Browsing by Author "Neema, PK"

Now showing 1 - 20 of 56
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    2-Dimensional Echocardiography and M-Mode Doppler of the Interatrial Septum for Assessment of Left Ventricular Diastolic Function
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2011) Neema, PK; Misra, S; Manikandan, S; Rathod, RC
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    A case of a missing J-tip of the guidewire during internal jugular vein cannulation: A fractured and embolized J-tip or a manufacturing defect?
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2008) Manikandan, S; Neema, PK; Rathod, RC
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    A Rounded Image Inside the Left Ventricle: The Mechanism of the Artifact Formation
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2010) Neema, PK; Singha, S; Manikandan, S
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    A simple technique to secure the endotracheal tube over an intubating fibrescope
    (CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 2007) Neema, PK; Sethuraman, M; Rathod, RC
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    A Sudden Increase in Bispectral Index Score During Carotid Endarterectomy After Shunt Insertion
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2009) Neema, PK; Manikandan, S; Rathod, RC
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    Acute Hemodynamic Instability in an Infant After Pulsatile Bidirectional Cavopulmonary (Glenn Shunt) Anastomosis: Mechanisms and Resolution
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2011) Neema, PK; Sethuraman, M; Krishna, M; Rathod, RC
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    Airway problems caused by hypogonadism in male patients undergoing neurosurgery
    (ANESTHESIA AND ANALGESIA, 2005)
    Unanticipated difficult endotracheal intubations can pose challenges for the anesthesiologist. Risks include airway injury, hypoxemia, and death. There is intubation difficulty in various conditions including Downs syndrome, achondroplasia, acromegaly, and dwarfism. We describe difficulty in intubating the trachea with an appropriate sized endotracheal tube in two young male patients with hypogonadism presenting for neurosurgical procedures under general anesthesia. We discuss the role of hypogonadism and the effects of gonadotropin hormones on pubertal laryngeal growth in male patients.
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    Anesthesia and intracranial arteriovenous malformation
    (NEUROLOGY INDIA, 2004)
    Anesthetic management of intracranial arteriovenous malformation (AVM) poses multiple challenges to the anesthesiologist in view of its complex and poorly understood pathophysiology and multiple modalities for its treatment involving different sub-specialties. The diagnosis of AVM is based on clinical presentation as well as radiological investigation. Pregnant patients with intracranial AVM and neonates with vein of Galen malformation may also pose a,special challenge and require close attention. Despite technological advancement, reported morbidity or mortality after AVM treatment remains high and largely depends on age of the patient, recruitment of perforating vessels, its size, location in the brain, history of previous bleed and post-treatment hyperemic complication. Anesthetic management includes a thorough preoperative visit with meticulous planning based on different modalities of treatment including anesthesia for radiological investigation. Proper attention should be directed while transporting the patient for the procedure. Protecion of the airway, adequate monitoring, and maintaining neurological and cardiovascular stability, and the patient's immobility during the radiological procedures, appreciation and management of various complications that can occur during and after the procedure and meticulous ICU management is essential.
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    Anesthetic implications of surgical repair of an aortocaval fistula
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2003)
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    Author's reply to: anesthesia care for muscle biopsy in children with myopathies by Dr Ferrari Fabio
    (PEDIATRIC ANESTHESIA, 2009) Manikandan, S; Neema, PK; Rathod, RC
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    Bradycardia and sinus arrest following saline irrigation of the brain during epilepsy surgery
    (JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY, 2004)
    Adverse cardiac events during the intraoperative period are life-threatening. The authors report three episodes of severe bradycardia and sinus arrest that occurred in a patient undergoing anterior temporal lobectomy and amygdalo-hippocampectomy for the treatment of epilepsy. The first episode occurred during resection of the amygdala; the other two episodes were observed during subsequent irrigation of the exposed brain structures, most likely the brain stem structures, because of a rent that the surgeon had deliberately made into the basilar cistern for better anatomic appreciation of the structures to be excised. The patient responded well to treatment with no adverse outcomes. The probable mechanisms leading to this event are discussed; the authors excluded insular cortex stimulation, the effects of the anesthetic drugs used, and venous air embolism as a cause of bradycardia and sinus arrest. The amygdala resection was the most likely cause of the first episode of bradycardia; the second episode of bradycardia and sinus arrest occurred because of inadvertent stimulation of brain structures by the high temperature (42degreesC) of the saline used for irrigation. To counter its effects, saline irrigation at room temperature (20degreesC) was started, and this caused the third episode of bradycardia, most likely because of "temperature shock" of the exposed brain. Prompt communication with the surgical team and vigilance are crucial for the appropriate management of such an incident, which may pose a threat to life. Avoiding irrigation of the exposed brain with high-temperature saline may prevent such an incident.
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    Clinical profile and surgical outcome for pulmonary aspergilloma: A single center experience
    (ANNALS OF THORACIC SURGERY, 2005)
    Background. This retrospective study was designed to study the clinical profile, indications, postoperative complications and long-term outcome of pulmonary aspergilloma operated in our institute.Methods. From 1985 to 2003, 60 patients underwent surgery for pulmonary aspergilloma at Sree Chitra Tirunal Institute for Medical Sciences and Technology.Results. The group consisted of 36 male patients and 24 female patients with a mean age of 42.7 +/- 11.8 years. The most common indication for surgery was hemoptysis (93.3%). The common underlying lung diseases were tuberculosis (45%), bronchiectasis (28.3%), and lung abscess (11.6%). Fourteen patients (23%) had simple aspergilloma (SA) and 46 (77%) had complex aspergilloma (CA). The procedures performed were lobectomy (n = 55), pneumonectomy (n = 2), segmental resection (n = 2), and cavernoplasty (n = 2). One patient underwent bilateral lobectomy at 14 months interval. The operative mortality was 4.3% and 0% in CA and SA, respectively (p = 1.0). Major complications occurred in 26.1% patients of CA, whereas none occurred in SA (p = 0.052). The complications included bleeding (n = 2), prolonged air leak (n = 4), empyema (n = 4), repeated pneumothorax (n = 1), and wound dehiscence (n = 1). Three patients needed thoracoplasty. The mean follow-up period was 40 +/- 24 months. The actuarial survival at 10 years was 78% and 92% for CA and SA, respectively. There was no recurrence of disease or hemoptysis.Conclusions. Surgical resection of pulmonary aspergilloma prevents recurrence of hemoptysis. Complex aspergilloma resection was associated with low mortality but significant morbidity, whereas SA had no associated early mortality and morbidity. Long-term outcome is good for SA and satisfactory for CA.
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    Clinical profile of post-operative ductal aneurysm and usefulness of sternotomy and circulatory arrest for its repair
    (EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2005)
    Objective: Post-operative ductal aneurysm is a rare but fatal condition. We retrospectively analyzed the clinical profile of post-operative ductal aneurysm and outcome of their repair with different surgical approaches. Methods: From January 1976 to December 2002, 13 patients underwent repair of post-operative ductal aneurysm. The case data of the patients operated were analyzed and survivors were followed-up. Three patients underwent repair through left thoracotomy, femoro-femoral bypass and 10 patients underwent patch aortoplasty through sternotomy using total circulatory arrest with minimal dissection. Among the sternotomy group, nine patients had midline sternotomy and one patient had transverse sternotomy with the patient in semi-right-lateral position. Hemoptysis (69%) was the commonest presenting symptom. Ten patients had ligation and three patients had division of ductus. Mean age at ductus interruption was 13.7 +/- 8.2 years; mean time interval for development of aneurysm was 3.6 +/- 4.2 years; mean age at aneurysm surgery was 16.9 +/- 8.8 years. Residual left to right shunt was detected in 6 (46%) patients. Results: Three patients repaired through left thoracotomy with femoro-femoral bypass died during surgery due to rupture of aneurysm during dissection and profuse bleeding. Thirty-day survival in patients operated through sternotomy using circulatory arrest was 90% (9/10). Two patients required additional incision in second left intercostal space along with midline sternotomy, for access to descending thoracic aorta. Of these two patients, one patient had bleeding from friable aorta and died; another patient developed left hemiplegia; circulatory arrest time was prolonged in this patient. Mean follow-up period was 9.6 +/- 5.3 years. Persistent left vocal cord palsy was seen in one patient. One patient was lost to follow-up after 3-years. Remaining eight patients were asymptomatic at follow-up. Conclusion: Repair of postoperative ductal aneurysm through left thoracotomy is difficult due to extreme fragility of aneurysm and because of reoperative difficulties. The immediate and long-term outcome of the cases operated through sternotomy using total circulatory arrest with minimal dissection is good. Midline sternotomy limits approach to descending thoracic aorta that can be circumvented by using transverse sternotomy with semi-right-lateral positioning of the patient. (c) 2004 Elsevier B.V. All rights reserved.
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    Combined monitored anesthesia care and femoral nerve block for muscle biopsy in children with myopathies
    (PEDIATRIC ANESTHESIA, 2008) Sethuraman, M; Neema, PK; Rathod, RC
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    Complications of unrecognized urinary bladder distension
    (ANESTHESIA AND ANALGESIA, 2007) Neema, PK; Rao, S; Manikandan, S; Rathod, RC
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    Continuous direct left atrial pressure monitoring during closed mitral commissurotomy
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1995) Neema, PK; Neelakandhan, KS; Waikar, HD
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    Defective triple-lumen catheter - An unusual cause of hypotension
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2003)
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    Difficulty in visualizing endotracheal tube tip in X-ray in a child who underwent cardiac surgery
    (PEDIATRIC ANESTHESIA, 2008) Sethuraman, M; Neema, PK; Rathod, RC
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    Disappearance of signs of coarctation during dissection in a neonate - An unusual phenomenon
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1996) Neema, PK; Waikar, HD; Giri, R