Browsing by Author "Sinha, PK"

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    A Novel Technique for Easy Identification of the Subclavian Vein During Ultrasound-Guided Cannulation
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2010) Muralikrishna, T; Koshy, T; Misra, S; Sinha, PK
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    An alternative and simple technique of guidewire retrieval in a failed Seldinger technique
    (ANESTHESIA AND ANALGESIA, 2005) Unnikrishnan, KP; Sinha, PK; Nalgirkar, RS
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    An alternative site for entropy sensor placement
    (ANESTHESIA AND ANALGESIA, 2006) Sinha, PK; Suneel, PR; Unnikrishnan, KP; Smita, V; Rathod, RC
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    An unusual case of looping of the central venous catheter: Who is the culprit?
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2008) Misra, S; Sinha, PK
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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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    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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    Anesthesia for craniotomy in a patient with previous paralytic polio
    (JOURNAL OF CLINICAL ANESTHESIA, 2008) Suneel, PR; Sinha, PK; Unnikrishnan, KP; Abraham, M
    Poliomyelitis remains endemic in many developing nations. Patients may develop residual muscle weakness in one or more, limbs after an attack of poliomyelitis in childhood. We report an adult patient who presented for right temporal cortical grid placement. He had childhood poliomyelitis and, while showing no evidence of postpolio syndrome, demonstrated excessive sensitivity to nondepolarizing muscle relaxants and developed prolonged muscle weakness during the postoperative period. (c) 2008 Elsevier Inc. All rights reserved.
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    Anesthetic implications of surgical repair of an aortocaval fistula
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2003)
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    Atypical presentation of bilateral phrenic nerve palsy and its unusual recovery after coronary artery bypass grafting.
    (THORACIC AND CARDIOVASCULAR SURGEON, 2006) Duara, R; Sarma, AK; Sinha, PK; Ashalatha, R; Misra, M
    Bilateral phrenic nerve paralysis after coronary artery bypass surgery in a 47-year-old female patient is reported. This became evident on the 5th post-extubation day and mimicked acute coronary syndrome and led to difficulty in diagnosis. The patient required re-intubation and mechanical ventilation for only 6 days. The diagnosis of clinical and radiological abnormalities suggestive of bilateral phrenic nerve dysfunction was assisted by fluoroscopy, measurement of needle electromyography, and phrenic nerve motor conduction studies. The patient was followed up postoperatively for 14 weeks with complete regression of the neuropathy one month after surgery. An awareness of this complication should lead to improved care and successful postoperative management of patients.
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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 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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    Defective double lumen tubes: Mallinckrodt the culprit!
    (ANESTHESIA AND ANALGESIA, 2007) Sinha, PK; Koshy, T
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    Defective triple-lumen catheter - An unusual cause of hypotension
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2003)
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    Effect of lung ventilation with 50% oxygen in air or nitrous oxide versus 100% oxygen on oxygenation index after cardiopulmonary bypass
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2006)
    Objective: This study was designed to assess the use of 100% oxygen or 50% oxygen in air or nitrous oxide after cardiopulmonary bypass (CPB) on atelectasis, as evidenced by the oxygenation index (PaO2/F1O2), after coronary artery bypass graft (CABG) surgery.Design: Prospective, randomized clinical study.Setting: University teaching hospital.Participant: Thirty-six adult patients undergoing CABG surgery.Interventions: Patients either received 50% O-2 in air (50% O-2 group), 50% O-2 in N2O (50% N2O group), or 100% O-2 (100% 02 group) after CPB.Measurements and Main Results: Apart from demographic and perioperative clinical data, extubation time, mediastinal drainage, and pulmonary complications were also recorded. After CPB, arterial blood gases done at various time points until 3 hours postextubation and oxygenation index were calculated. No significant differences were noted in demographic and perioperative data except preoperative hemoglobin and fluid use. Significant deterioration in arterial oxygenation was noted in the 100% O-2 group from the baseline value, whereas significant improvement was seen in the 50% O-2 group at 4 time points from baseline value and at all time points from the 100% O-2 group. After initial deterioration in oxygenation, no further change was evident in the 50% N2O group. Furthermore, there was a greater increase in the oxygenation index as compared with the 100% O-2 group. Time to extubation was also longer in the 100% O-2 group than the 50% O-2 group.Conclusion: Significant deterioration in arterial oxygenation and an increase in the extubation time occurred with the use of 100% O-2 after CPB, whereas better oxygenation was evident with the use of 50% O-2 in air. (c) 2006 Elsevier Inc. All rights reserved.
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    Effect of nitrous oxide in reducing pain of propofol injection in adult patients
    (ANAESTHESIA AND INTENSIVE CARE, 2005)
    In a randomized, double-blind, prospective trial we compared the efficacy of pre-treatment with nitrous oxide (with or without premixed lignocaine in propofol) for the prevention of propofol-induced pain. Ninety consecutive patients were recruited in the study and divided into three groups of 30 each, who received either 50% nitrous oxide in oxygen along with lignocaine 40 mg mixed in 1% propofol 20 ml (Group NL), 50% nitrous oxide in oxygen without lignocaine in propofol (Group N), and 50% oxygen in air with lignocaine mixed in propofol 40 mg (Group L). Pain scores were graded on a four point verbal rating scale (0-3). Eighty-nine patients completed the study while one patient developed excitement, agitation and tremor during nitrous oxide in oxygen inhalation. Eleven patients (36.7%) complained of pain in the group L compared to 7 (23.3%), and 1 (3.3%), in groups N and NL respectively [group NL vs group L (P< 0.001) and group NL vs N (P< 0.001)]. There was no statistical difference observed between group N and group L. Inhalation of 50% nitrous oxide reduces pain on propofol injection. The combination of 50% nitrous oxide and lignocaine mixed with propofol was the most effective treatment.
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    Evaluating the efficacy of the Valsalva maneuver on venous cannulation pain: A prospective, randomized study
    (ANESTHESIA AND ANALGESIA, 2005) Agarwal, A; Sinha, PK; Tandon, M; Dhiraaj, S; Singh, U
    Pain associated with venous cannula is a distressing symptom. We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation. Seventy-five adults, ASA physical status I and II, either sex, undergoing elective surgery, were included in this study. Patients were randomized into 3 groups of 25 each. Group I (C): control; Group II (V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was performed. Venous cannulation pain was graded using a 4-point scale: 0-3, where 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain, and visual analog scale of 0-10, where 0 = no pain and 10 = worst imaginable pain. A significant reduction in the incidence of pain was observed in the Valsalva group: 18 of 25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P < 0.001). A significant reduction in the severity of pain, number of patients in whom one needed to make the vein prominent before cannulation, and the time taken for the same were observed in the Valsalva group (P < 0.001).
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    Fractured central venous catheter - Potential consequences
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2003) Neema, PK; Sinha, PK; Rathod, RC
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    Inadvertent interruption of descending thoracic aorta on cardiopulmonary bypass during repair of a ventricular septal defect and interruption of a patent ductus arteriosus: Its recognition, consequences, and prevention
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2004)
    PATENT DUCTUS ARTERIOSUS (PDA) is commonly closed through a left thoracotomy. The sizes of the PDA, pulmonary artery (PA), and aorta can be quite similar, and to identify the ductus, the surgeon can test occlude the vessel to be ligated.(1) Accidental interruption of the ascending aorta, pulmonary artery (PA) or descending thoracic aorta (DTA) can lead to devastating results. Placement of the pulse oximeter on a lower extremity and the blood pressure cuff on the right arm allow the anesthesiologist to assess flow in the ascending and descending aorta. Occlusion of the PA is characterized by a decrease in the arterial saturation and a decrease followed by an increase in end-tidal carbon dioxide tension.(1) These methods of identification of the vessel test occluded are dependent on pulsatile blood flow and intermittent positive-pressure ventilation. During simultaneous repair of intracardiac lesions and interruption of PDA through a midsternotomy,(2) PDA is ligated either before(3) or after(4) initiation of cardiopulmonary bypass (CPB). PDA is identified by its anatomic location, by its relationship with the left pulmonary artery and the undersurface of the aortal and by identifying its opening from within the pulmonary artery.(2) On CPB, collapse of the PA and rise in the mean arterial pressure after ligation are the indirect features that suggest that the vessel Occluded is the PDA. The monitoring used during PDA ligation through a left thoracotomy to prevent accidental ligation of a vessel other than the PDA is less useful during CPB because of the loss of pulsatile blood flow and discontinuation of ventilation. A case of fatal accidental ligation of DTA in a child who underwent ventricular septal defect (VSD) repair and PDA interruption Under CPB is described.