Browsing by Author "Arulvelan, A"

Now showing 1 - 8 of 8
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    A Retrospective Analysis of Stridor After Vestibular Schwannoma Surgery
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2014) Arulvelan, A; Gayatri, P; Smita, V; Nair, SN
    Background:Transient lower cranial nerve deficits may occur after surgery in the posterior cranial fossa. Stridor has been reported after cerebellopontine angle epidermoid resection. The aim of this retrospective study is to find out whether any preoperative, intraoperative, and postoperative factors lead to stridor after resection of vestibular schwannoma.Methods:Data of patients who underwent vestibular schwannoma resection from 2006 to 2011 were collected. We collected the following factorsage, sex, weight, diabetes, hypertension, preoperative cranial nerve deficits, tumor characteristics, intraoperative use of nitrous oxide, difficult endotracheal intubation, duration of surgery, postoperative cough and swallowing difficulty, limb weakness, and facial edema. Data of patients who developed stridor were compared with those who did not develop stridor. Odds ratio (OR) was used to assess the risk of developing stridor with each factor.Results:Thirteen patients (4.65%) developed stridor in immediate postextubation period. The risk of stridor was significantly high in patients who had difficult intubation (OR=9.56), longer duration of surgery (P=0.034) and in patients who developed facial edema (OR=13.33), upperlimb weakness (OR=32.88), poor cough (OR=7.72), and swallowing difficulty (OR=24.97) in the postoperative period.Conclusions:The identification of the exact etiology of stridor often is difficult. Our results suggest that stridor may be more likely in patients who were difficult to intubate, had longer duration of surgery, who develop facial and neck edema and upperlimb weakness, poor cough, and swallowing after surgery. Establishing airway patency with intubation of the trachea may be required if patients develop oxygen desaturation due to stridor.
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    Anesthetic management of a patient with polycythemia vera for neurosurgery
    (JOURNAL OF ANESTHESIA, 2016) Gautham, NS; Arulvelan, A; Manikandan, S
    Polycythemia vera (PV) is a myeloproliferative disorder characterized by excess red cell clonality. The increased number of red blood cells can lead to increased viscosity of the blood and ultimately compromise the blood supply to the end organs. Thromboembolic and hemorrhagic complications can also develop. Patients with PV presenting with neurological diseases that require surgical intervention are at an increased risk due to various factors, such as immobility, prolonged surgical time, hypothermia and dehydration. We report anesthetic management of a patient with PV who underwent neurosurgical intervention for vestibular schwannoma excision.
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    Effect of Loading Dose of Dexmedetomidine on Dynamic Cerebral Blood Flow Autoregulation in Patients With Intracranial Glial Neoplasms
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2015) Arulvelan, A; Manikandan, S; Easwer, HV; Krishnakumar, K
    Background: Dexmedetomidine has been widely used in neuroanesthesia and critical care settings. The effects of dexmedetomidine on cerebral vascular autoregulation and hemodynamics in patients with intracranial pathology are not well defined. This study is aimed to address this issue. Methods: Fifteen patients with unilateral supratentorial glial tumor (group S) and 15 patients without any intracranial pathology (group C) were included in this study. Transient hyperemic response testing was conducted bilaterally in both groups with transcranial color Doppler. Dynamic autoregulation was assessed with transient hyperemic response ratio (THRR) and strength of autoregulation (SA) at baseline and after infusion of inj. dexmedetomidine (1 mcg/kg) over 10 minutes. Results: THRR and SA values in the hemisphere that had tumor (group S) showed no difference from baseline after a loading dose of dexmedetomidine (P=0.914, 0.217). In the nontumor hemisphere of group S and in both the hemispheres of group C, significant reduction in THRR and SA values were observed (P<0.001) after administration of a loading dose of dexmedetomidine. THRR values were higher in the tumor hemisphere when compared with the nonpathologic hemispheres (P<0.001), suggesting the possibility of baseline hyperemia. Conclusions: In the hemisphere that had glial tumor, autoregulatory indices showed no significant change after dexmedetomidine. It can be because of abnormal vascular architecture and its altered reactivity to dexmedetomidine, or because of baseline hyperemia itself, but the exact mechanism needs to be elucidated. In the nonpathologic hemispheres, THRR and SA values were decreased, suggesting impaired autoregulation with the use of loading dose of dexmedetomidine.
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    Stylet-Assisted Tracheal Intubation Through an ILMA in a Patient with an Anterior Larynx
    (ANESTHESIA AND ANALGESIA, 2012) Singh, G; Arulvelan, A; Gopalakrishna, KN; Manikandan, S; Smita, V; Rathod, RC
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    Sudden Bradycardia and Hypotension in Neurosurgery: Trigeminocardiac Reflex (TCR) and More
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2016) Vimala, S; Arulvelan, A
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    Transesophageal echocardiographic evaluation of left ventricular systolic and diastolic function in response to 20% mannitol and 3% hypertonic saline infusion in neurosurgical patients undergoing cran
    (J Neurosurg Anesthesiol., 2014-07) Gayatri, P; Misra, S; Menon, G; Arulvelan, A; Jissa, VT
    BACKGROUND: Mannitol and hypertonic saline (HS) are routinely used during craniotomy. Both increase myocardial preload and reduce afterload, and may improve cardiac output. It is not currently known whether this results in an improvement in the global myocardial function. Thus, the aim of this study was to compare the effects of a single equiosmolar bolus of 20% mannitol (5 mL/kg) or 3% HS (5 mL/kg) on the global myocardial function by tissue Doppler-derived myocardial performance index (TD-MPI) in patients undergoing craniotomy. METHODS: Fifty adult patients were included and randomized to receive either mannitol or 3% HS. Transesophageal echocardiography was performed in all patients. Early (E) and late (A) peak mitral inflow velocity, early diastolic mitral annular velocity (E prime), isovolumetric relaxation time (IVRT), ejection time (ET), and isovolumetric contraction time (IVCT) were recorded at baseline and at 15, 30, 60, and 120 minutes after administration of the hyperosmolar solutions. TD-MPI was calculated as IVRT+IVCT/ET. RESULTS: There were no significant differences in the TD-MPI (HS vs. mannitol: 0.43 vs. 0.44 [baseline], 0.45 vs. 0.43 [15 min], 0.44 vs. 0.45 [30 min], 0.47 vs. 0.45 [60 min], 0.45 vs. 0.46 [120 min]), E/A ratio, IVCT, and E/E' either within or between the 2 groups at any time point. IVRT was prolonged in HS group as compared with baseline at 15, 30, and 60 minutes postinfusion. ET was decreased in both the groups at 120 minutes postinfusion. Neither of these altered the TD-MPI. CONCLUSIONS: Equiosmolar administration of 20% mannitol and 3% HS did not show any difference in global myocardial performance as measured by TD MPI.
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    Transesophageal Echocardiographic Evaluation of Left Ventricular Systolic and Diastolic Function in Response to 20% Mannitol and 3% Hypertonic Saline Infusion in Neurosurgical Patients Undergoing Craniotomy
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2014) Gayatri, P; Misra, S; Menon, G; Arulvelan, A; Thulaseedharan, JV
    Background: Mannitol and hypertonic saline (HS) are routinely used during craniotomy. Both increase myocardial preload and reduce afterload, and may improve cardiac output. It is not currently known whether this results in an improvement in the global myocardial function. Thus, the aim of this study was to compare the effects of a single equiosmolar bolus of 20% mannitol (5 mL/kg) or 3% HS (5 mL/kg) on the global myocardial function by tissue Doppler-derived myocardial performance index (TD-MPI) in patients undergoing craniotomy. Methods: Fifty adult patients were included and randomized to receive either mannitol or 3% HS. Transesophageal echocardiography was performed in all patients. Early (E) and late (A) peak mitral inflow velocity, early diastolic mitral annular velocity (E prime), isovolumetric relaxation time (IVRT), ejection time (ET), and isovolumetric contraction time (IVCT) were recorded at baseline and at 15, 30, 60, and 120 minutes after administration of the hyperosmolar solutions. TD-MPI was calculated as IVRT + IVCT/ET. Results: There were no significant differences in the TD-MPI (HS vs. mannitol: 0.43 vs. 0.44 [baseline], 0.45 vs. 0.43 [15 min], 0.44 vs. 0.45 [30 min], 0.47 vs. 0.45 [60 min], 0.45 vs. 0.46 [120 min]), E/A ratio, IVCT, and E/E' either within or between the 2 groups at any time point. IVRT was prolonged in HS group as compared with baseline at 15, 30, and 60 minutes postinfusion. ET was decreased in both the groups at 120 minutes postinfusion. Neither of these altered the TD-MPI. Conclusions: Equiosmolar administration of 20% mannitol and 3% HS did not show any difference in global myocardial performance as measured by TD MPI.
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    Transesophageal Echocardiography as a Guide to Central Venous Catheter Placement in a Patient With Functional Ventriculo-atrial CSF Shunt
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2015) Soumya, M; Arulvelan, A; Manikandan, S