Browsing by Author "Dash, PK"

Now showing 1 - 10 of 10
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    Advantages of bupivacaine over lignocaine in maxillary nerve and sphenopalatine ganglion block
    (NEUROLOGY INDIA, 1996) Rout, A; Suresh, L; Dash, PK
    Using Bupivacaine as local anaesthetic to block bilateral maxillary nerve and sphenopalatline ganglion for transsphenoidal excision of pituitary tumours, a prospective study in a series of 10 patients was carried out, This paper presents advantages of Bupivacaine over lignocaine block.
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    Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: An interventional study.
    (Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2011)
    BACKGROUND: Interventional studies on the effect of alcohol-based hand rub on ventilator-associated pneumonia (VAP) among neurosurgical patients are scarce.AIM: To observe the effect of alcohol-based hand rub on tracheobronchial colonization and VAP after elective neurosurgical procedures.MATERIALS AND METHODS: An interventional study using a "before-after" design in a tertiary care center in Kerala. Two 9-month study periods were compared; between these periods, an infection control protocol incorporating an alcohol-based hand rub was implemented for a period of 3 months and continued thereafter. Consecutive patients who required mechanical ventilation after neurosurgery between January and September 2006 and 2007, respectively, were included. Outcome measures included VAP rate, tracheobronchial colonization rate, profile of microorganisms and patient survival.RESULTS: A total of 352 patients were on mechanical ventilator for a varying period of 1-125 days. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. Tracheobronchial colonization was seen in 86 (48.6%) of 177 in the control group and 73 (41.7%) of 175 among the intervention group (P = 0.195). The VAP rates in the control and intervention groups were 14.03 and 6.48 per 1000 ventilator days (P = 0.08). The predominant organisms causing VAP and tracheobronchial colonization were Klebsiella and Pseudomonas aeruginosa, respectively, in both groups. Patient survival rates were 87.6% (control) and 92% (intervention).CONCLUSION: Clinical results indicated a better outcome, showing a reduction in tracheobronchial colonization rate and VAP rate, although this was not statistically significant.
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    An unusual cause of high airway pressure and inadequate ventilation because of a defective connector despite accurate placement of a double-lumen tube
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2006) Koshy, T; Sinha, PK; Vijayakumar, A; Dash, PK; Unnikrishnan, KP
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    Dexmedetomidine as an Anesthetic Adjuvant in Patients Undergoing Transsphenoidal Resection of Pituitary Tumor
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2015) Gopalakrishna, KN; Dash, PK; Chatterjee, N; Easwer, HV; Ganesamoorthi, A
    Background: Transnasal transsphenoidal (TNTS) resection of pituitary tumors involves wide fluctuation in hemodynamic parameter and causes hypertension and tachycardia due to intense noxious stimuli during various stages of surgery. None of routinely used anesthetic agents effectively blunts the undesirable hemodynamic responses, and therefore usually there is a need to use increased doses of anesthetic agents. Dexmedetomidine (DEX) an alpha-2 adrenergic receptor agonist, because its sympatholytic and antinociceptive properties may ensure optimal intraoperative hemodynamic stability during critical moments of surgical manipulation. In addition, DEX reduced the anesthetic requirement with rapid recovery at the end of surgery. The main aim of our study was to evaluate the effect of DEX on perioperative hemodynamics, anesthetic requirements, and recovery characteristics in patients undergoing TNTS resection of pituitary tumors. Materials and Methods: Forty-six patients scheduled for elective TNTS resection of pituitary tumor were randomized to receive a continuous infusion of DEX (group D) or 0.9% saline (group C). Patients in both the groups were subjected to a standardized anesthesia comprising of induction with propofol, fentanyl, vecuronium, and positive pressure ventilation with O-2/air (1: 1)/isoflurane. The response entropy target range during maintenance of anesthesia was 40 to 60. The hemodynamic variables at various stages of surgery, intraoperative anesthetic, and analgesic and recovery characteristics were recorded. Results: Total fentanyl consumption during the study period was significantly lower in group D compared with group C (4.7 and 7.7 mu g/kg, respectively; P < 0.01). End-tidal isoflurane concentration requirement was found to be significantly reduced in group D compared with group C throughout the surgical period. Fentanyl and end-tidal isoflurane concentration requirement was reduced in group D compared with group C by 40% and 33.3%, respectively. Heart rate and mean arterial pressure were significantly higher in the group C compared with group D after intubation, during various stages of surgery and immediately after extubation. The group D had excellent surgical conditions and lesser bleeding in comparison to group C. Emergence time and extubation time were significantly shorter in group D compared with group C. Conclusions: DEX as an anesthetic adjuvant improved hemodynamic stability and decreased anesthetic requirements in patients undergoing TNTS resection of pituitary tumor. In addition, DEX provided better surgical field exposure conditions and early recovery from anesthesia.
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    Effect of age on atrial contribution to ventricular filling after balloon mitral valvuloplasty in mitral stenosis
    (INTERNATIONAL JOURNAL OF CARDIOLOGY, 2004)
    Objective: Ventricular filling takes place during the conduit and pump functions of the atrium. While studying whether relief of mitral valve obstruction improves atrial filling, the effect of age on atrial contribution to ventricular filling was studied before and after balloon mitral valvuloplasty (BMV) and on follow-up at 1 year. Methods: Patients with mitral stenosis (MS) and sinus rhythm (n = 59) were divided into group I (< 18 years, n = 13), group 11 (< 30 years, n = 29) and group III (>30 years, n = 17). Two-dimensional mitral valve area (MVA in cm(2)), transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (ANTI), difference between total VTI and ANTI (E-VTI), percentage contribution of ANTI to the total VTI (A-%) and difference between A-% before and after BMV (delta-A-%) were noted. Follow-up data was obtained at I year. The change in A-% at follow-up (A-%-FU) was calculated as the difference between A-% before BMV and A-% at follow-up. Results: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, ANTI and A-% were similar. After BMV, there was increase in ANTI and A-% in all the groups with a trend to be more in younger patients. ANTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, delta-A-% after BMV was significantly higher (13.2+/-7.6, 7.9+/-5.1 and 6.5+/-4.5, respectively, in groups 1, 11 and 111; P < 0.01). Correlation coefficient of age against delta-A-% was - 0.55 (p < 0.01). Correlation coefficients of delta-A-% against post-BMV-MVA and MG were not good. At follow-up of 11.3+/-1.2 months, changes achieved in total VTI, ANTI, E-VTI and A-% were maintained. Total VTI, ANTI, E-VTI and A-% were similar at the time of follow-up on comparing the three groups. But younger patients had significantly higher A-%-FU (12.1+/-5.8, 9.4+/-4.6 and 7.3+/-3.1, respectively, in groups 1, 11 and III; p < 0.01). Conclusions: Prior to BMV, there is an age related reduction in atrial contribution to ventricular filling that improves with relief of MS. Advancing age reduces the immediate and late recovery of atrial contribution after BMV. This may be due to increasing left atrial fibrosis with age that prevents an improvement in atrial pump function. The differential improvement in atrial function in younger patients warrants earlier intervention in MS to achieve better recovery of atrial function. (C) 2004 Elsevier Ireland Ltd. All rights reserved.
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    Prediction of atrial fibrillation in patients with severe mitral stenosis - role of atrial contribution to ventricular filling
    (SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2003)
    Objective - Atrial contribution to ventricular filling was studied to assess its role in predicting the future development of atrial fibrillation ( AF) in patients with severe mitral stenosis ( MS) and sinus rhythm.Design - Two hundred and eight patients with severe MS and sinus rhythm were followed up for 1 year. Baseline data were compared between group I ( who developed AF at follow- up) and group II ( who maintained sinus rhythm). Left atrial size, severity of MS, velocity time integral ( VTI) of mitral valve flow and VTI due to atrial systole ( A- VTI) were noted. Percentage contribution of A- VTI to the total VTI ( A-%) was calculated. Sensitivity and specificity of A-% to predict the onset of AF was obtained.Results - Left atrial size, severity of MS and total VTI were similar in the two groups. Group I patients were older ( 31.1 +/- 9.1 and 18.4 +/- 6.5 years, respectively, p < 0.03) with smaller A- VTI ( 5.3 +/- 2.2 and 6.7 +/- 3.4 cm, respectively, p < 0.01) and A-% ( 8.9 +/- 1.8 and 11.2 +/- 2.7, respectively, p < 0.003). A-% of < 9% ( mean value of A- VTI in group I) had high sensitivity ( 84%, positive predictive value 76%) and specificity ( 80%, negative predictive value 87%) to predict the development of AF.Conclusion - Atrial contribution to ventricular filling is reduced in patients prone to develop AF ( due to inefficient left atrial contraction, much before its dilatation). It can be used for early identification of patients likely to develop AF with high sensitivity and specificity. It is simple, easily available, cost- effective and will guide earlier intervention and more frequent follow- up. There is a preclinical loss in atrial pump function much before the eventual onset of AF.
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    Response of different grades of pulmonary artery hypertension to balloon mitral valvuloplasty
    (AMERICAN JOURNAL OF CARDIOLOGY, 2002)
    Patients with mitral stenosis and severe pulmonary artery hypertension, initially have a worse clinical and hemodynamic profile, more severe disease processes, and a higher restenosis rate. Despite the use of a larger balloon, a smaller valve area with higher gradients and residual pressures occurs. For optimal symptomatic and hemodynamic benefit, early balloon mitral valvuloplasty is indicated.
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    Staged hybrid repair for symptomatic extensive aortic aneurysm from distal ascending across aortic arch till supraceliac thoracic aorta
    (JOURNAL OF VASCULAR SURGERY, 2013) Nedounsejiane, M; Dash, PK; Kapilamoorthy, TR; Unnikrishnan, M
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    Transseptal catheterization without needle puncture
    (SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2001)
    Objective-The aim was to see if probing the fossa ovalis for transseptal puncture during balloon mitral valvuloplasty will reduce time consumed for the procedure.Design-Twenty-five patients had probing of fossa ovalis for left atrial entry (group I). In 30 patients (group II), standard needle puncture was done for left atrial entry. Puncture time and fluoroscopy time were noted and oxymetry was done. Later, a further 60 patients underwent probing of fossa ovalis for validation of the technique.Results-Puncture times in groups I and II were 84.7 +/- 27.5 and 116.1 +/- 37.9 s, respectively (p < 0.02). Fluoroscopy time was 51.2 +/- 19.6 and 73.6 +/- 22.3 s in groups I and II, respectively (p < 0.03). During validation of the technique, 54 of 60 patients (90%) had successful left atrial entry through probing. Atrial level shunt was not seen.Conclusion-Probing the fossa achieves left atrial entry in 90% of patients. It avoids needle puncture and reduces puncture time as well as fluoroscopy time. It is a safe technique.