1±23.9 vs. 102.7± 24.8 min, P=0.001), and recovery from anesthesia (7.4±5.9 vs. 13.2±6.5 min, P=0.004) was observed in the Dex group compared with GA group. Perioperative hemodynamic fluctuations were more common in the GA group as against the Dex group. Postoperative complications (n=2 vs. 9, P=0.021) and length of hospital stay (1.05±0.23 vs. 1.79±2.1 d, P=0.007) were significantly less in the Dex group as against the GA group. Dexmedetomidine sedation with local anesthesia is a safe and effective technique for burr hole and evacuation of CSDH. It is associated with significantly shorter operative time, lesser hemodynamic fluctuations, postoperative complications, and length of hospital stay, thus it is a better alternative to GA.

Journal of Neuroanaesthesiology and Critical Care, 2021

Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in ps... more Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders pr...

Journal of Neurosciences in Rural Practice

Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraope... more Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS). Methods This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure. Results A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The I...

Introduction: The Surgical Apgar Score (SAS) was developed as a tool to predict morbidity and mor... more Introduction: The Surgical Apgar Score (SAS) was developed as a tool to predict morbidity and mortality after surgery, incorporating three intraoperative variables [heart rate, mean arterial blood pressure (MAP), and estimated blood loss (EBL)] to identify patients at the highest risk of postoperative complications and death. We conducted this study to determine the usefulness of SAS in predicting postoperative complications in patients undergoing elective cranial neurosurgical procedures. Materials & Methods: In this retrospective study, data of 150 adult patients (aged above 18) undergoing elective neurosurgical procedures was retrieved. The primary endpoint of our study was the occurrence of major complications or mortality within 30 days of the index surgery. Results: The patients’ mean age was 42 years (± 14.8) and 44.7% of those patients were females. The overall mortality rate for the cohort was 3.33% (five out of 150) and 105 patients (70%) had developed one or more complica...

Journal of Neuroanaesthesiology and Critical Care, Apr 13, 2020

Vasoconstrictors are commonly administered with local anesthetics (LAs) to decrease intraoperativ... more Vasoconstrictors are commonly administered with local anesthetics (LAs) to decrease intraoperative bleeding. However, inadvertent systemic absorption of adrenaline is not uncommon and is associated with significant hemodynamic consequences and arrhythmias, which are usually inconsequential. We report a case of suspected intravascular adrenaline absorption in a 1-year-old girl with craniosynostosis, which led to subarachnoid hemorrhage, herniation, and death.

20th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care (ISNACC)

Materials and Methods: Perioperative data of infants and children who had undergone craniosynosto... more Materials and Methods: Perioperative data of infants and children who had undergone craniosynostosis correction surgery by a single surgical team over a period of 10 years were retrospectively collected after IRB approval. Results: There were 22 patients, of whom 9 (40.9%) were females; Mean age-21.4 months; weight of 8.6 kg. The most common suture involved was coronal in 18 (81.8%), followed by sagittal 13 (59.1%), metopic in 12 (54.6%), and lambdoid in 11 (50%). Seven (31.8%) infants had all four-suture involvement, two had three sutures, seven had two sutures, and six had single-suture involvement. Of these, 13 (59.1%) were syndromic (Crouzon's, Apert's, and Down's syndromes). Sevoflurane induction was performed in 17 (77.3%), and rest had intravenous induction. Anesthesia was maintained with inhalational in 18 (81.8%), and 4 (18.2%) had combination of IV and inhalational agents. Eighteen (81.8%) had an anticipated difficult airway; of these, 5 had CL grade of 3, most of them (4/5) were syndromic. Average blood loss was 40.9 mL/kg; syndromic group had higher loss 51.2 mL/kg vs. 25.9 mL/kg (p = 0.049). Three out of 22 patients did not receive tranexamic acid, these children had increased blood loss 68.3 vs. 36.5 mL/kg (p = 0.09). Hypofibrinogenemia was the most common coagulation abnormality. Those who had intraoperative coagulation abnormality had higher blood loss, 58.0 mL/kg vs. 29.7 mL/kg (p = 0.004). 14/22 (64%) had intraoperative hypotension requiring nor-adrenaline infusion. Few (2/22) had both noradrenaline and adrenaline. Children who had intraoperative ABG (15/22), six (40%) had lactate of > 2 mmol/L. Hyperchloremia (45.4%) was the most commonly observed electrolyte abnormality, followed by hypocalcemia. Average duration of anesthesia was 352 minutes. There was no correlation between the number of sutures involved and the duration of surgery (p = 0.418) nor with the blood loss (p = 0.331). Four (18%) out of 22 children had postoperative ventilation. The mean ICU and hospital stays were 1.7 and 5 days, respectively. Seven out of 22 had postoperative coagulation profile, of whom 1 had both low levels of fibrinogen and a prolonged APTT and 4 had purely hypofibrinogenemia; 1 had thrombocytopenia. No postoperative complication or death noted in these series. Conclusions: Anticipation, adequate preparation for airway and blood loss, administration of titrated anesthetic, maintenance of hemodynamics, and timely administration of tranexamic acid and blood and blood products reduced the complication in these children.

Journal of Neuroanaesthesiology and Critical Care

Background: Coagulopathy in isolated traumatic brain injury (TBI) is well-known, and studies have... more Background: Coagulopathy in isolated traumatic brain injury (TBI) is well-known, and studies have found an association between coagulopathy and unfavourable outcomes. This study was conducted to determine the incidence and causes of coagulopathy in patients with TBI undergoing craniotomy and its effect on post-operative outcome. Materials and Methods: The data collected was demographics, computed tomography diagnosis, post-resuscitation Glasgow Coma Scale (GCS) score, pre- and post-operative platelet count, liver function tests, intraoperative blood loss and transfusion, fluids infused and incidence of redo surgery. Point of care (Coaguchek XS) monitor was used to obtain prothrombin time and international normalised ratio (INR) at 24 h and 72 h of injury. Coagulopathy was defined as INR ≥1.3 and thrombocytopenia as platelet count ≤100,000/mcL. Outcome measures assessed were the length of hospital stay, GCS at discharge and in-hospital mortality. Results: In 166 patients, the average...

15th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care

Asian Journal of Psychiatry

OBJECTIVE To examine the differences in whole brain topology and connectivity in 17 children of t... more OBJECTIVE To examine the differences in whole brain topology and connectivity in 17 children of the ages 3-8 years across severity of ASD, we performed resting state fMRI using a 3T MRI scanner and graph theoretical analysis of networks. METHOD Patients were partitioned into two cohorts based on the severity of ASD, determined using the Childhood Autism Rating Scale (CARS) scores (Mild, 30-36; Severe, 37+). Standard preprocessing pipeline was used, followed by independent component analysis (ICA) to identify regions of interest (ROIs) to construct subject-specific Z-correlation matrices representing the whole brain network. Following which, graph theory measures were calculated in the range of sparsity 6%-35% and statistically analyzed, and corrected for significance (FDR corrected, p < 0.05). Regional clustering coefficient that revealed significant between-group (mild vs. severe) differences were correlated against clinical scores (CARS). RESULTS Children with severe ASD revealed significantly increased clustering coefficient and small-worldness compared to those with mild or moderate ASD. Region of interest analysis revealed altered clustering in the Heschl's gyrus that significantly correlated with CARS scores. CONCLUSION The findings from the current study provide early stage evidence of aberrant brain connectivity appearing in severe ASD, prior to the effect of environmental bias and pruning mechanisms. The clustering of the Heschl's gyrus correlated to the severity of ASD symptoms and agrees with current literature on ASD-associated cortical changes, reflecting early changes to language processing regions.

Journal of Neurosurgical Anesthesiology

Supplemental Digital Content is available in the text. Background: There is paucity of literature... more Supplemental Digital Content is available in the text. Background: There is paucity of literature on the prognostic value of tissue oxygen saturation (StO2) and regional cerebral oxygen saturation (rSO2) in neurological patients with sepsis. In this preliminary study, we investigated the prognostic value of StO2 and rSO2 in a group of neurological patients and correlated StO2 and rSO2 with hemodynamic and metabolic parameters. Materials and Methods: This preliminary, prospective observational study was conducted in 45 adult neurological patients admitted to intensive care unit. Once a diagnosis of sepsis or septic shock was established, parameters of oxygenation (StO2, rSO2, central venous oxygen saturation [ScvO2]), serum lactate, illness severity scores (Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, Glasgow Coma Scale) were recorded at 0, 6, 12, 24, 36, and 48 hours, and once daily thereafter. Outcomes were in-hospital mortality attributable to sepsis and the Glasgow outcome score at hospital discharge. Results: There was a moderately positive correlation between StO2 and rSO2 at baseline (r=0.599; P=0.001). StO2, illness severity scores and serum lactate, but not rSO2, were significantly different between survivors (n=29) and nonsurvivors (n=16) at baseline and during the first 48 hours. An rSO2 of 62.5% had a sensitivity of 83% and specificity of 67% to differentiate survivors and nonsurvivors of septic shock at 48 hours. StO2 had a higher correlation with ScvO2 and serum lactate than rSO2. Conclusions: StO2 prognosticates survival and favorable/unfavorable outcomes in neurological patients with sepsis. The role of rSO2 in predicting survival in milder form of sepsis is doubtful.

Journal of neurosurgical anesthesiology, Jan 5, 2017

Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nocic... more Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nociception Index (ANI) monitor based on the high frequency component of heart rate variability has been launched into clinical practice. We monitored analgesia during craniotomy using ANI monitor and compared it with cardiovascular parameters and response entropy (RE) of entropy monitor. In 21 patients undergoing a craniotomy for a supratentorial lesion, we monitored ANI, heart rate (HR), mean arterial pressure (MAP), state entropy, and RE throughout the surgery. Also, ANI, hemodynamic variables and spectral entropy values were noted at the times of maximal stimulation, such as induction, intubation, head pin fixation, skin incision, craniotomy, durotomy, and skin closure. We also compared ANI with RE during administration of bolus doses of fentanyl. There was an inverse correlation between ANI values and the hemodynamic changes. When the HR and MAP increased, ANI decreased suggesting a good...

Journal of Neuroanaesthesiology and Critical Care

Background: Illness severity scoring systems (SSs) are increasingly being used to provide informa... more Background: Illness severity scoring systems (SSs) are increasingly being used to provide information about patients’ severity of illness and outcome in terms of mortality or length of Intensive care Unit (ICU) and hospital stay. In this retrospective study, we compared the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE) II and IV, Simplified Acute Physiology Score (SAPS), Mortality Prediction Model at 24 h and Glasgow Coma Scale (GCS) with actual in-hospital 28 day mortality in patients admitted to neuro-ICU over a period of 6 months. Methods: The data required for calculation of above scores was retrieved from medical records. The 28-day post-admission outcome including in-hospital mortality was measured by Glasgow Outcome Scale (GOS). Logistic regression was used to determine the mortality prediction power of each SS. Results: A total of 197 adult patients with varied neurological diagnosis were included in this study. The in-hospital 28-day mortality ...

Journal of Neurosurgical Anesthesiology, 2017

ETCO2, such as inadequate ventilation, increase in dead space, and increased metabolism such as f... more ETCO2, such as inadequate ventilation, increase in dead space, and increased metabolism such as fever, partial muscle relaxation, and exhausted soda lime causing partial rebreathing were all ruled out in our case. We postulate that in presence of raised ICP, to maintain a constant cerebral blood flow, the body reacts by increasing the systemic vascular resistance (SVR).1,2 This increase in SVR diverts the systemic splanchnic blood to pulmonary circulation, thereby increasing the cardiac output to maintain a constant cerebral perfusion pressure. This increase in pulmonary blood flow will increase the ETCO2 and decreases the pulmonary compliance.3–5 In our case, the increase in ETCO2 despite an adequate ventilatory setting could be due to the above-mentioned effect. After the ventricular tapping, a transient decrease in blood pressure and an improvement in ventilation (ETCO2 decrease) could be explained by a decrease in SVR and causing decrease in pulmonary blood flow. From this case, we wanted to highlight that aggressive ventilation to maintain a normal ETCO2 can dangerously increase the ICP by increasing the airway pressure, especially in neonates with poor intracranial compliance. One limitation of this report is that we did not perform a blood gas test to determine the correlation between the arterial CO2 and ETCO2.

Indian Journal of Neurotrauma, 2016

Journal of Anaesthesiology Clinical Pharmacology, 2015

Background and Aims: Electroconvulsive therapy (ECT) is an established modality of treatment for ... more Background and Aims: Electroconvulsive therapy (ECT) is an established modality of treatment for severe psychiatric illnesses. Among the various complications associated with ECT, oxygen desaturation is often under reported. None of the previous studies has evaluated the predictive factors for oxygen desaturation during ECT. The objective of this study was to evaluate the incidence of oxygen desaturation during recovery from anesthesia for modified ECT and evaluate its risk factors in a large sample. Materials and Methods: All patients aged above 15 years who were prescribed a modified ECT for their psychiatric illness over 1 year were prospectively included in this observational study. The association between age, body mass index (BMI), doses of thiopentone and suxamethonium, stimulus current, ECT session number, pre-and post-ECT heart rate and mean arterial pressure, seizure duration, and pre-and post ECT oxygen saturation, was systematically studied. Results: The incidence of oxygen desaturation was 29% (93/316 patients). Seizure duration and BMI were found to be significantly correlated with post ECT desaturation. Conclusion: In this prospective observational study, the incidence of oxygen desaturation during recovery from anesthesia for ECT was high. The study identified obesity and duration of seizure as the independent predictors of this complication. This knowledge is likely to help in identifying and optimizing such patients before subsequent ECT sessions.

The Indian Journal of Neurotrauma, 2014

ABSTRACT Post-traumatic acute subdural hematoma (ASDH) requires immediate surgical evacuation in ... more ABSTRACT Post-traumatic acute subdural hematoma (ASDH) requires immediate surgical evacuation in most cases. We present two cases of ASDH which resolved spontaneously. The first patient had 9 mm thick ASDH in left fronto-temporo-parietal region with initial GCS of E1V1M3 which improved to E2VtM4 within 7 h. Repeat CT of the brain showed a decrease in the size of ASDH. Hence, patient was conservatively managed with anti-edema measures and elective ventilation. The patient improved and ASDH also resolved completely. The second patient also had 8 mm thick ASDH in the right fronto-temporo-parietal region with GCS of E1V2M5 which 5 h later improved to E3V4M5. With conservative measures, there was clinical and radiological improvement. Based on previous reports, certain characteristic features have been shown to favor spontaneous resolution of ASDH; absence of underlying contusion and the presence of a low-density band between the skull and the hematoma on imaging were features common to our patients also.

Journal of Neurosurgical Anesthesiology, 2012

The requirement of anesthetic drugs in a patient with an intracranial space-occupying lesion is o... more The requirement of anesthetic drugs in a patient with an intracranial space-occupying lesion is of relevance to the neuroanesthetist. The requirement is often presumed to have reduced or at least altered. However, not much research has focused on this issue. Hence, we conducted this study to examine whether intracranial tumors reduce the induction dose of propofol in patients undergoing craniotomy based on plasma and effect site concentrations (Ce) of propofol and the effect of additional fentanyl. A total of 80 patients were recruited into the study. The study group included patients with supratentorial tumors undergoing craniotomy, and the control group consisted of patients undergoing spinal surgeries. Patients in each group were randomized further to receive propofol alone or propofol preceded by fentanyl for induction of anesthesia. They were divided into the following groups: patients with supratentorial tumor receiving only propofol (group T1), or fentanyl and propofol (group T2); patients who were undergoing spinal surgery and receiving only propofol (group S1) or fentanyl and propofol (group S2). Anesthesia was induced with infusion of propofol through a Target Controlled Infusion pump. At the point of loss of verbal contact, plasma concentration (Cp) and Ce of propofol, time taken for loss of consciousness, and the total dose of propofol required were noted. Hemodynamic variables were recorded before and after induction of anesthesia. There were 19, 21, 19, and 21 patients in groups TI, T2, S1, and S2, respectively. In group T2 the Cp, Ce, time to loss of verbal contact, and dose required for induction were all significantly lower compared with the other groups. There were no significant differences in the study parameters between T1 and S1, whereas the differences were significant between T2 and S2 (Cp: 3.9±1.1 vs. 4.9±1.2 μg/mL; Ce: 2.6±1.0 vs. 3.7±1.2 μg/mL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Propofol dose for induction of anesthesia was significantly reduced when administered after fentanyl in patients with supratentorial tumors. Tumors per se without fentanyl coadministration do not decrease the propofol requirement for induction of anesthesia.

Journal of Neurosurgical Anesthesiology, 2014

To JNA Readers: A 60-year-old man presented with history of a fall 6 months back after which he d... more To JNA Readers: A 60-year-old man presented with history of a fall 6 months back after which he developed neck pain, lower limb weakness, and urinary retention. There were no respiratory complaints. Medical history was not significant. Hypertonia was present in both the lower limbs with power of 3/5. The lungs were clear on auscultation. Magnetic resonance imaging of the spine revealed cord compression at the cervical (C3-C5) and thoracic (T10) levels. Laminectomy at T10T11 and excision of T10-T12 ossified ligamentum flavum were planned. X-ray reports of the chest showed bilateral upper-zone focal abnormalities with fibrotic bands and emphysematous changes. Computed tomography scan of the chest showed bilateral gross pleural thickening, upper-zone lesions with fibrotic strands, and calcified mediastinal lymph nodes (Fig. 1A). On the right side, multiple large emphysematous bullae were seen (Fig. 1B). Radiologic findings were suggestive of pulmonary tuberculosis. Pulmonary function test revealed severe restriction. In view of emphysematous bullae, general anesthesia (GA) with spontaneous respiration was planned to avoid positive pressure ventilation (PPV). Patient was premedicated with 0.2mg of glycopyrrolate and 1mg of midazolam intravenously. Airway was anesthetized with 4% lignocaine nebulization, topical 10% spray, and transtracheal block. A dosage of 50mg of propofol and a dosage of 40mg IV fentanyl were given to facilitate intubation. Anesthesia was maintained using 1% to 2% sevoflurane and O2 with air (35:75). Analgesia was provided with fentanyl boluses. Throughout the procedure, spontaneous respiration was maintained (respiratory rate 8 to 12/min, end tidal carbon dioxide 40 to 42mm Hg). Airway pressures and systemic parameters were monitored carefully to diagnose the occurrence of pneumothorax at the earliest. Postoperatively, patient was breathing comfortably with no new complications. Bulla is a pathologic entity caused by a confluence of 2 or more terminal elements of bronchial tree. It may get infected or enlarge progressively and may lead to pneumothorax. It exists frequently in conditions like tuberculosis. Various anesthetic techniques have been tried in patients with bullae presenting for extrathoracic surgery such as GA with double-lumen tube,1 inhalational anesthetics and spontaneous ventilation,2 and awake craniotomy using dexmedetomidine sedation. Iwakura et al used spontaneous ventilation, although initially succinylcholine was used to facilitate intubation. Because of preoperative paraparesis, we avoided succinylcholine. To blunt airway reflexes, we used topical anesthesia and airway blocks. In another case report, authors have used laryngeal mask airway with epidural catheter in a spontaneously breathing patient. We did not consider regional anesthesia, despite being a good option in patients with lung bulla, in view of preoperative limb weakness. Placing a patient in prone position presents significant challenges to the anesthetist. A decrease in the mean arterial pressure, stroke volume, and the cardiac index can occur. Abdominal compression can worsen the obstruction to inferior vena cava leading to an increased surgical-site bleeding. Accidental extubation and endotracheal tube obstruction are other feared complications. Prone position increases functional residual capacity and improves oxygenation by reducing the ventilation perfusion mismatch. Spontaneous breathing can have synergistic effect with prone position. Active

Acta Neurochirurgica, 2015

The Glasgow Coma Scale (GCS) is considered the gold standard for assessment of unconsciousness in... more The Glasgow Coma Scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury (TBI) against which other scales are compared. To overcome the disadvantages of GCS, the Full Outline Of Unresponsiveness (FOUR) score was proposed. We aimed to compare the predictability of FOUR score and GCS for early mortality, after moderate and severe TBI. This is a prospective observational study of patients with moderate and severe TBI. Both FOUR and GCS scores were determined at admission. The primary outcome was mortality at the end of 2 weeks of injury. A total of 138 (117 males) patients were included in the study. Out of these, 17 (12.3 %) patients died within 2 weeks of injury. The mean GCS and FOUR scores were 9.5 (range, 3-13) and 11 (0-16), respectively. The total GCS and FOUR scores were significantly lower in patients who did not survive. At a cut-off score of 7 for FOUR score, the AUC was 0.97, with sensitivity of 97.5 and specificity of 88.2 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). For GCS score, AUC was 0.95, with sensitivity of 98.3 % and specificity of 82.4 % with cut-off score of 6 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The correlation coefficient was 0.753 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) between the GCS and FOUR scores. The predictive value of the FOUR score on admission of patients with TBI is no better than the GCS score.

Journal of Neurosurgical Anesthesiology, 2016

In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general ... more In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general anesthesia (GA) and local anesthesia with or without sedation are used for the surgical treatment of CSDH. Sedation with dexmedetomidine has been safely used for various diagnostic and therapeutic procedures. However, its effectiveness against GA has not been evaluated for surgical treatment of CSDH. We tried to compare dexmedetomidine sedation technique with the GA technique for surgical treatment of CSDH. In this prospective-randomized study, 76 patients undergoing surgery for CSDH were divided into 2 groups using computer-generated randomized tables; Dex group ([n=38]; received IV bolus of dexmedetomidine 1 mcg/kg over 10 min followed by maintenance infusion 0.5 mcg/kg/h) and GA group ([n=38; of which 4 patients were dropped out]; received endotracheal intubation with balanced anesthesia). Both anesthesia techniques (Dex group; n=35/38 [92.1%] and GA group; n=34/34 [100%]) were successfully used for surgical treatment of CSDH. Significantly less time for anesthesia onset (14.2±4.2 vs. 20.5±3.4 min, P=0.001), total duration of surgery (77.1±23.9 vs. 102.7± 24.8 min, P=0.001), and recovery from anesthesia (7.4±5.9 vs. 13.2±6.5 min, P=0.004) was observed in the Dex group compared with GA group. Perioperative hemodynamic fluctuations were more common in the GA group as against the Dex group. Postoperative complications (n=2 vs. 9, P=0.021) and length of hospital stay (1.05±0.23 vs. 1.79±2.1 d, P=0.007) were significantly less in the Dex group as against the GA group. Dexmedetomidine sedation with local anesthesia is a safe and effective technique for burr hole and evacuation of CSDH. It is associated with significantly shorter operative time, lesser hemodynamic fluctuations, postoperative complications, and length of hospital stay, thus it is a better alternative to GA.