β-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalasse... more β-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalassemia major is the severe form of disease, and the patients often display an array of associated organ dysfunction which thus increase the risk associated with surgery and anesthesia. Patients with β-thalassemia major can have multiple pathological defects that may lead to thromboembolic events. Here, we report such a case who was complicated by occurrence of cerebral sinus thrombosis and presented for decompressive hemicraniectomy under general anesthesia. The anesthetic challenges during in such scenario have been discussed.
Why chest compressions should start when systolic arterial blood pressure is below 50 mm Hg in the anaesthetised patient. Reply to Br J Anaesth 2020; 124: 234–8
The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has ra... more The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be independent neurological manifestations of COVID-19. Critically ill neurological patients are more vulnerable to contracting SARS-CoV-2 infection. Also, neurological patients with comorbidities and multisystem involvement are at increased risk of adverse outcomes. Though SARS-CoV-2 predominantly affects the pulmonary system, it can complicate the assessment and management of neurological patients. With increasing COVID-19 numbers, the hospitalizations of both non-COVID and COVID-19 neurological patients will bring significant strain on the hospital and neurocritical care facilities. Streamlining work pattern, understanding the pathophysio...
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions and is usuall... more Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions and is usually treated by simple burr-hole drainage. Prognosis is usually good unless complications occur. Use of infant feeding tube (IFT) for irrigation of hematoma in case of CSDH with septum is a common practice. However, it poses a significant risk. We present two cases of intraparenchymal hemorrhage as a complication of CSDH evacuation in which IFT was used for irrigation.
19th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC)
Introduction: A brachial plexus injury (BPI) could be one of the most devastating injures to a pa... more Introduction: A brachial plexus injury (BPI) could be one of the most devastating injures to a patient effectively crippling function and potentially leading to unemployment, hardship and depression. With modern techniques in hand along with microsurgery and individualized anesthetic techniques, it is totally feasible to restore function in this valuable segment of our population. Methodology/Description: Information of BPIs from 2015 to 2017 was obtained from the Department of Anesthesia, P. D. Hinduja Hospital, Mumbai, using the Anesthesia Record Keeping System. We operated upon 48 cases in the year 2015, 64 cases in the year 2016, and 45 cases till date in the year 2017. Out of these, four were position-related iatrogenic injuries. Conclusion: Successful management of a case of BPI involves a balanced approach involving TIVA, inhalational agents along with monitoring of the depth of anesthesia and neuromuscular monitoring. Drugs should be well-titrated to avoid awareness and present a deep plane of anesthesia without using muscle relaxants.
In continuation with previous years' success, Department of Neuroanaesthesiology and Critical Car... more In continuation with previous years' success, Department of Neuroanaesthesiology and Critical Care, AIIMS conducted the fifth consecutive AIIMS Neuroanaesthesia Update from October 6 to 7, 2017, at the All India Institute of Medical Sciences (AIIMS), New Delhi, India. This was preceded by pre-conference workshops and followed by a 1.5-day "AIIMS Neurological Life Support" course for the first time. AIIMS Neuroanaesthesia Update started in 2013 with the idea of providing a unique platform to budding neuroenthusiasts to exchange knowledge and information, share experience, and interact with the masters in the field of neuroanesthesiology and neurocritical care. This year, the AIIMS Neuroanaesthesia Update was organized by Dr. Gyaninder Pal Singh (organizing secretary) under the leadership of Dr. Arvind Chaturvedi (organizing chairman). With 212 delegates, this was one of the most well-attended Neuroanaesthesia Update so far. The participants included neuroanesthesiologists, neurointensivists, fellows, residents, and medical students from all over the country. The event started on October 5 with preconference workshops on transcranial Doppler (TCD) ultrasonography, intracranial pressure (ICP) monitoring, cerebral microdialysis, neurophysiology monitoring, and ultrasound-guided vascular access. The workshop on TCD was exclusively conducted as a full-day workshop by Dr.
Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the tre... more Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the treating neurosurgeon working in eloquent areas of the brain. Furthermore, with the implementation of intraoperative magnetic resonance imaging (I-MRI), one can afford the luxury of imaging to assess surgical resection of the underlying gross imaging defined neuropathology and the surrounding eloquent areas. Ideally, the combination of I-MRI and awake craniotomy could provide the maximal lesion resection with the least morbidity and mortality. However, more resection with the aid of real time imaging and awake craniotomy techniques might give opposite outcome results. The goal of this systematic review.is to identify the available literature on combined I-MRI and awake craniotomy techniques, to better understand the potential morbidity and mortality associated. Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception up to December 2016. A total of 10 articles met inclusion in to the review, with a total of 324 adult patients. Results: All studies showed transient neurological deficits between 2.9 to 76.4%. In regards to persistent morbidity, the mean was ∼10% (ranges from zero to 35.3%) with a follow up period between 5 days and 6 months. Conclusion: The preliminary results of this review also suggest this combined technique may impose acceptable post-operative complication profiles and morbidity. However, this is based on low quality evidence, and is therefore questionable. Further, well-designed future trials with the long-term follow-up are needed to provide various aspects of feasibility and outcome data for this approach.
Unilateral bronchospasm during microcatheter manipulation in an interventional neuroradiology suite
Journal of Anesthesia, Jan 26, 2010
To the Editor: Bronchospasm during general anesthesia has many eti-ologies, including the patient... more To the Editor: Bronchospasm during general anesthesia has many eti-ologies, including the patient's intrinsic disease and mechanical, chemical or neurogenic causes [1, 2]. Reactions to drugs used for embolization and contrast drugs are important causes of bronchospasm in ...
β-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalasse... more β-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalassemia major is the severe form of disease, and the patients often display an array of associated organ dysfunction which thus increase the risk associated with surgery and anesthesia. Patients with β-thalassemia major can have multiple pathological defects that may lead to thromboembolic events. Here, we report such a case who was complicated by occurrence of cerebral sinus thrombosis and presented for decompressive hemicraniectomy under general anesthesia. The anesthetic challenges during in such scenario have been discussed.
Why chest compressions should start when systolic arterial blood pressure is below 50 mm Hg in the anaesthetised patient. Reply to Br J Anaesth 2020; 124: 234–8
The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has ra... more The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be independent neurological manifestations of COVID-19. Critically ill neurological patients are more vulnerable to contracting SARS-CoV-2 infection. Also, neurological patients with comorbidities and multisystem involvement are at increased risk of adverse outcomes. Though SARS-CoV-2 predominantly affects the pulmonary system, it can complicate the assessment and management of neurological patients. With increasing COVID-19 numbers, the hospitalizations of both non-COVID and COVID-19 neurological patients will bring significant strain on the hospital and neurocritical care facilities. Streamlining work pattern, understanding the pathophysio...
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions and is usuall... more Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions and is usually treated by simple burr-hole drainage. Prognosis is usually good unless complications occur. Use of infant feeding tube (IFT) for irrigation of hematoma in case of CSDH with septum is a common practice. However, it poses a significant risk. We present two cases of intraparenchymal hemorrhage as a complication of CSDH evacuation in which IFT was used for irrigation.
19th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC)
Introduction: A brachial plexus injury (BPI) could be one of the most devastating injures to a pa... more Introduction: A brachial plexus injury (BPI) could be one of the most devastating injures to a patient effectively crippling function and potentially leading to unemployment, hardship and depression. With modern techniques in hand along with microsurgery and individualized anesthetic techniques, it is totally feasible to restore function in this valuable segment of our population. Methodology/Description: Information of BPIs from 2015 to 2017 was obtained from the Department of Anesthesia, P. D. Hinduja Hospital, Mumbai, using the Anesthesia Record Keeping System. We operated upon 48 cases in the year 2015, 64 cases in the year 2016, and 45 cases till date in the year 2017. Out of these, four were position-related iatrogenic injuries. Conclusion: Successful management of a case of BPI involves a balanced approach involving TIVA, inhalational agents along with monitoring of the depth of anesthesia and neuromuscular monitoring. Drugs should be well-titrated to avoid awareness and present a deep plane of anesthesia without using muscle relaxants.
In continuation with previous years' success, Department of Neuroanaesthesiology and Critical Car... more In continuation with previous years' success, Department of Neuroanaesthesiology and Critical Care, AIIMS conducted the fifth consecutive AIIMS Neuroanaesthesia Update from October 6 to 7, 2017, at the All India Institute of Medical Sciences (AIIMS), New Delhi, India. This was preceded by pre-conference workshops and followed by a 1.5-day "AIIMS Neurological Life Support" course for the first time. AIIMS Neuroanaesthesia Update started in 2013 with the idea of providing a unique platform to budding neuroenthusiasts to exchange knowledge and information, share experience, and interact with the masters in the field of neuroanesthesiology and neurocritical care. This year, the AIIMS Neuroanaesthesia Update was organized by Dr. Gyaninder Pal Singh (organizing secretary) under the leadership of Dr. Arvind Chaturvedi (organizing chairman). With 212 delegates, this was one of the most well-attended Neuroanaesthesia Update so far. The participants included neuroanesthesiologists, neurointensivists, fellows, residents, and medical students from all over the country. The event started on October 5 with preconference workshops on transcranial Doppler (TCD) ultrasonography, intracranial pressure (ICP) monitoring, cerebral microdialysis, neurophysiology monitoring, and ultrasound-guided vascular access. The workshop on TCD was exclusively conducted as a full-day workshop by Dr.
Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the tre... more Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the treating neurosurgeon working in eloquent areas of the brain. Furthermore, with the implementation of intraoperative magnetic resonance imaging (I-MRI), one can afford the luxury of imaging to assess surgical resection of the underlying gross imaging defined neuropathology and the surrounding eloquent areas. Ideally, the combination of I-MRI and awake craniotomy could provide the maximal lesion resection with the least morbidity and mortality. However, more resection with the aid of real time imaging and awake craniotomy techniques might give opposite outcome results. The goal of this systematic review.is to identify the available literature on combined I-MRI and awake craniotomy techniques, to better understand the potential morbidity and mortality associated. Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception up to December 2016. A total of 10 articles met inclusion in to the review, with a total of 324 adult patients. Results: All studies showed transient neurological deficits between 2.9 to 76.4%. In regards to persistent morbidity, the mean was ∼10% (ranges from zero to 35.3%) with a follow up period between 5 days and 6 months. Conclusion: The preliminary results of this review also suggest this combined technique may impose acceptable post-operative complication profiles and morbidity. However, this is based on low quality evidence, and is therefore questionable. Further, well-designed future trials with the long-term follow-up are needed to provide various aspects of feasibility and outcome data for this approach.
Unilateral bronchospasm during microcatheter manipulation in an interventional neuroradiology suite
Journal of Anesthesia, Jan 26, 2010
To the Editor: Bronchospasm during general anesthesia has many eti-ologies, including the patient... more To the Editor: Bronchospasm during general anesthesia has many eti-ologies, including the patient's intrinsic disease and mechanical, chemical or neurogenic causes [1, 2]. Reactions to drugs used for embolization and contrast drugs are important causes of bronchospasm in ...
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