Journal of Neuroanaesthesiology and Critical Care, 2020
With the advent of minimally invasive neurosurgical techniques and rapid innovations in the field... more With the advent of minimally invasive neurosurgical techniques and rapid innovations in the field of neurointervention, there has been a sharp rise in diagnostic and therapeutic modalities requiring radiation exposure. Neuroanesthesiologists are currently involved in various procedures inside as well as outside the operating room (OR) like intensive care units, interventional suites, and gamma knife units. The ambit expands from short-lasting diagnostic scans to lengthy therapeutic procedures performed under fluoroscopic guidance. Hence, a modern-day neuroanesthesiologist has to bear the brunt of the radiation exposure in both inside and outside the OR. However, obliviousness and nonadherence to the relevant radiation safety measures are still prevalent. Radiation protection and safety are topics that need to be discussed with new vigor in the light of current practice.
Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregul... more Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregulation. This study assessed its effect on dynamic cerebral autoregulation (dCA) using a transcranial Doppler (TCD).Methods: Thirty American Society of Anesthesiologists physical status I and II patients between 18 and 60 years, who underwent lumbar spine surgery, received infusions of dexmedetomidine (Group D) or normal saline (Group C), followed by anesthesia with propofol and fentanyl, and maintenance with oxygen, nitrous oxide and sevoflurane. After five minutes of normocapnic ventilation and stable bispectral index value (BIS) of 40-50, the right middle cerebral artery flow velocity (MCAFV) was recorded with TCD. The transient hyperemic response (THR) test was performed by compressing the right common carotid artery for 5-7 seconds. The lungs were hyperventilated to test carbon dioxide (CO2) reactivity. Hemodynamic parameters, arterial CO2 tension, pulse oximetry (SpO2), MCAFV and BIS...
Journal of Neuroanaesthesiology and Critical Care, 2020
Neurosurgical procedures involve various patient positions such as supine, prone, lateral, and si... more Neurosurgical procedures involve various patient positions such as supine, prone, lateral, and sitting position. Prone positioning is routinely used in neurosurgical practice to obtain access to posterior neuroanatomical structures like the posterior fossa or suboccipital region. 1 Sphinx and Concorde positions are modifications of the conventional prone position that are practiced less commonly in neurosurgery, probably because it requires neuroanesthesiologists and neurosurgeons, who are familiar with these positions, and more manpower, skills, and expertise to achieve the final positioning. Since these two positions are less commonly encountered in neuroanesthesiology practice, reports about these two positions in neuroanesthesiology literature are scarce. So, we have tried to review the indications, positioning method in the operating room, advantages, and disadvantages of these modified prone positions, with further modifications added to the classical methods described earlier to further facilitate the surgical practice and perioperative care.
Background Major blood loss during neurosurgery can lead to several complications, including life... more Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p ...
Background and Objectives Suboptimal management of postcraniotomy pain causes sympathetic and hem... more Background and Objectives Suboptimal management of postcraniotomy pain causes sympathetic and hemodynamic perturbations, leading to deleterious effects on the neurological system and overall patient outcome. Opioids are the mainstay of postoperative pain management but have various problems when given in high doses, or for prolonged durations in neurosurgical patients. The ideal method of pain control following craniotomy generally relies on a combination of various drugs. Oral pregabalin may be an attractive alternative in these patients. Materials and Methods Sixty, American Society of Anesthesiologists class I and II patients posted for elective supratentorial craniotomy, aged 18 and 60 years, were randomly assigned into three groups of 20 each to receive oral placebo (Group A), pregabalin 75 mg (Group B), or pregabalin 150 mg (Group C) before the induction of anesthesia. At the end of the surgery, patient-controlled analgesia was started with intravenous fentanyl. Visual analog ...
Background: Decompressive craniectomy (DC) is done for the management of intracranial hypertensio... more Background: Decompressive craniectomy (DC) is done for the management of intracranial hypertension due to severe traumatic brain injury (sTBI). Despite DC, a number of patients die and others suffer from severe neurological disability. We conducted this observational study to assess functional outcome as measured by Glasgow outcome scale-extended (GOSE) in survivors of DC. The correlation between various factors at admission and hospital with functional outcome was also obtained. Materials and Methods: Patients (15–65 years) posted for cranioplasty following DC due to sTBI were prospectively enrolled. Demographic profile, clinical data, and GOSE were noted at the time of admission for cranioplasty from the patient or nearest relative or both. Retrospective data noted from hospital records included admission Marshalls grading, Glasgow coma score (GCS), motor response, mean arterial pressure (MAP), and timing of DC at the time of initial admission following sTBI. Results: A total of 8...
Journal of Neuroanaesthesiology and Critical Care, 2017
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Journal of Neuroanaesthesiology and Critical Care, 2019
The role of palliative care in patients with cancer is widely acknowledged and practiced. Though ... more The role of palliative care in patients with cancer is widely acknowledged and practiced. Though its role in chronic, progressive, and incurable neurological conditions is being recognized now, it is not widely practiced. Lack of awareness and training are important factors contributing to this. Neurological patients differ from oncological patients with respect to their symptoms, fluctuating disease course, varied prognoses, and difficulty in identifying end-of-life stage. Knowledge of different neurological conditions is important to practice neuropalliative care appropriately. Growth of neuropalliative care services must begin with the neurologist at the center of the multidisciplinary team. Neurologists need to be trained in communication skills and advance care planning, and must be aware of end-of-life care, do-not-resuscitate policies, and withdrawal of life support measures. This article elaborates on these aspects of neuropalliative care and discusses its role in various ne...
17th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care, 2016
Background: Atlantoaxial dislocation (AAD) is highly unstable and usually fatal injury resulting ... more Background: Atlantoaxial dislocation (AAD) is highly unstable and usually fatal injury resulting from osseoligamentous disruption between the C1 and C2 vertebrae, it is at high risk of life-threatening neurological injury so cervical spine management is essential, manual in-line stabilisation is used to decrease cervical spine injury. The major difficulty encountered is that of airway management. Intraoperative management should focus on maintaining adequate perfusion pressure and oxygenation of spinal cord. This study is to provide an update on airway management, intraoperative haemodynamics and post-operative complications in patients of AAD. Methodology: After Ethics Committee approval, we retrospectively analysed 105 patients operated for AAD at Neurosurgery Department of K.E.M. Hospital, Mumbai from March 2012 to March 2015. Difficult intubations were evaluated on basis of all 3 = MPC-III or IV, sternomental distance = <12.5 cm, mouth opening = <3 fingers. AirTraq, McGrath, Macintosh, McCoy, intubating laryngeal mask airway (ILMA) were compared, intraoperative haemodynamics and post-operative complications were analysed. Results: After analysis of data, 38 (36.2%) patients were difficult and 67 (63.8%) were not difficult intubations. 7 (6.67%) patients were intubated with AirTraq, 2 (1.90%) McGrath, 69 (65.71%) Macintosh, 13 (12.38%) McCoy, 14 (13.33%) ILMA, respectively. Successful intubation in first attempt among total was = AirTraq 6 (85.7%), McGrath 2 (100%), Macintosh 35 (50.7%), McCoy 4 (30.8%), ILMA 7 (50%). Moreover, among difficult intubation were = AirTraq 2 (66.7%), McGrath 2 (100%), Macintosh 5 (22.7%), McCoy 0 (0%), ILMA 2 (40%). Intubation requiring more than two attempts = AirTraq 1 (33.3%), McGrath 0 (0%), Macintosh 13 (59.1%), McCoy 5 (83.3%), ILMA 1 (20%). Major blood loss (>1500 ml) was in 24 (22.86%) patients. Five patients had bradycardia and hypotension intraoperatively, 3 of them had major blood loss. Four were recurrent AAD, 3 with rheumatoid arthritis, 2 with Down's syndrome. Post-operatively, 4 patients were neurologically same and 2 were deteriorated. Post-operative mortality recorded in 5 patients, of which 3 had major blood loss and 2 were pre-operatively bad (power = 0). Discussion: Indirect laryngoscopy-McGrath and AirTraq were better than other intubation techniques. Major blood loss had higher incidence of post-operative ventilator support and mortality. No overall correlation between post-operative ventilatory support and neurological deterioration with intubation technique. Being retrospective, missing data are major limitation Awake fibreoptic bronchoscope was not used for intubation. ISNACC-S-33 Effects of 20% mannitol and 3% hypertonic saline on intracranial pressure and systemic haemodynamics
15th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care, 2015
Background: Patients in neuro-critical care may require tracheostomy for either long-term ventila... more Background: Patients in neuro-critical care may require tracheostomy for either long-term ventilation or for maintaining and protecting the airway. Many of these patients receive anti-coagulant/anti-platelet therapy for DVT prophylaxis or for primary disease like stroke, coronary artery disease, valvular heart disease. These drugs can't be withheld for prolonged periods while preparing the patients for percutaneous tracheostomy. Hence bleeding is a major concern for the anaesthesiologist. The aim is to assess the effect of anticoagulant/antiplatelet drugs in post tracheostomy bleeding. Materials and Methods: ICU records of patients who underwent percutaneous dilatational tracheostomy by Anaesthesiologists in the year 2012-13 were analyzed for bleeding incidences. Post procedure bleeding was classified as mild, moderate and severe within 72 hours. Results: Among 74 patients, 24 had mild to severe bleeding after tracheostomy. Most of the cases had mild oozing. No statistical differences were observed in the use of specific anticoagulants/antiplatelet agents between patients who had bleeding and the rest of the patients (P > 0.05). Bleeding episodes were managed with adrenaline packing, and Botropase infiltration. Conclusion: Our experience shows percutaneous tracheostomy can safely be performed in patients on anticoagulants without increasing risk of post procedure bleeding and prolonged stopping of anticoagulants/antiplatelet drugs.
19th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC), 2018
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.
Journal of Neuroanaesthesiology and Critical Care, 2015
The proposing speaker was Dr. H. Patel and the opposing speaker was Dr. Angus Vincent, Newcastle.... more The proposing speaker was Dr. H. Patel and the opposing speaker was Dr. Angus Vincent, Newcastle. This was followed by the Annual General Meeting of the NASGBI, where apart from other issues, a decision on renaming of NASGBI to NACCSGBI (Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland) was finalised. Simultaneously, breakout sessions were organised in adjoining halls from 12:15 to 01:30 PM, which covered topics like "Probono Legal Advice, Cerebral Blood flow, Neuroradiology" and Simulation on Adult/Obstetric/ Paediatric neurosurgical anaesthesia." This was followed by a sumptuous lunch. Session III commenced shortly after lunch and was themed on "Neurovascular Disease." It was chaired by Dr. H. Patel, Consultant Neurovascular Surgeon, Salford Royal Hospital. In this session, Prof. Gabriel Rinkel of University of Utrecht spoke on "Delayed Neurological Deficit-Known Knowns, Known Unknowns…." This talk was followed by a lecture on "Manipulating Coagulation-Starting and Stopping the Clot" by Dr. Akbar Vohra of Central Manchester.
Journal of Neuroanaesthesiology and Critical Care, 2014
Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative n... more Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 softwar...
Journal of Neuroanaesthesiology and Critical Care, 2020
With the advent of minimally invasive neurosurgical techniques and rapid innovations in the field... more With the advent of minimally invasive neurosurgical techniques and rapid innovations in the field of neurointervention, there has been a sharp rise in diagnostic and therapeutic modalities requiring radiation exposure. Neuroanesthesiologists are currently involved in various procedures inside as well as outside the operating room (OR) like intensive care units, interventional suites, and gamma knife units. The ambit expands from short-lasting diagnostic scans to lengthy therapeutic procedures performed under fluoroscopic guidance. Hence, a modern-day neuroanesthesiologist has to bear the brunt of the radiation exposure in both inside and outside the OR. However, obliviousness and nonadherence to the relevant radiation safety measures are still prevalent. Radiation protection and safety are topics that need to be discussed with new vigor in the light of current practice.
Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregul... more Background: There are conflicting opinions on the effect of dexmedetomidine on cerebral autoregulation. This study assessed its effect on dynamic cerebral autoregulation (dCA) using a transcranial Doppler (TCD).Methods: Thirty American Society of Anesthesiologists physical status I and II patients between 18 and 60 years, who underwent lumbar spine surgery, received infusions of dexmedetomidine (Group D) or normal saline (Group C), followed by anesthesia with propofol and fentanyl, and maintenance with oxygen, nitrous oxide and sevoflurane. After five minutes of normocapnic ventilation and stable bispectral index value (BIS) of 40-50, the right middle cerebral artery flow velocity (MCAFV) was recorded with TCD. The transient hyperemic response (THR) test was performed by compressing the right common carotid artery for 5-7 seconds. The lungs were hyperventilated to test carbon dioxide (CO2) reactivity. Hemodynamic parameters, arterial CO2 tension, pulse oximetry (SpO2), MCAFV and BIS...
Journal of Neuroanaesthesiology and Critical Care, 2020
Neurosurgical procedures involve various patient positions such as supine, prone, lateral, and si... more Neurosurgical procedures involve various patient positions such as supine, prone, lateral, and sitting position. Prone positioning is routinely used in neurosurgical practice to obtain access to posterior neuroanatomical structures like the posterior fossa or suboccipital region. 1 Sphinx and Concorde positions are modifications of the conventional prone position that are practiced less commonly in neurosurgery, probably because it requires neuroanesthesiologists and neurosurgeons, who are familiar with these positions, and more manpower, skills, and expertise to achieve the final positioning. Since these two positions are less commonly encountered in neuroanesthesiology practice, reports about these two positions in neuroanesthesiology literature are scarce. So, we have tried to review the indications, positioning method in the operating room, advantages, and disadvantages of these modified prone positions, with further modifications added to the classical methods described earlier to further facilitate the surgical practice and perioperative care.
Background Major blood loss during neurosurgery can lead to several complications, including life... more Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p ...
Background and Objectives Suboptimal management of postcraniotomy pain causes sympathetic and hem... more Background and Objectives Suboptimal management of postcraniotomy pain causes sympathetic and hemodynamic perturbations, leading to deleterious effects on the neurological system and overall patient outcome. Opioids are the mainstay of postoperative pain management but have various problems when given in high doses, or for prolonged durations in neurosurgical patients. The ideal method of pain control following craniotomy generally relies on a combination of various drugs. Oral pregabalin may be an attractive alternative in these patients. Materials and Methods Sixty, American Society of Anesthesiologists class I and II patients posted for elective supratentorial craniotomy, aged 18 and 60 years, were randomly assigned into three groups of 20 each to receive oral placebo (Group A), pregabalin 75 mg (Group B), or pregabalin 150 mg (Group C) before the induction of anesthesia. At the end of the surgery, patient-controlled analgesia was started with intravenous fentanyl. Visual analog ...
Background: Decompressive craniectomy (DC) is done for the management of intracranial hypertensio... more Background: Decompressive craniectomy (DC) is done for the management of intracranial hypertension due to severe traumatic brain injury (sTBI). Despite DC, a number of patients die and others suffer from severe neurological disability. We conducted this observational study to assess functional outcome as measured by Glasgow outcome scale-extended (GOSE) in survivors of DC. The correlation between various factors at admission and hospital with functional outcome was also obtained. Materials and Methods: Patients (15–65 years) posted for cranioplasty following DC due to sTBI were prospectively enrolled. Demographic profile, clinical data, and GOSE were noted at the time of admission for cranioplasty from the patient or nearest relative or both. Retrospective data noted from hospital records included admission Marshalls grading, Glasgow coma score (GCS), motor response, mean arterial pressure (MAP), and timing of DC at the time of initial admission following sTBI. Results: A total of 8...
Journal of Neuroanaesthesiology and Critical Care, 2017
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Journal of Neuroanaesthesiology and Critical Care, 2019
The role of palliative care in patients with cancer is widely acknowledged and practiced. Though ... more The role of palliative care in patients with cancer is widely acknowledged and practiced. Though its role in chronic, progressive, and incurable neurological conditions is being recognized now, it is not widely practiced. Lack of awareness and training are important factors contributing to this. Neurological patients differ from oncological patients with respect to their symptoms, fluctuating disease course, varied prognoses, and difficulty in identifying end-of-life stage. Knowledge of different neurological conditions is important to practice neuropalliative care appropriately. Growth of neuropalliative care services must begin with the neurologist at the center of the multidisciplinary team. Neurologists need to be trained in communication skills and advance care planning, and must be aware of end-of-life care, do-not-resuscitate policies, and withdrawal of life support measures. This article elaborates on these aspects of neuropalliative care and discusses its role in various ne...
17th Annual Conference of Indian Society of Neuroanaesthesiology and Critical Care, 2016
Background: Atlantoaxial dislocation (AAD) is highly unstable and usually fatal injury resulting ... more Background: Atlantoaxial dislocation (AAD) is highly unstable and usually fatal injury resulting from osseoligamentous disruption between the C1 and C2 vertebrae, it is at high risk of life-threatening neurological injury so cervical spine management is essential, manual in-line stabilisation is used to decrease cervical spine injury. The major difficulty encountered is that of airway management. Intraoperative management should focus on maintaining adequate perfusion pressure and oxygenation of spinal cord. This study is to provide an update on airway management, intraoperative haemodynamics and post-operative complications in patients of AAD. Methodology: After Ethics Committee approval, we retrospectively analysed 105 patients operated for AAD at Neurosurgery Department of K.E.M. Hospital, Mumbai from March 2012 to March 2015. Difficult intubations were evaluated on basis of all 3 = MPC-III or IV, sternomental distance = <12.5 cm, mouth opening = <3 fingers. AirTraq, McGrath, Macintosh, McCoy, intubating laryngeal mask airway (ILMA) were compared, intraoperative haemodynamics and post-operative complications were analysed. Results: After analysis of data, 38 (36.2%) patients were difficult and 67 (63.8%) were not difficult intubations. 7 (6.67%) patients were intubated with AirTraq, 2 (1.90%) McGrath, 69 (65.71%) Macintosh, 13 (12.38%) McCoy, 14 (13.33%) ILMA, respectively. Successful intubation in first attempt among total was = AirTraq 6 (85.7%), McGrath 2 (100%), Macintosh 35 (50.7%), McCoy 4 (30.8%), ILMA 7 (50%). Moreover, among difficult intubation were = AirTraq 2 (66.7%), McGrath 2 (100%), Macintosh 5 (22.7%), McCoy 0 (0%), ILMA 2 (40%). Intubation requiring more than two attempts = AirTraq 1 (33.3%), McGrath 0 (0%), Macintosh 13 (59.1%), McCoy 5 (83.3%), ILMA 1 (20%). Major blood loss (>1500 ml) was in 24 (22.86%) patients. Five patients had bradycardia and hypotension intraoperatively, 3 of them had major blood loss. Four were recurrent AAD, 3 with rheumatoid arthritis, 2 with Down's syndrome. Post-operatively, 4 patients were neurologically same and 2 were deteriorated. Post-operative mortality recorded in 5 patients, of which 3 had major blood loss and 2 were pre-operatively bad (power = 0). Discussion: Indirect laryngoscopy-McGrath and AirTraq were better than other intubation techniques. Major blood loss had higher incidence of post-operative ventilator support and mortality. No overall correlation between post-operative ventilatory support and neurological deterioration with intubation technique. Being retrospective, missing data are major limitation Awake fibreoptic bronchoscope was not used for intubation. ISNACC-S-33 Effects of 20% mannitol and 3% hypertonic saline on intracranial pressure and systemic haemodynamics
15th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care, 2015
Background: Patients in neuro-critical care may require tracheostomy for either long-term ventila... more Background: Patients in neuro-critical care may require tracheostomy for either long-term ventilation or for maintaining and protecting the airway. Many of these patients receive anti-coagulant/anti-platelet therapy for DVT prophylaxis or for primary disease like stroke, coronary artery disease, valvular heart disease. These drugs can't be withheld for prolonged periods while preparing the patients for percutaneous tracheostomy. Hence bleeding is a major concern for the anaesthesiologist. The aim is to assess the effect of anticoagulant/antiplatelet drugs in post tracheostomy bleeding. Materials and Methods: ICU records of patients who underwent percutaneous dilatational tracheostomy by Anaesthesiologists in the year 2012-13 were analyzed for bleeding incidences. Post procedure bleeding was classified as mild, moderate and severe within 72 hours. Results: Among 74 patients, 24 had mild to severe bleeding after tracheostomy. Most of the cases had mild oozing. No statistical differences were observed in the use of specific anticoagulants/antiplatelet agents between patients who had bleeding and the rest of the patients (P > 0.05). Bleeding episodes were managed with adrenaline packing, and Botropase infiltration. Conclusion: Our experience shows percutaneous tracheostomy can safely be performed in patients on anticoagulants without increasing risk of post procedure bleeding and prolonged stopping of anticoagulants/antiplatelet drugs.
19th Annual Conference of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC), 2018
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.
Journal of Neuroanaesthesiology and Critical Care, 2015
The proposing speaker was Dr. H. Patel and the opposing speaker was Dr. Angus Vincent, Newcastle.... more The proposing speaker was Dr. H. Patel and the opposing speaker was Dr. Angus Vincent, Newcastle. This was followed by the Annual General Meeting of the NASGBI, where apart from other issues, a decision on renaming of NASGBI to NACCSGBI (Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland) was finalised. Simultaneously, breakout sessions were organised in adjoining halls from 12:15 to 01:30 PM, which covered topics like "Probono Legal Advice, Cerebral Blood flow, Neuroradiology" and Simulation on Adult/Obstetric/ Paediatric neurosurgical anaesthesia." This was followed by a sumptuous lunch. Session III commenced shortly after lunch and was themed on "Neurovascular Disease." It was chaired by Dr. H. Patel, Consultant Neurovascular Surgeon, Salford Royal Hospital. In this session, Prof. Gabriel Rinkel of University of Utrecht spoke on "Delayed Neurological Deficit-Known Knowns, Known Unknowns…." This talk was followed by a lecture on "Manipulating Coagulation-Starting and Stopping the Clot" by Dr. Akbar Vohra of Central Manchester.
Journal of Neuroanaesthesiology and Critical Care, 2014
Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative n... more Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 softwar...
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