Browsing by Author "Koshy, Thomas"

Now showing 1 - 20 of 26
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    A Novel Technique To Assess Aortic Valve Repair Before Releasing the Aortic Cross-Clamp
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2009)
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    A Phantom in the Aortic Valve: Tumor, Thrombus, or Artifact?
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2011)
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    Accurate Localization and Echocardiographic-Pathologic Correlation of Tricuspid Valve Angiolipoma by Intraoperative Transesophageal Echocardiography
    (ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, 2009)
    Angiolipoma (angiolipohamartoma) of the tricuspid valve (TV) is a rare tumor which may be occasionally misdiagnosed as right atrial (RA) myxoma. Transesophageal echocardiography (TEE) provides accurate information regarding the size, shape, mobility as well as site of attachment of RA tumors and is a superior modality as compared to transthoracic echocardiography (TTE). Correct diagnosis of RA tumors has therapeutic significance and guides management of patients, as myxomas are generally more aggressively managed than lipomas. We describe a rare case of a pedunculated angiolipoma of the TV which was misdiagnosed as RA myxoma on TTE and discuss the echocardiographic-pathologic correlates of the tumor as well as its accurate localization by TEE. (ECHOCARDIOGRAPHY, Volume 26, November 2009).
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    Airway implications of post-ductal coarctation of the aorta and an aberrant right subclavian artery
    (CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 2008)
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    An Intimal Flap-like Projection in the Aortic Root
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2009)
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    An unusual chest radiograph
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2007)
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    Anesthesia for awake craniotomy: A retrospective study
    (NEUROLOGY INDIA, 2007)
    Context: Awake craniotomy is increasingly performed the world over. We share our experience of performing craniotomy awake with our anesthetic protocol. Aims: To evaluate and analyze the anesthesia records of the patients who underwent awake craniotomy at our institution. Settings and Design: University teaching hospital, Retrospective study. Materials and Methods: We reviewed records of the 42 consecutive patients who underwent awake craniotomy under conscious sedation using Fentanyl and Propofol infusion until December 2005. The drugs were titrated (Bispectral monitoring was used in 16 patients) to facilitate intermittent intraoperative neurological testing. All patients received scalp blocks with a mixture of bupivacaine and lignocaine with adrenaline. Haloperidol and ondansetron were administered in all patients at induction of anesthesia. Results: All patients completed the procedure. One patient each needed endotracheal intubation and LMA for airway control during closure, while another required CPAP perioperatively because of desaturation to <80%. There was significantly decreased use of anesthetics (P<0.001) and a trend towards reduction in complications (e.g. respiratory depression and deep sedation) (P>0.05) with the use of BIS as compared to without BIS. Intraoperative complications were hypertension (19%), tight brain (14.2%), focal seizure (9.5%) respiratory depression (7.1%), deep sedation (7.1%), tachycardia (7.1%) and bradycardia. Two patients desaturated to <95%. 23.8% patients developed transient neurological deficits. The most frequent postoperative complications were PONV (19%) and seizures (16.6%). Conclusions: With the use of advanced monitoring and newer anesthetics, awake craniotomy is a relatively safe procedure with an accepted rate of complications.
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    Case 2-2008 - Rheumatic mitral stenosis associated with partial anomalous pulmonary venous return
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2008)
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    Changes in Left Ventricular Preload, Afterload, and Cardiac Output in Response to a Single Dose of Mannitol in Neurosurgical Patients Undergoing Craniotomy: A Transesophageal Echocardiographic Study
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2012)
    Background: Mannitol increases intravascular volume by withdrawing water from the brain and causes significant changes in stroke volume, cardiac output (CO), systemic vascular resistance, central venous pressure (CVP), and blood pressure. No previous studies have demonstrated changes in left ventricular (LV) preload, afterload, and CO using transesophageal echocardiography (TEE).Methods: Fifteen adult patients undergoing elective supratentorial craniotomy received 20% mannitol 1.0 gm/kg over 15 minutes before dural opening. The following hemodynamic and TEE-derived parameters were recorded before and after the administration of mannitol: heart rate (HR), mean arterial pressure (MAP), CVP, LV end diastolic area (EDA), end systolic area, fractional area change, stroke volume, and CO.Results: EDA and CVP significantly increased at 5 minutes (P=0.002 and < 0.001) after mannitol infusion and remained insignificantly elevated till 15 minutes, thereafter returning to baseline values. CO also increased significantly at 5 and 15 minutes (P=0.001 and 0.013) and remained insignificantly elevated till 25 minutes, and thereafter returned to baseline values. A concomitant significant decline in systemic vascular resistance was observed at 5 and 15 minutes (P=0.002 and 0.008 at 5 and 15 min, respectively). Although EDA increased significantly at 5 minutes, there were no appreciable changes in MAP and HR throughout the study period.Conclusions: In conclusion, in patients undergoing craniotomy, TEE demonstrated that a single bolus dose of 20% mannitol (1.0 gm/kg) caused significant but short-duration alterations in LV preload, afterload, and CO without concomitant changes in hemodynamic variables (MAP/HR).
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    Embolization of Atrial Septal Occluder Device into the Pulmonary Circulation: Role of Transesophageal Echocardiography
    (ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, 2009)
    (ECHOCARDIOGRAPHY, Volume 26, July 2009).
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    Gabapentin Premedication Decreases the Hemodynamic Response to Skull Pin Insertion in Patients Undergoing Craniotomy
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2011)
    Background: In patients undergoing craniotomy, skull pin insertion produces significant increases in heart rate (HR) and blood pressure. We investigated whether premedication with gabapentin would prevent or attenuate this increase.Methods: Forty-seven ASA I and II patients, 18 to 60 years, undergoing elective craniotomy for intracranial tumor surgery were recruited prospectively and randomly divided into 3 groups; L (oral placebo plus 2% lidocaine infiltration at pin sites; n = 12), G (oral gabapentin 900 mg plus normal saline infiltration; n = 21) and GL (oral gabapentin 900mg plus 2% lidocaine infiltration; n = 14). The oral medications were administered 2 hours before induction of anesthesia. Measurements were made at preinduction baseline, before skull pin insertion and at every 1 minute from pin insertion till end of 10 minutes.Results: Forty-three patients completed the study (L, n = 11; G, n = 20; GL, n = 12). Premedication with gabapentin significantly attenuated the rise in systolic (SBP) and mean arterial pressure (MAP) after pin insertion when compared with placebo (for SBP, P < 0.001 at 1 and 2 min and < 0.05 at 3 to 5 min between L and G; P < 0.001 at 1 to 4 min and < 0.05 at 5 min between L and GL; for MAP, P < 0.05 at 1 min, < 0.001 at 2 min and < 0.05 at 3 to 4 min between L and G; P < 0.001 at 1 to 2 min and < 0.05 at 3 to 5 min between L and GL). HR responses were also attenuated in patients premedicated with gabapentin; however, the responses were more variable in group G (P = 0.03 between L and G at 4 min after pin insertion) as compared with group GL (P < 0.05 at 1 min, < 0.001 at 2 min and < 0.05 at 3 to 10 min between L and GL).Conclusion: In conclusion, 900mg of gabapentin, administered orally 2 hours before induction of anesthesia along with lidocaine scalp infiltration abolished the hemodynamic response after skull pin insertion. Premedication with gabapentin alone significantly attenuated the SBP and MAP; however, HR responses were more variable. A larger trial is required to corroborate the findings of the study before clinical recommendations would be warranted.
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    Holt-oram syndrome with hemizygous continuation of inferior vena cava.
    (Asian cardiovascular & thoracic annals, 2006)
    A rare and previously unreported combination of Holt-Oram syndrome, atrial septal defect, patent ductus arteriosus, isolated left atrial isomerism and inferior vena caval interruption with hemizygous continuation to the left superior vena cava is described.
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    Is Collapse of the Lung With Increased Lucency on a Chest X-Ray Always a Pneumothorax?
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2009)
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    Nasogastric tube withdrawal: An unusual cause of accidental extubation and near cardiac arrest in an infant
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2008)
    INSERTING A NASOGASTRIC TUBE (NGT) is one of the most frequent procedures performed by anesthesiologists during perioperative care of the patient. There have been numerous reports of major complications resulting from NGT insertion that include intracranial placement, digestive tract injury, misplacement to the trachea and lung with associated complications, intussusception resulting in bowel obstruction, and massive hemorrhage.(1-6) Rare reports of airway compromise in adult patients after NGT insertion also have been reported.(7-9) A rare incident in which accidental extubation occurred while withdrawing an NGT in an infant scheduled for cardiac magnetic resonance imaging (cMRI) that resulted in rapid desaturation and near cardiac arrest is described, along with the possible mechanisms and ways to prevent such incidents while anesthetizing an infant in such remote locations.