keshav goyal - Academia.edu (original) (raw)

Papers by keshav goyal

Neurocritical Care, 2020

Background: Traumatic brain injury (TBI) is associated with majority of trauma deaths, and object... more Background: Traumatic brain injury (TBI) is associated with majority of trauma deaths, and objective tools are required to understand the severity of injury. The application of a biomarker like procalcitonin (PCT) in TBI may allow for assessment of severity and thus aid in prognostication and correlation with mortality and outcome. Aims: The primary objective is to determine the correlation between PCT concentrations with TBI outcomes (mainly in terms of mortality) at intensive care unit (ICU)/hospital discharge. Secondary objectives are to evaluate correlation with associated extra cranial injuries and complications during hospital stay. Methods: In total, 186 TBI patients aged > 18 years with minimum survival for at least 12 h admitted to the ICU at the level 1 trauma center were prospectively included in the study and divided into two groups: TBI with and without extra cranial injuries. All admitted patients were treated according to the standard institutional protocol. The PCT levels were obtained on admission, on day 2, and 5. Clinical, laboratory, diagnostic, and therapeutic data were also collected. Primary mortality is defined as death related to central nervous system (CNS) injury, while secondary mortality defined as death related to sepsis or extracranial cause. Results: Median PCT levels at admission, day 2, and day 5 in TBI patients with extracranial injuries were 3.0, 0.83, and 0.69 ng/ml. In total, primary mortality was observed in 18 (9.7%) patients, while secondary causes were attributable in 20 (12.3%) patients. Regression analysis for primarily CNS cause of mortality showed PCT cutoff level at admission more than 5.5 ng/ml carried sensitivity and specificity of 75%, but for secondary cause (sepsis) of mortality, PCT cutoff values on day 2 > 1.15 ng/ml were derived significant with sensitivity of 70% and specificity of 66%. No significant association of parameters like length of ICU stay, Glasgow outcome scale (GOS), and primary/secondary mortality with the presence of extracranial injuries in TBI patients as compared with TBI alone was noted.

Indian Journal of Critical Care Medicine, 2019

Background: There are studies comparing USG guided percutaneous dilatational tracheostomy (PDT) w... more Background: There are studies comparing USG guided percutaneous dilatational tracheostomy (PDT) with bronchoscopy guided PDT. We have compared USG guided PDT to conventional landmark guided PDT using bronchoscopy in both the groups. Objective: The primary outcome was the time of procedure and the secondary outcome was incidence of complications in USG guided PDT in comparision to the conventional PDT. Materials and Methods: Seventy adult patients were randomly allocated in two groups, i.e., conventional landmark percutaneous dilatational tracheostomy (PDT) and ultrasonography (USG) guided PDT. Demographic data, injury severity score, time taken for the procedure, attempts of tracheal puncture, major and minor complications, and outcome were compared. Results: The median time taken for the procedure was 12 minutes [min., max.; 8, 20] in conventional group 1 and 16 minutes [9, 24] in group 2 (USG guided) which was statistically significant. Minor bleeding was seen in 7 (20%) patients in group 1 and only in 4 patients (11.5%) in group 2. The rate of other complications and the long term outcome were similar in both the groups. Conclusion: The use of real time USG during PDT may confer advantage over conventional PDT when using bronchoscopy in terms of decreasing the incidence of minor bleeding but duration of the procedure gets prolonged.

15th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care, 2014

Journal of pediatric neurosciences

Topiramate is a potent antiepileptic drug with multiple modes of action including inhibition of c... more Topiramate is a potent antiepileptic drug with multiple modes of action including inhibition of carbonic anhydrase activity. Inhibition of this enzyme predisposes to non-anion gap metabolic acidosis which has been amply described in the literature. However, the severity is yet to be well defined. We encountered a case of topiramate-induced non-anion gap metabolic acidosis associated with hemodynamic perturbations in an 8-year-old child in the postoperative period.

Anaesthesiology intensive therapy, 2017

The significant advantages of percutaneous tracheostomy over surgical (open) tracheostomy has ena... more The significant advantages of percutaneous tracheostomy over surgical (open) tracheostomy has enabled its widespread acceptability and practice in intensive care units. Over the years, various modifications in the technique of percutaneous tracheostomy has increased its safety profile and reduced the overall complication rate. However, even though it is a bedside procedure, inappropriate patient selection and poor adherence to protocols can lead to devastating complications. One such complication, namely pneumothorax, is often overlooked. In this article, we have highlighted all the possible etiologies of pneumothorax during percutaneous tracheostomy. A brief insight into some of the preventable strategies is also discussed.

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.

Nigerian Medical Journal, 2014

An otherwise healthy young male patient weighing 62 kg was taken for an urgent craniotomy and exc... more An otherwise healthy young male patient weighing 62 kg was taken for an urgent craniotomy and excision for left parieto-occipital space occupying lesion. Due to deteriorating consciousness, he was in an emergency room and shifted to OR. Anaesthesia was induced with fentanyl 100 µg and propofol 80 mg. Maintenance of anaesthesia was done with oxygen, isoflurane, fentanyl, and vecuronium. Intra operatively, we observed see-CASE REPORT Case 1 An otherwise healthy young male patient weighing 60 kg was presented for olfactory groove meningioma surgery. The patient was induced and maintained with balanced

Indian Journal of Neurosurgery, 2017

Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through... more Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through changes in arterial carbon dioxide levels. Neurosurgical patients might require mechanical ventilation for correction and maintenance of changes in the pulmonary system that occur either due to neurosurgical pathology or following surgery during the acute phase. This review discusses the basics of mechanical ventilation relevant to the neurosurgeon in the day-today management of neurosurgical patient requiring artificial support of the respiration.

Journal of Neuroanaesthesiology and Critical Care, 2015

Rate-dependent left bundle branch block (LBBB) in neurosurgical intensive care unit (NSICU) is a ... more Rate-dependent left bundle branch block (LBBB) in neurosurgical intensive care unit (NSICU) is a rare entity. We report an unusual presentation of heart rate-dependent transient, but intermittent LBBB in a patient with traumatic brain injury (TBI) without previous history of cardiac disease.

Journal of Neuroanaesthesiology and Critical Care, 2014

A 25-year-old 58 kg ASA 1 male was scheduled for an anterior cervical discectomy and fusion (ACDF... more A 25-year-old 58 kg ASA 1 male was scheduled for an anterior cervical discectomy and fusion (ACDF) for traumatic prolapsed inter vertebral disc (PIVD) at third and fourth cervical vertebra (C 3-4) level. His routine blood investigation and airway examination

Saudi Journal of Anaesthesia, 2012

Letters to Editor Thirdly, the hypercapnia produced by CO 2 absorption during laparoscopy can dec... more Letters to Editor Thirdly, the hypercapnia produced by CO 2 absorption during laparoscopy can decrease the myocardial contractility and lower the arrhythmia threshold. [2,3] In our patient, we maintained the EtCO 2 between 28 and 32 mmHg by adjusting the ventilator settings to minimize the chances of hypercapnea. Fourthly, patients with Ebstein's anomaly already have a high propensity for tachyarrhthmias and paradoxical embolism, for which we avoided the insertion of central venous catheter. [3,4] Moreover, because excess fluid administration can lead to an increase in right to left shunt and hypoxemia, we made every effort to prevent any excess fluid administration. We believe that the anesthetic challenges posed by the patients with Ebstein's anomaly can vary from patient to patient depending of the physical status, type of surgery and monitoring techniques. [5,6]

Journal of Neuroanaesthesiology and Critical Care, 2015

moderated the workshop and facilitated the discussion between the audience and experts. Complete ... more moderated the workshop and facilitated the discussion between the audience and experts. Complete anesthetic management including preoperative preparation, intraoperative concerns, and management and post-operative plan was discussed for each case. Besides this, Dr Navdeep (AIIMS, New Delhi) demonstrated the use of cardiac output monitor and its applications during the intraoperative anesthetic management of neurosurgical cases. HTML pages have been optimized of mobile and other hand-held devices (such as iPad, Kindle, iPod) for faster browsing speed. Click on [Mobile Full text] from Table of Contents page. This is simple HTML version for faster download on mobiles (if viewed on desktop, it will be automatically redirected to full HTML version) E-Pub for hand-held devices EPUB is an open e-book standard recommended by The International Digital Publishing Forum which is designed for reflowable content i.e. the text display can be optimized for a particular display device. Click on [EPub] from Table of Contents page. There are various e-Pub readers such as for Windows: Digital Editions, OS X: Calibre/Bookworm, iPhone/iPod Touch/iPad: Stanza, and Linux: Calibre/Bookworm. E-Book for desktop One can also see the entire issue as printed here in a 'flip book' version on desktops. Links are available from Current Issue as well as Archives pages. Click on View as eBook

Saudi Journal of Anaesthesia, 2013

Saudi Journal of Anaesthesia, 2014

Saudi Journal of Anaesthesia, 2011

Neurogenic pulmonary edema (NPE) is a well-known entity, occurs after acute severe insult to the ... more Neurogenic pulmonary edema (NPE) is a well-known entity, occurs after acute severe insult to the central nervous system. It has been described in relation to different clinical scenario. However, NPE has rarely been mentioned after endovascular coiling of intracranial aneurysms. Here, we report the clinical course of a patient who developed NPE after aneurysmal rupture during endovascular surgery. There was significant cardiovascular instability possibly from stimulation of hypothalamus adjacent to the site of aneurysm. This case highlights the predisposition of minimally invasive procedures like endovascular coiling to life-threatening complications such as NPE.