Vinayak Pujari | Shivaji University, Kolhapur, India (original) (raw)
Papers by Vinayak Pujari
Saudi Journal of Anaesthesia
Journal of Health and Allied Sciences NU
Celiac plexus block is a time tested method for management of pain. It is conventionally done via... more Celiac plexus block is a time tested method for management of pain. It is conventionally done via posterior approach. We report successful use of anterior celiac plexus to manage pain in a case of chronic pancreatitis with necrotising fasciitis of the back.
Indian Journal of Anesthesia and Analgesia
Indian Journal of Anesthesia and Analgesia
Anesthesia, essays and researches
Caudal analgesia is the most popular regional anesthesia technique in pediatric population for in... more Caudal analgesia is the most popular regional anesthesia technique in pediatric population for intraoperative and postoperative analgesia. Clonidine, an α2 agonist, prolongs analgesia without causing significant respiratory depression after systemic or neuraxial administration. However, the most beneficial route of its administration is still controversial. Thus, we compared the effects of caudal and intravenous (i.v) clonidine on postoperative analgesia produced by caudal levobupivacaine in children undergoing infraumbilical surgery. A comparative three group study was carried out in seventy-five pediatric patients who underwent elective surgery for infraumbilical procedures, under general anesthesia with caudal block. Group A (n = 25) received levobupivacaine 0.25% 1 mL/kg caudally and 5 mL of normal saline i.v, Group B (n = 25) received levobupivacaine 0.25% 1 mL/kg with 1 μg/kg clonidine caudally and 5 mL of normal saline i.v, and Group C (n = 25) received levobupivacaine 0.25% ...
Anesthesia: Essays and Researches
Women undergoing cesarean (CS) delivery present a unique set of challenges to the anesthetist in ... more Women undergoing cesarean (CS) delivery present a unique set of challenges to the anesthetist in terms of postoperative pain management. This study was conducted to compare the analgesic efficacy of intrathecal buprenorphine (ITB) with ultrasound-guided transversus abdominis plane (TAP) block in post-CS delivery pain. A prospective randomized comparative study of sixty American Society of Anesthesiologists physical status I and II pregnant patients divided into two groups of thirty each as ITB group and TAP block group after satisfying the inclusion criteria. In the present study, demographic data were comparable between both groups. The time to first analgesic request was significantly longer in ITB group (389.67 ± 90.78 min) compared to TAP group (669.17 ± 140.65 min) and was statistically significant, P < 0.001. The mean paracetamol consumption in the first 24 h was higher in the TAP group (3.5 g) compared to the ITB group (1.13 g) and was statistically significant, P < 0.0001, and the mean tramadol consumed in first 24 h was higher in the TAP (46.66 mg) group as compared to the ITB group (16.66 mg) and was statistically significant, P < 0.001. The mean visual analog scale scores assessed at 4, 6, 12, and 24 h was higher in the TAP group and was statistically significant, P < 0.001. Our study showed that patients receiving ITB for post-CS pain management reported longer duration of analgesia, lower pain scores, and lower analgesic consumption during the first 24 h. The benefits of neuraxial opiates are significant and far outweigh the side effects.
Anesthesia: Essays and Researches
The application of skull pin holder elicits an adverse hemodynamic response that can be deleterio... more The application of skull pin holder elicits an adverse hemodynamic response that can be deleterious; there are many drugs that have been used to attenuate this response. We have conducted this study to evaluate the efficacy of intravenous (i.v.) dexmedetomidine on attenuation of hemodynamic responses to skull pin head holder application and to compare the effectiveness of two doses of i.v. dexmedetomidine (1 μg/kg and 0.5 μg/kg bolus). Ninety American Society of Anesthesiologists physical Status I-III patients undergoing craniotomy were randomized into three groups of thirty each. After intubation, patients in Group A received 1 μg/kg of i.v. dexmedetomidine, Group B received 0.5 μg/kg of i.v. dexmedetomidine, whereas Group C received an equivalent quantity of normal saline. Hemodynamic parameters were monitored regularly after skull pin insertion. There was no significant difference in the monitored hemodynamic parameters among the three groups from baseline until intubation. Heart rate (HR) and mean arterial pressure (MAP) increased significantly at skull pin insertion and subsequent points in Group C, whereas the values decreased in Groups A and B (P < 0.05). Patients in Group A showed a higher and sustained attenuation of MAP. Patients in Group C had a higher incidence of tachycardia and hypertension requiring additional measures to attenuate the response. Dexmedetomidine in either dosage (1 μg/kg or 0.5 μg/kg) was effective in attenuating hemodynamic response to skull pin insertion. Dexmedetomidine in doses of 0.5 μg/kg was as effective in attenuating the HR and MAP response to skull pin insertion as compared to a dose of 1 μg/kg.
Journal of Anaesthesiology Clinical Pharmacology, 2017
Background and Aims: The primary aim of this study was to evaluate the effect of addition of dexm... more Background and Aims: The primary aim of this study was to evaluate the effect of addition of dexmedetomidine on the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Material and Methods: Sixty patients of American Society of Anesthesiologists physical status I/II/III undergoing elective upper limb surgeries under supraclavicular brachial plexus block using nerve stimulator were randomized into two groups. Group A (n = 30) received 30 mL 0.5% ropivacaine and 1 mL normal saline, and Group B (n = 30) received 30 mL 0.5% ropivacaine and 1 µg/kg of dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included time to onset and duration of sensory/motor blockade. Statistical Analysis: Results on continuous measurements are presented as mean ± standard deviation and compared using Student's unpaired t-test. Results on categorical measurements are presented in number (%) and compared using Chi-square test. Results: Onset of sensory and motor block in Group A (13.0 ± 4.1 and 23.5 ± 5.6 min) was slower than those in Group B (9.5 ± 5.8 and 15.6 ± 6.3 min; P = 0.009 for sensory and P < 0.001 for the motor block). Duration of sensory and motor block in Group A (400.8 ± 86.6 and 346.9 ± 76.9 min) was shorter than those in Group B (630.6 ± 208.2 and 545.9 ± 224.0 min; (P < 0.001). The duration of analgesia in Group A (411.0 ± 91.2 min) was shorter than that in Group B (805.7 ± 205.9 min; P < 0.001). The incidence of bradycardia and hypotension was higher in Group B than in Group A (P < 0.001). Conclusion: Perineural dexmedetomidine with ropivacaine provides prolonged postoperative analgesia, hastens the onset of sensory and motor block and prolongs the duration of the supraclavicular brachial plexus block.
Anaesthetic Management of a Patient With Complicated Malignant Otitis Externa Vocal Cord Palsy and Multiple Level Intervertebral Disc Prolapse, Jun 27, 2013
Volume Preloading Prior to Subarachnoid Block Comparison Between Hetastarch Polygelatin Ringer S Lactate Solution, Nov 22, 2013
Anesthesia: Essays and Researches, 2015
To assess the amount of propofol required for induction based on bispectral index (BIS) after adm... more To assess the amount of propofol required for induction based on bispectral index (BIS) after administering epidural anesthesia with ropivacaine alone and ropivacaine with dexmedetomidine in patients undergoing lower extremities and abdominal surgeries. A double-blinded randomized clinical trial was carried out in 60 patients over a period of 2 years in a tertiary care hospital. American Society of Anaesthesiologists I or II in age group 18-65 years were included in the study. Group R received epidural anesthesia with ropivacaine alone, and Group D received ropivacaine and dexmedetomidine. General anesthesia was induced with propofol under BIS monitoring after 15 min. Onset of sensory and motor block, time for loss of consciousness and total amount of propofol used during induction to achieve the BIS value &amp;lt; 55 were recorded. Student&amp;#39;s t-test and Chi-square test were used to find the significance of study parameters. Time of onset of sensory block (Group R 11.30 ± 1.64/Group D 8.27 ± 0.83 min), motor block (Group R 14.16 ± 1.33/Group D 12.63 ± 1.22 min), time for loss of consciousness (Group R 90.57 ± 11.05/Group D 73.67 ± 16.34 s), and total amount of propofol (Group R 129.83 ± 22.38/Group D 92.13 ± 12.93 s) were reduced in Group D which was statistically significant with P &amp;lt; 0.001. Epidural ropivacaine with dexmedetomidine significantly reduces the total propofol dose required for induction of anesthesia. Also, it decreases the onset time of sensory and motor block and provides good hemodynamic stability.
Journal of clinical and diagnostic research : JCDR, 2014
Von Hippel Lindau (VHL) syndrome has a predilection to manifest multiple haemangioblastomas in th... more Von Hippel Lindau (VHL) syndrome has a predilection to manifest multiple haemangioblastomas in the retina and central nervous system. We report a rare case of raised intracranial pressure during bilateral laparoscopic adrenalectomy for pheochromocytoma in a patient of VHL syndrome who had a ventriculoperitoneal shunt.
Egyptian Journal of Anaesthesia, 2014
Saudi Journal of Anaesthesia, 2015
left ventricular systolic dysfunction with ejection fraction 40% and hypokinetic apex and apical ... more left ventricular systolic dysfunction with ejection fraction 40% and hypokinetic apex and apical anterolateral septum. Patient was diagnosed as acute anterior wall MI with cardiogenic shock and taken up for percutaneous transluminal coronary angioplasty and implantation of drug eluting stents to proximal and mid left anterior descending artery. An intraarotic balloon pump (IABP) was inserted in the right femoral artery. She was started on heparin and furosemide infusion. IABP was removed on the 3 rd day. After removal of IABP patient complained of pain in the right lower limb and peripheral pulses were not felt. A vascular surgeon reference was sought. Injection clexane 60 ug subcutaneous was given. A Doppler study revealed superficial femoral artery occlusion. She was diagnosed as ALI and was posted immediately for transfemoral thrombectomy. On preanesthetic examination, patient was conscious, tachypneic. Bilateral pitting edema was noted. Her blood pressure was 150/70 mm Hg, pulse rate was 90/min, regular. On auscultation, bilateral basal crepitations and rhochi were present. Her saturation on the oxygen mask was 92%. Her Hb was 9 gm% and rest of the hematological investigations were normal. Her arterial blood gas on oxygen revealed pH-7.5, PCO 2 −31.2, PO 2 −57.8, HCO 3 −26.7. She was on ecosprin and clopidogrel apart from her routine antihypertensive medication and insulin. Patient had taken breakfast 3 h before surgery. She was accepted as American
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014
Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy... more Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy haematoma is a rare but life threatening complication of thyroid surgery leading to airway obstruction. We report a case of huge goiter that underwent near total thyroidectomy and developed post thyroidectomy haematoma. Within no time it resulted in near fatal airway obstruction, pulmonary oedema and cardiac arrest. The haematoma was evacuated immediately and patient was resuscitated successfully. Pulmonary oedema was further worsened by subsequent aggressive fluid resuscitation. She was electively ventilated with PEEP and was extubated after five days. Except for right vocal cord palsy her postoperative stay was uneventful. This is unique case where a post thyoidectomy haematoma has resulted in fatal supraglottic oedema and pulmonary oedema. Early recognition, immediate intubation and evacuation of haematoma are the key to manage this complication. We highlight on the pathophysiology of haematoma and discuss the strategies to prevent similar events in future.
Saudi Journal of Anaesthesia, 2015
Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology affecting... more Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology affecting most commonly larynx. A 5-year-old child with stridor was posted for microlaryngoscopic excision of laryngeal papilloma. We discuss the perioperative management of case with the various ventilation strategies. In child with stridor intubation remains the safest option. It is suggested to maintain spontaneous ventilation until intubation as mask ventilation could be difficult.
Anesthesia: Essays and Researches, 2012
Children with arthrogryposis multiplex congenita often require multiple orthopedic corrective pro... more Children with arthrogryposis multiplex congenita often require multiple orthopedic corrective procedures. We present a case of a child with arthrogryposis multiplex congenita posted for contracture release of both lower limbs that were successfully managed with total intravenous anesthesia and caudal epidural analgesia with Bupernorphine as an additive.
Journal of clinical and diagnostic research : JCDR, 2014
Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA) in o... more Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA) in our institution. There are multiple studies which have found spinal anaesthesia as a safe alternative. We have conducted this study of LC, performed under spinal anesthesia to assess its safety and feasibility in comparison with GA. Fifty patients with symptomatic gallstone disease and American Society of Anesthesiologists status I or II were randomised to have LC under spinal (n = 25) or general (n = 25) anesthesia. Intraoperative vitals, postoperative pain, complications, recovery, and surgeon satisfaction were compared between the 2 groups. In the SA group six patients (24%) complained of shoulder pain, two patients required conversion to GA (8%) as the pain did not subside with Fentanyl. None of the patients in the SA group had immediate postoperative pain at operated site. Only two (8%) patients had pain score of 4 at the operative site within eight hours requiring rescue analgesic. ...
Saudi Journal of Anaesthesia
Journal of Health and Allied Sciences NU
Celiac plexus block is a time tested method for management of pain. It is conventionally done via... more Celiac plexus block is a time tested method for management of pain. It is conventionally done via posterior approach. We report successful use of anterior celiac plexus to manage pain in a case of chronic pancreatitis with necrotising fasciitis of the back.
Indian Journal of Anesthesia and Analgesia
Indian Journal of Anesthesia and Analgesia
Anesthesia, essays and researches
Caudal analgesia is the most popular regional anesthesia technique in pediatric population for in... more Caudal analgesia is the most popular regional anesthesia technique in pediatric population for intraoperative and postoperative analgesia. Clonidine, an α2 agonist, prolongs analgesia without causing significant respiratory depression after systemic or neuraxial administration. However, the most beneficial route of its administration is still controversial. Thus, we compared the effects of caudal and intravenous (i.v) clonidine on postoperative analgesia produced by caudal levobupivacaine in children undergoing infraumbilical surgery. A comparative three group study was carried out in seventy-five pediatric patients who underwent elective surgery for infraumbilical procedures, under general anesthesia with caudal block. Group A (n = 25) received levobupivacaine 0.25% 1 mL/kg caudally and 5 mL of normal saline i.v, Group B (n = 25) received levobupivacaine 0.25% 1 mL/kg with 1 μg/kg clonidine caudally and 5 mL of normal saline i.v, and Group C (n = 25) received levobupivacaine 0.25% ...
Anesthesia: Essays and Researches
Women undergoing cesarean (CS) delivery present a unique set of challenges to the anesthetist in ... more Women undergoing cesarean (CS) delivery present a unique set of challenges to the anesthetist in terms of postoperative pain management. This study was conducted to compare the analgesic efficacy of intrathecal buprenorphine (ITB) with ultrasound-guided transversus abdominis plane (TAP) block in post-CS delivery pain. A prospective randomized comparative study of sixty American Society of Anesthesiologists physical status I and II pregnant patients divided into two groups of thirty each as ITB group and TAP block group after satisfying the inclusion criteria. In the present study, demographic data were comparable between both groups. The time to first analgesic request was significantly longer in ITB group (389.67 ± 90.78 min) compared to TAP group (669.17 ± 140.65 min) and was statistically significant, P < 0.001. The mean paracetamol consumption in the first 24 h was higher in the TAP group (3.5 g) compared to the ITB group (1.13 g) and was statistically significant, P < 0.0001, and the mean tramadol consumed in first 24 h was higher in the TAP (46.66 mg) group as compared to the ITB group (16.66 mg) and was statistically significant, P < 0.001. The mean visual analog scale scores assessed at 4, 6, 12, and 24 h was higher in the TAP group and was statistically significant, P < 0.001. Our study showed that patients receiving ITB for post-CS pain management reported longer duration of analgesia, lower pain scores, and lower analgesic consumption during the first 24 h. The benefits of neuraxial opiates are significant and far outweigh the side effects.
Anesthesia: Essays and Researches
The application of skull pin holder elicits an adverse hemodynamic response that can be deleterio... more The application of skull pin holder elicits an adverse hemodynamic response that can be deleterious; there are many drugs that have been used to attenuate this response. We have conducted this study to evaluate the efficacy of intravenous (i.v.) dexmedetomidine on attenuation of hemodynamic responses to skull pin head holder application and to compare the effectiveness of two doses of i.v. dexmedetomidine (1 μg/kg and 0.5 μg/kg bolus). Ninety American Society of Anesthesiologists physical Status I-III patients undergoing craniotomy were randomized into three groups of thirty each. After intubation, patients in Group A received 1 μg/kg of i.v. dexmedetomidine, Group B received 0.5 μg/kg of i.v. dexmedetomidine, whereas Group C received an equivalent quantity of normal saline. Hemodynamic parameters were monitored regularly after skull pin insertion. There was no significant difference in the monitored hemodynamic parameters among the three groups from baseline until intubation. Heart rate (HR) and mean arterial pressure (MAP) increased significantly at skull pin insertion and subsequent points in Group C, whereas the values decreased in Groups A and B (P < 0.05). Patients in Group A showed a higher and sustained attenuation of MAP. Patients in Group C had a higher incidence of tachycardia and hypertension requiring additional measures to attenuate the response. Dexmedetomidine in either dosage (1 μg/kg or 0.5 μg/kg) was effective in attenuating hemodynamic response to skull pin insertion. Dexmedetomidine in doses of 0.5 μg/kg was as effective in attenuating the HR and MAP response to skull pin insertion as compared to a dose of 1 μg/kg.
Journal of Anaesthesiology Clinical Pharmacology, 2017
Background and Aims: The primary aim of this study was to evaluate the effect of addition of dexm... more Background and Aims: The primary aim of this study was to evaluate the effect of addition of dexmedetomidine on the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block. Material and Methods: Sixty patients of American Society of Anesthesiologists physical status I/II/III undergoing elective upper limb surgeries under supraclavicular brachial plexus block using nerve stimulator were randomized into two groups. Group A (n = 30) received 30 mL 0.5% ropivacaine and 1 mL normal saline, and Group B (n = 30) received 30 mL 0.5% ropivacaine and 1 µg/kg of dexmedetomidine. The primary outcome was the duration of analgesia. Secondary outcomes included time to onset and duration of sensory/motor blockade. Statistical Analysis: Results on continuous measurements are presented as mean ± standard deviation and compared using Student's unpaired t-test. Results on categorical measurements are presented in number (%) and compared using Chi-square test. Results: Onset of sensory and motor block in Group A (13.0 ± 4.1 and 23.5 ± 5.6 min) was slower than those in Group B (9.5 ± 5.8 and 15.6 ± 6.3 min; P = 0.009 for sensory and P < 0.001 for the motor block). Duration of sensory and motor block in Group A (400.8 ± 86.6 and 346.9 ± 76.9 min) was shorter than those in Group B (630.6 ± 208.2 and 545.9 ± 224.0 min; (P < 0.001). The duration of analgesia in Group A (411.0 ± 91.2 min) was shorter than that in Group B (805.7 ± 205.9 min; P < 0.001). The incidence of bradycardia and hypotension was higher in Group B than in Group A (P < 0.001). Conclusion: Perineural dexmedetomidine with ropivacaine provides prolonged postoperative analgesia, hastens the onset of sensory and motor block and prolongs the duration of the supraclavicular brachial plexus block.
Anaesthetic Management of a Patient With Complicated Malignant Otitis Externa Vocal Cord Palsy and Multiple Level Intervertebral Disc Prolapse, Jun 27, 2013
Volume Preloading Prior to Subarachnoid Block Comparison Between Hetastarch Polygelatin Ringer S Lactate Solution, Nov 22, 2013
Anesthesia: Essays and Researches, 2015
To assess the amount of propofol required for induction based on bispectral index (BIS) after adm... more To assess the amount of propofol required for induction based on bispectral index (BIS) after administering epidural anesthesia with ropivacaine alone and ropivacaine with dexmedetomidine in patients undergoing lower extremities and abdominal surgeries. A double-blinded randomized clinical trial was carried out in 60 patients over a period of 2 years in a tertiary care hospital. American Society of Anaesthesiologists I or II in age group 18-65 years were included in the study. Group R received epidural anesthesia with ropivacaine alone, and Group D received ropivacaine and dexmedetomidine. General anesthesia was induced with propofol under BIS monitoring after 15 min. Onset of sensory and motor block, time for loss of consciousness and total amount of propofol used during induction to achieve the BIS value &amp;lt; 55 were recorded. Student&amp;#39;s t-test and Chi-square test were used to find the significance of study parameters. Time of onset of sensory block (Group R 11.30 ± 1.64/Group D 8.27 ± 0.83 min), motor block (Group R 14.16 ± 1.33/Group D 12.63 ± 1.22 min), time for loss of consciousness (Group R 90.57 ± 11.05/Group D 73.67 ± 16.34 s), and total amount of propofol (Group R 129.83 ± 22.38/Group D 92.13 ± 12.93 s) were reduced in Group D which was statistically significant with P &amp;lt; 0.001. Epidural ropivacaine with dexmedetomidine significantly reduces the total propofol dose required for induction of anesthesia. Also, it decreases the onset time of sensory and motor block and provides good hemodynamic stability.
Journal of clinical and diagnostic research : JCDR, 2014
Von Hippel Lindau (VHL) syndrome has a predilection to manifest multiple haemangioblastomas in th... more Von Hippel Lindau (VHL) syndrome has a predilection to manifest multiple haemangioblastomas in the retina and central nervous system. We report a rare case of raised intracranial pressure during bilateral laparoscopic adrenalectomy for pheochromocytoma in a patient of VHL syndrome who had a ventriculoperitoneal shunt.
Egyptian Journal of Anaesthesia, 2014
Saudi Journal of Anaesthesia, 2015
left ventricular systolic dysfunction with ejection fraction 40% and hypokinetic apex and apical ... more left ventricular systolic dysfunction with ejection fraction 40% and hypokinetic apex and apical anterolateral septum. Patient was diagnosed as acute anterior wall MI with cardiogenic shock and taken up for percutaneous transluminal coronary angioplasty and implantation of drug eluting stents to proximal and mid left anterior descending artery. An intraarotic balloon pump (IABP) was inserted in the right femoral artery. She was started on heparin and furosemide infusion. IABP was removed on the 3 rd day. After removal of IABP patient complained of pain in the right lower limb and peripheral pulses were not felt. A vascular surgeon reference was sought. Injection clexane 60 ug subcutaneous was given. A Doppler study revealed superficial femoral artery occlusion. She was diagnosed as ALI and was posted immediately for transfemoral thrombectomy. On preanesthetic examination, patient was conscious, tachypneic. Bilateral pitting edema was noted. Her blood pressure was 150/70 mm Hg, pulse rate was 90/min, regular. On auscultation, bilateral basal crepitations and rhochi were present. Her saturation on the oxygen mask was 92%. Her Hb was 9 gm% and rest of the hematological investigations were normal. Her arterial blood gas on oxygen revealed pH-7.5, PCO 2 −31.2, PO 2 −57.8, HCO 3 −26.7. She was on ecosprin and clopidogrel apart from her routine antihypertensive medication and insulin. Patient had taken breakfast 3 h before surgery. She was accepted as American
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014
Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy... more Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy haematoma is a rare but life threatening complication of thyroid surgery leading to airway obstruction. We report a case of huge goiter that underwent near total thyroidectomy and developed post thyroidectomy haematoma. Within no time it resulted in near fatal airway obstruction, pulmonary oedema and cardiac arrest. The haematoma was evacuated immediately and patient was resuscitated successfully. Pulmonary oedema was further worsened by subsequent aggressive fluid resuscitation. She was electively ventilated with PEEP and was extubated after five days. Except for right vocal cord palsy her postoperative stay was uneventful. This is unique case where a post thyoidectomy haematoma has resulted in fatal supraglottic oedema and pulmonary oedema. Early recognition, immediate intubation and evacuation of haematoma are the key to manage this complication. We highlight on the pathophysiology of haematoma and discuss the strategies to prevent similar events in future.
Saudi Journal of Anaesthesia, 2015
Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology affecting... more Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology affecting most commonly larynx. A 5-year-old child with stridor was posted for microlaryngoscopic excision of laryngeal papilloma. We discuss the perioperative management of case with the various ventilation strategies. In child with stridor intubation remains the safest option. It is suggested to maintain spontaneous ventilation until intubation as mask ventilation could be difficult.
Anesthesia: Essays and Researches, 2012
Children with arthrogryposis multiplex congenita often require multiple orthopedic corrective pro... more Children with arthrogryposis multiplex congenita often require multiple orthopedic corrective procedures. We present a case of a child with arthrogryposis multiplex congenita posted for contracture release of both lower limbs that were successfully managed with total intravenous anesthesia and caudal epidural analgesia with Bupernorphine as an additive.
Journal of clinical and diagnostic research : JCDR, 2014
Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA) in o... more Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA) in our institution. There are multiple studies which have found spinal anaesthesia as a safe alternative. We have conducted this study of LC, performed under spinal anesthesia to assess its safety and feasibility in comparison with GA. Fifty patients with symptomatic gallstone disease and American Society of Anesthesiologists status I or II were randomised to have LC under spinal (n = 25) or general (n = 25) anesthesia. Intraoperative vitals, postoperative pain, complications, recovery, and surgeon satisfaction were compared between the 2 groups. In the SA group six patients (24%) complained of shoulder pain, two patients required conversion to GA (8%) as the pain did not subside with Fentanyl. None of the patients in the SA group had immediate postoperative pain at operated site. Only two (8%) patients had pain score of 4 at the operative site within eight hours requiring rescue analgesic. ...