Browsing by Author "Krishnakumar, K"

Now showing 1 - 5 of 5
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    Alcohol-based hand rub and surgical site infection after elective neurosurgery: An intervention
    (NEUROLOGY INDIA, 2011)
    Background: Controlled studies on the effect of alcohol-based hand rub before and after each patient contact on surgical site infection (SSI) among neurosurgical patients are scarce. Aim: To evaluate the effect of alcohol-based hand rub before and after each patient contact on SSI after elective neurosurgical procedures. Setting and Design: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. An intervention study using a 'before-after' design. Material and Methods: 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 underwent neurosurgery between January and September 2006 (control group, before protocol) and between January and September 2007 (intervention group, after protocol) were included. Outcome measures included SSI rates, profile of microorganisms and patient survival. Statistical Analysis: SPSS statistics version 17.0. Results: A total of 1,899 operated cases were reviewed. The patients in the control and intervention groups were similar with regard to sex, age and type of neurosurgery. The surgical site infection rates were 22 (2.3%) out of 974 in the control group and 14 (1.5%) out of 925 in the intervention group (P = 0.2). Patient survival rates were 97.6% (control) and 98.3% (intervention). Post hoc power calculation for an alpha value equal to 0.05, the power obtained was 24.9%, showing inadequacy of sample size to get significant results. To achieve 80% power, the sample size required is about 4,800 each for the control and intervention groups. Conclusion: Use of alcohol-based hand rub before and after each patient contact in the neurosurgical intensive care unit did not show a significant reduction in SSI in the present study. This lack of difference between the two groups may be related to the inadequate sample size. The other possibility is that both the strategies are of equal efficacy for prevention of SSIs.
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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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    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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    Tumefactive demyelinating lesions: A Clinicopathological correlative study
    (INDIAN JOURNAL OF PATHOLOGY AND MICROBIOLOGY, 2012) Neelima, R; Krishnakumar, K; Nair, MD; Kesavadas, C; Hingwala, DR; Radhakrishnan, VV; Nair, SS
    Tumefactive demyelinating (TDL) lesions are focal zones of demyelination in the central nervous system and they often mimic the neuroimaging features of an intraxial neoplasm. In this report we describe the clinical, neuroimaging and neuropathological features of six cases of TDL. Only in two patients the neuroimaging features in MRI (magnetic resonance imaging) scans were suggestive of TDL while in the other four cases a diagnosis of glioma was suggested. In order to establish a confirmatory diagnosis neuronavigation/stereotactic biopsy was undertaken and the diagnosis of TDL was established in all six cases at histopathology. Two out of six patients did not respond to the conventional corticosteroid therapy and they were treated with plasma exchange. It is being concluded that neuronavigation biopsy, though provide only a small amount of tissue, and is extremely useful in making the diagnosis of TDL.