Sunanda Gupta - Academia.edu (original) (raw)

Papers by Sunanda Gupta

Research paper thumbnail of Recent Advances in Labour Analgesia

Labour pain analgesia is ever evolving since its inception by etherisation of labour. Adverse eff... more Labour pain analgesia is ever evolving since its inception by etherisation of labour. Adverse effects of labour pain on both mother and foetus remain a major concern for care providers. Childbirth is associated with intense, excruciating pain and to overcome this unpleasant experience many strategies both pharmacological and non-pharmacological have been extensively researched and utilized. Non-pharmacological methods provide psychological support to cope with painful situations rather than mitigating the pain completely. Recent trends in labour pain relief includes use of remifentanil IV-PCA, Nitronox, low concentration of local anaesthetics, use of levobupivacaine and ropivacaine along with adjuvants like clonidine, dexmedetomidine, neostigmine, dexamethasone. Technical advances such as computer integrated patient controlled epidural analgesia, programmed intermittent or automated mandatory epidural boluses and ultrasound guided neuraxial technique are other innovations. Skilled a...

Research paper thumbnail of Management of pregnant laboring women during COVID-19 pandemic

Journal of Anaesthesiology Clinical Pharmacology

Research paper thumbnail of Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists

Indian Journal of Anaesthesia

Research paper thumbnail of Comparison of Oral Pregabalin Versus Bolus Dose of Intravenous Dexmedetomidine in Attenuating the Hemodynamic responses During Laparoscopic Cholecystectomy: A Prospective Randomized double Blind Study

Indian Journal of Anesthesia and Analgesia

Research paper thumbnail of Neuraxial techniques of labour analgesia

Indian Journal of Anaesthesia

Research paper thumbnail of Sub-anaesthetic bolus dose of intravenous ketamine for postoperative pain following caesarean section

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of Prophylactic administration of two different bolus doses of phenylephrine for prevention of spinal-induced hypotension during cesarean section: A prospective double-blinded clinical study

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of Tranexamic acid: Beware of anaesthetic misadventures

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of I-gel for day care diagnostic laparoscopic gynecological surgery: A comparison of two regimes of IV propofol with dexmedetomidine or butorphanol

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of Category I caesarean delivery and preferred mode of anaesthesia: Dilemma persists

Indian Journal of Anaesthesia

Research paper thumbnail of Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital

Journal of anaesthesiology, clinical pharmacology

The American College of Obstetricians and Gynecologists (ACOG) committee on professional standard... more The American College of Obstetricians and Gynecologists (ACOG) committee on professional standards and the National Institute of Clinical Excellence (NICE) guidelines suggest that decision-to-delivery interval (DDI) and emergency cesarean section (CS) should not be more than 30 min, and a delay of more than75 min in the presence of maternal or fetal compromise can lead to poor outcome. This prospective 1-year study was conducted on emergency CS in a tertiary care hospital to evaluate the DDI, factors affecting it and to analyze their effects on maternal and neonatal outcome. A structured proforma was used to analyze the data from all women undergoing emergency CS, during a 1-year period, included in Category 1 and 2 of NICE guidelines for CS. A total of 453 emergency CSs were evaluated, with a mean DDI of 36.3 ± 17.2 min for Category 1 CS and 38.1 ± 17.7 min for Category 2 CS (P > 0.05). Only 42.4% emergency CSs confirmed to the 30 min DDI while 57.6% had a DDI of more than 30 mi...

Research paper thumbnail of Comparison of 0.25% Ropivacaine for Intraperitoneal Instillation v/s Rectus Sheath Block for Postoperative Pain Relief Following Laparoscopic Cholecystectomy: A Prospective Study

Journal of clinical and diagnostic research : JCDR, 2016

As Laparoscopic Cholecystectomy (LC) is not a totally pain free procedure, with the pain being mo... more As Laparoscopic Cholecystectomy (LC) is not a totally pain free procedure, with the pain being most intense on the day of surgery and on the following day. Various techniques are available for postoperative pain relief like intraperitoneal instillation of local anaesthetics and rectus sheath block (RSB)which may provide effective pain relief. To compare the efficacy of preemptive administration (initiated before the surgical procedure) of intraperitoneal instillation and rectus sheath block using ropivacaine for postoperative analgesia after laparoscopic cholecystectomy. A total of 75 selected patients were randomly assigned to three equal groups as Group R, who received bilateral RSB with 0.25 % ropivacaine 15 ml on either side; Group I, who received intraperitoneal instillation of 0.25% ropivacaine 50 ml and Group C (Control group), who received only rescue analgesic on pain. These were compared regarding postoperative analgesia in terms of Visual Analog Scale (0-10 cm), Prince He...

Research paper thumbnail of Post-tonsillectomy pain: Different modes of pain relief

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2002

Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) gr... more Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) grade I and II, undergoing tonsillectomy, were randomly allocated to receive either preroperative intramuscular diclofenac sodium(group A) or pre- incisional bilateral infiltration of bupivacaine in the peritonsillar fossa (group B) or post operative Trunscutaneous Electric Nerve Stimulation - TENS (group C) at fixed time intervals. Pain scores (Visual analogue scale VAS, 0- 100 mm) were assessed at rest and on deglutition at 1,3,6,9,12 and 24 hours after surgery. Pentazocine 1actale 15 mg IV was given as rescue analgesic whenever VAS estimation was more than 30 mm at rest (not deglutition). Constant incisional pain was significantly less ( p < 0.01 ANOVA) in group C after 3 hours of surgery as compared to group A and B. Similarly pain on deglutition was significantly less (p <0.01, ANOVA) in group C during the entire study period as compared to Group A and B. There was significant r...

Research paper thumbnail of Superior vena caval syndrome in children--A case report

Middle East journal of anaesthesiology, 2006

Research paper thumbnail of Wound instillation with 0.25% bupivacaine as continuous infusion following hysterectomy

Middle East journal of anaesthesiology, 2005

Postoperative pain relief was assessed by the effects of local anesthetic wound instillation on 1... more Postoperative pain relief was assessed by the effects of local anesthetic wound instillation on 100 patients who had undergone total abdominal hysterectomy with bilateral salpingo oophorectomy (TAH with BSO). Patients were divided into four groups of wound and non-wound instillation: Wound instillation Group A1 received diclofenac IM. Group A2 received diclofenac suppository. Non-wound instillation Group B1 received diclofenac IM. Group B2 received diclofenac suppository. A standard general anesthesia technique was administered. For would instillation, a multiholed (1 cm apart) 18G epidural catheter was placed above rectus sheath. This was connected to a pediatric regulated drip set with "Dial-a flo" to deliver 0.25% bupivacaine 10 ml/hour for 6 hours after a basal bolus of 10 ml. During first 6 hours after surgery rescue pentazocine 15 mg was administered to achieve VAS score < or = 30. Thereafter, rescue diclofenac was administered to patients. The requirement of resc...

Research paper thumbnail of Maternal cardiac arrest and resuscitation: Some burning issues!

Journal of Obstetric Anaesthesia and Critical Care, 2013

Research paper thumbnail of Chapter-01 Anatomical Changes in Pregnancy and Practical Implications

Anesthesia, Critical Care, and Pain: Analgesia and Anesthesia in Labor and Delivery-I, 2013

Research paper thumbnail of Comparison of hydroxyethyl starch versus normal saline for epidural volume extension in combined spinal epidural anesthesia for cesarean section

Journal of Obstetric Anaesthesia and Critical Care, 2012

Research paper thumbnail of Epidural labor analgesia: A comparison of ropivacaine 0.125% versus 0.2% with fentanyl

Journal of Obstetric Anaesthesia and Critical Care, 2013

Research paper thumbnail of Dose-dependent effect of intrathecal dexmedetomidine on isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy: Effect on block characteristics and hemodynamics

Journal of Anaesthesiology Clinical Pharmacology, 2015

Background and Aims: Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine... more Background and Aims: Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy is not much investigated. The objective was to assess the dose dependent effect of dexmedetomidine (3 mcg vs 5 mcg) as an adjunct to isobaric ropivacaine in spinal anesthesia. Materials and Methods: Forty selected female patients were randomized to receive intrathecal 0.5% isobaric ropivacaine (15 mg) with dexmedetomidine 3 mcg (Group D3) or 5 mcg (Group D5) in spinal anesthesia for abdominal hysterectomy. Block characteristics, hemodynamic changes, postoperative analgesia, and adverse effects were compared. Results: Both groups were comparable regarding sensory-motor block characteristics and postoperative analgesia (P > 0.05). Four (10%) patients of Group D5 and 5 (12.5%) of Group D3 could not achieve desired T6 sensory level and Bromage score of 3(complete motor block) hence were converted to general anesthesia at the outset. Nine (22.5%) patients each in both groups required ketamine supplementation (0.5 mg/kg) for intraoperative pain at the time of uterine manipulation. Incidence of hypotension was comparable (55.56% in Group D5 and 37.14% in Group D3, P = 0.11), but this occurred significantly earlier in Group D5, P < 0.001. Sedation was also significantly more in Group D5 as compared with Group D3, P < 0.01. Conclusion: We conclude that spinal anesthesia with isobaric ropivacaine (15 mg) with dexmedetomidine (3 mcg or 5 mcg) did not show much promise for abdominal hysterectomy as one third cases required analgesic supplementation. Both doses of dexmedetomidine produced a similar effect on block characteristic and postoperative analgesia; however, a dose of 5 mcg dose was associated with more hypotension and sedation.

Research paper thumbnail of Recent Advances in Labour Analgesia

Labour pain analgesia is ever evolving since its inception by etherisation of labour. Adverse eff... more Labour pain analgesia is ever evolving since its inception by etherisation of labour. Adverse effects of labour pain on both mother and foetus remain a major concern for care providers. Childbirth is associated with intense, excruciating pain and to overcome this unpleasant experience many strategies both pharmacological and non-pharmacological have been extensively researched and utilized. Non-pharmacological methods provide psychological support to cope with painful situations rather than mitigating the pain completely. Recent trends in labour pain relief includes use of remifentanil IV-PCA, Nitronox, low concentration of local anaesthetics, use of levobupivacaine and ropivacaine along with adjuvants like clonidine, dexmedetomidine, neostigmine, dexamethasone. Technical advances such as computer integrated patient controlled epidural analgesia, programmed intermittent or automated mandatory epidural boluses and ultrasound guided neuraxial technique are other innovations. Skilled a...

Research paper thumbnail of Management of pregnant laboring women during COVID-19 pandemic

Journal of Anaesthesiology Clinical Pharmacology

Research paper thumbnail of Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists

Indian Journal of Anaesthesia

Research paper thumbnail of Comparison of Oral Pregabalin Versus Bolus Dose of Intravenous Dexmedetomidine in Attenuating the Hemodynamic responses During Laparoscopic Cholecystectomy: A Prospective Randomized double Blind Study

Indian Journal of Anesthesia and Analgesia

Research paper thumbnail of Neuraxial techniques of labour analgesia

Indian Journal of Anaesthesia

Research paper thumbnail of Sub-anaesthetic bolus dose of intravenous ketamine for postoperative pain following caesarean section

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of Prophylactic administration of two different bolus doses of phenylephrine for prevention of spinal-induced hypotension during cesarean section: A prospective double-blinded clinical study

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of Tranexamic acid: Beware of anaesthetic misadventures

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of I-gel for day care diagnostic laparoscopic gynecological surgery: A comparison of two regimes of IV propofol with dexmedetomidine or butorphanol

Journal of Obstetric Anaesthesia and Critical Care

Research paper thumbnail of Category I caesarean delivery and preferred mode of anaesthesia: Dilemma persists

Indian Journal of Anaesthesia

Research paper thumbnail of Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital

Journal of anaesthesiology, clinical pharmacology

The American College of Obstetricians and Gynecologists (ACOG) committee on professional standard... more The American College of Obstetricians and Gynecologists (ACOG) committee on professional standards and the National Institute of Clinical Excellence (NICE) guidelines suggest that decision-to-delivery interval (DDI) and emergency cesarean section (CS) should not be more than 30 min, and a delay of more than75 min in the presence of maternal or fetal compromise can lead to poor outcome. This prospective 1-year study was conducted on emergency CS in a tertiary care hospital to evaluate the DDI, factors affecting it and to analyze their effects on maternal and neonatal outcome. A structured proforma was used to analyze the data from all women undergoing emergency CS, during a 1-year period, included in Category 1 and 2 of NICE guidelines for CS. A total of 453 emergency CSs were evaluated, with a mean DDI of 36.3 ± 17.2 min for Category 1 CS and 38.1 ± 17.7 min for Category 2 CS (P > 0.05). Only 42.4% emergency CSs confirmed to the 30 min DDI while 57.6% had a DDI of more than 30 mi...

Research paper thumbnail of Comparison of 0.25% Ropivacaine for Intraperitoneal Instillation v/s Rectus Sheath Block for Postoperative Pain Relief Following Laparoscopic Cholecystectomy: A Prospective Study

Journal of clinical and diagnostic research : JCDR, 2016

As Laparoscopic Cholecystectomy (LC) is not a totally pain free procedure, with the pain being mo... more As Laparoscopic Cholecystectomy (LC) is not a totally pain free procedure, with the pain being most intense on the day of surgery and on the following day. Various techniques are available for postoperative pain relief like intraperitoneal instillation of local anaesthetics and rectus sheath block (RSB)which may provide effective pain relief. To compare the efficacy of preemptive administration (initiated before the surgical procedure) of intraperitoneal instillation and rectus sheath block using ropivacaine for postoperative analgesia after laparoscopic cholecystectomy. A total of 75 selected patients were randomly assigned to three equal groups as Group R, who received bilateral RSB with 0.25 % ropivacaine 15 ml on either side; Group I, who received intraperitoneal instillation of 0.25% ropivacaine 50 ml and Group C (Control group), who received only rescue analgesic on pain. These were compared regarding postoperative analgesia in terms of Visual Analog Scale (0-10 cm), Prince He...

Research paper thumbnail of Post-tonsillectomy pain: Different modes of pain relief

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2002

Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) gr... more Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) grade I and II, undergoing tonsillectomy, were randomly allocated to receive either preroperative intramuscular diclofenac sodium(group A) or pre- incisional bilateral infiltration of bupivacaine in the peritonsillar fossa (group B) or post operative Trunscutaneous Electric Nerve Stimulation - TENS (group C) at fixed time intervals. Pain scores (Visual analogue scale VAS, 0- 100 mm) were assessed at rest and on deglutition at 1,3,6,9,12 and 24 hours after surgery. Pentazocine 1actale 15 mg IV was given as rescue analgesic whenever VAS estimation was more than 30 mm at rest (not deglutition). Constant incisional pain was significantly less ( p < 0.01 ANOVA) in group C after 3 hours of surgery as compared to group A and B. Similarly pain on deglutition was significantly less (p <0.01, ANOVA) in group C during the entire study period as compared to Group A and B. There was significant r...

Research paper thumbnail of Superior vena caval syndrome in children--A case report

Middle East journal of anaesthesiology, 2006

Research paper thumbnail of Wound instillation with 0.25% bupivacaine as continuous infusion following hysterectomy

Middle East journal of anaesthesiology, 2005

Postoperative pain relief was assessed by the effects of local anesthetic wound instillation on 1... more Postoperative pain relief was assessed by the effects of local anesthetic wound instillation on 100 patients who had undergone total abdominal hysterectomy with bilateral salpingo oophorectomy (TAH with BSO). Patients were divided into four groups of wound and non-wound instillation: Wound instillation Group A1 received diclofenac IM. Group A2 received diclofenac suppository. Non-wound instillation Group B1 received diclofenac IM. Group B2 received diclofenac suppository. A standard general anesthesia technique was administered. For would instillation, a multiholed (1 cm apart) 18G epidural catheter was placed above rectus sheath. This was connected to a pediatric regulated drip set with "Dial-a flo" to deliver 0.25% bupivacaine 10 ml/hour for 6 hours after a basal bolus of 10 ml. During first 6 hours after surgery rescue pentazocine 15 mg was administered to achieve VAS score < or = 30. Thereafter, rescue diclofenac was administered to patients. The requirement of resc...

Research paper thumbnail of Maternal cardiac arrest and resuscitation: Some burning issues!

Journal of Obstetric Anaesthesia and Critical Care, 2013

Research paper thumbnail of Chapter-01 Anatomical Changes in Pregnancy and Practical Implications

Anesthesia, Critical Care, and Pain: Analgesia and Anesthesia in Labor and Delivery-I, 2013

Research paper thumbnail of Comparison of hydroxyethyl starch versus normal saline for epidural volume extension in combined spinal epidural anesthesia for cesarean section

Journal of Obstetric Anaesthesia and Critical Care, 2012

Research paper thumbnail of Epidural labor analgesia: A comparison of ropivacaine 0.125% versus 0.2% with fentanyl

Journal of Obstetric Anaesthesia and Critical Care, 2013

Research paper thumbnail of Dose-dependent effect of intrathecal dexmedetomidine on isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy: Effect on block characteristics and hemodynamics

Journal of Anaesthesiology Clinical Pharmacology, 2015

Background and Aims: Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine... more Background and Aims: Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy is not much investigated. The objective was to assess the dose dependent effect of dexmedetomidine (3 mcg vs 5 mcg) as an adjunct to isobaric ropivacaine in spinal anesthesia. Materials and Methods: Forty selected female patients were randomized to receive intrathecal 0.5% isobaric ropivacaine (15 mg) with dexmedetomidine 3 mcg (Group D3) or 5 mcg (Group D5) in spinal anesthesia for abdominal hysterectomy. Block characteristics, hemodynamic changes, postoperative analgesia, and adverse effects were compared. Results: Both groups were comparable regarding sensory-motor block characteristics and postoperative analgesia (P > 0.05). Four (10%) patients of Group D5 and 5 (12.5%) of Group D3 could not achieve desired T6 sensory level and Bromage score of 3(complete motor block) hence were converted to general anesthesia at the outset. Nine (22.5%) patients each in both groups required ketamine supplementation (0.5 mg/kg) for intraoperative pain at the time of uterine manipulation. Incidence of hypotension was comparable (55.56% in Group D5 and 37.14% in Group D3, P = 0.11), but this occurred significantly earlier in Group D5, P < 0.001. Sedation was also significantly more in Group D5 as compared with Group D3, P < 0.01. Conclusion: We conclude that spinal anesthesia with isobaric ropivacaine (15 mg) with dexmedetomidine (3 mcg or 5 mcg) did not show much promise for abdominal hysterectomy as one third cases required analgesic supplementation. Both doses of dexmedetomidine produced a similar effect on block characteristic and postoperative analgesia; however, a dose of 5 mcg dose was associated with more hypotension and sedation.