Background: To assess the existing knowledge about palliative care among physicians and to assess... more Background: To assess the existing knowledge about palliative care among physicians and to assess the existing awareness about palliative care practices among physicians. Methods: Cross-sectional, anonymous, self-administered questionnaire survey was done with a group of 100 conveniently sampled physicians. This study used psychometric methods, including item response theory, intraclass correlation coefficients, and known-group validity. included 20 items across the following 4 domains: (1) palliative care, (2) Hospise (3) Terminal illness (4) Pain control. There was a significant difference in the scores between palliative care specialists and other physicians. Results: Most of the physicians have heard about palliative care in their residency/ post graduation days and are aware that it is mainly for all terminally ill patients.None have received any formal education or training in palliative care. Almost 30% didn't know that the main aim of palliative care is to improve quality of life.Most physicians came to know about palliative care and hospice through their friends and internet. All physicians believe that patients should be taken care of at home or in hospice and there should be judicious use of opioids with spiritual councelling.Most of them were not aware about the Narcotic Drugs and Psychotropic Substances Amendment Act 2014 or WHO ladder of pain .Most only knew about VAS scoring system of pain and didn't know about other pain scores. Conclusion: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Amongst doctors of various departments, there is a lack of training and awareness in palliative care. Almost all are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care.
Background & Objectives: Anesthesiologists deal with arrhythmias frequently both inside and outsi... more Background & Objectives: Anesthesiologists deal with arrhythmias frequently both inside and outside operating room. Knowledge for recognition of arrhythmias is complex and difficult to impart to students despite various teaching methods suggested previously. The available methods though reported to be effective, are apparently complex and tested only on small groups. We designed an algorithm for recognition of bradyarrhythmias and assessed its effectiveness in recognition of correct rhythm among interns of our hospital.Methodology: This randomised control study was conducted after approval from institutional research committee. Study group included seventy medical students of our university, undergoing compulsory rotatory internship at its constituent hospital and agreed to participate in the study. A teaching session on basic cardiac electrophysiology was conducted for both of the groups. This was followed by a pre-test 15 days later. Immediately after the pre-test, the participan...
International Journal of Medical Research and Review, 2016
Background: Regional anesthesia is a recommended technique for upper limb surgeries with better p... more Background: Regional anesthesia is a recommended technique for upper limb surgeries with better postoperative profile. However paediatric regional anaesthesia for upper limb surgeries was till now difficult due to various problems like moving child, inability to elicit parasthesia and likely injury to brachial plexeus. With the advent of nerve stimulators and ultrasound guided blocks, we can now overcome the above problems. We evaluated the effect of ultrasound guided bupivacaine for quality and duration of post op analgesia. Methodology: Sixty paediatric patients posted for elective and emergency upper limb surgeries were enrolled for a prospective, randomized, study. Patients were divided into two groups, the control group A and the study group B. In group A (n =30) patients were given general anaesthesia for the surgery and at the end of it, conventional analgesics were given and In group B (n = 30), after GA, 10 ml of 0.325% bupivacaine + normal saline were given ultrasound guided supraclavicular brachial plexus block. Quality and duration of post op analgesia and time to first rescue analgesia were recorded. Results. The onset times for pain was significantly shorter in A than B group (p < 0.05). The duration of analgesia (DOA) was significantly longer in B group than A group (p < 0.0001). Heart rate levels in group B were significantly lower 15 min after block (p< 0.001). SBP and DBP levels in B group were significantly lower than in A (p < 0.001). No major adverse effects were observed in either of the groups except for sedation 8 and respiratory depression in 6 patients of group A. Conclusion: Supraclavicular brachial plexus block significantly lengthens the onset time of pain and prolongs the duration of post op analgesia. Patients in group B had good quality analgesia with no adverse effects.
International Journal of Medical Research and Review, 2015
Introduction: Various techniques and pharmacologic interventions have come in practice to blunt t... more Introduction: Various techniques and pharmacologic interventions have come in practice to blunt the hemodynamic responses of laryngoscopy and intubation. Beta blocker Esmolol is the drug used in our study to attenuate the stress response of laryngoscopy and intubation. The aim of our study was to observe the efficacy of Esmolol hydrochloride on cardiovascular responses to laryngoscopy and intubation. Methods: Two groups of 25 patients each were taken as control group and Esmolol group and Esmolol 1.5 mgs per kg IV as bolus dose was administered to Esmolol group 3 minutes prior to induction of anaesthesia followed by laryngoscopy and intubation. The vital parameters were recorded every minute for five minutes Results: There were no significant differences in the basal parameters in both the groups before giving Esmolol and with respect to age, sex and ASA grading. There was significant reduction in heart rate (6.4 %) at the time of induction as compared to rise of heart rate (15.16%) in control group. This was highly significant. Same way-there was fall in systolic blood pressure (7.69%) in esmolol group in comparison to a rise of 14.28% in control group. Diastolic blood pressure in esmolol group showed a fall of 2.9% as compared to a rise of 21.2% in control group. The RPP was found to decrease by 13.1% in esmolol group in comparison to a rise of 31.2 % in control group which was also highly statistically significant. Conclusion: Esmolol hydrochloride is proved to be a very effective drug, ultrashort acting rapid onset and offset of action, easily titrable, so highly useful in reducing the stress response of laryngoscopy and intubation.
Aspirin is routinely used drug in patients with cardiac problems. When a patient on aspirin requi... more Aspirin is routinely used drug in patients with cardiac problems. When a patient on aspirin requires dental treatment that has the risk of bleeding, the physician or dental surgeon often advices the patient to stop aspirin for few days. This however can lead to thromboembolic events to recur that may cause myocardial infarction, stroke or even death. The decision to stop the medicine prior to dental extraction or oral surgical procedure is critical.
Background: To assess the existing knowledge about palliative care among physicians and to assess... more Background: To assess the existing knowledge about palliative care among physicians and to assess the existing awareness about palliative care practices among physicians. Methods: Cross-sectional, anonymous, self-administered questionnaire survey was done with a group of 100 conveniently sampled physicians. This study used psychometric methods, including item response theory, intraclass correlation coefficients, and known-group validity. included 20 items across the following 4 domains: (1) palliative care, (2) Hospise (3) Terminal illness (4) Pain control. There was a significant difference in the scores between palliative care specialists and other physicians. Results: Most of the physicians have heard about palliative care in their residency/ post graduation days and are aware that it is mainly for all terminally ill patients.None have received any formal education or training in palliative care. Almost 30% didn't know that the main aim of palliative care is to improve quality of life.Most physicians came to know about palliative care and hospice through their friends and internet. All physicians believe that patients should be taken care of at home or in hospice and there should be judicious use of opioids with spiritual councelling.Most of them were not aware about the Narcotic Drugs and Psychotropic Substances Amendment Act 2014 or WHO ladder of pain .Most only knew about VAS scoring system of pain and didn't know about other pain scores. Conclusion: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Amongst doctors of various departments, there is a lack of training and awareness in palliative care. Almost all are interested and they are willing to have more training in pain control, breaking bad news, communication skills and terminal care.
Background & Objectives: Anesthesiologists deal with arrhythmias frequently both inside and outsi... more Background & Objectives: Anesthesiologists deal with arrhythmias frequently both inside and outside operating room. Knowledge for recognition of arrhythmias is complex and difficult to impart to students despite various teaching methods suggested previously. The available methods though reported to be effective, are apparently complex and tested only on small groups. We designed an algorithm for recognition of bradyarrhythmias and assessed its effectiveness in recognition of correct rhythm among interns of our hospital.Methodology: This randomised control study was conducted after approval from institutional research committee. Study group included seventy medical students of our university, undergoing compulsory rotatory internship at its constituent hospital and agreed to participate in the study. A teaching session on basic cardiac electrophysiology was conducted for both of the groups. This was followed by a pre-test 15 days later. Immediately after the pre-test, the participan...
International Journal of Medical Research and Review, 2016
Background: Regional anesthesia is a recommended technique for upper limb surgeries with better p... more Background: Regional anesthesia is a recommended technique for upper limb surgeries with better postoperative profile. However paediatric regional anaesthesia for upper limb surgeries was till now difficult due to various problems like moving child, inability to elicit parasthesia and likely injury to brachial plexeus. With the advent of nerve stimulators and ultrasound guided blocks, we can now overcome the above problems. We evaluated the effect of ultrasound guided bupivacaine for quality and duration of post op analgesia. Methodology: Sixty paediatric patients posted for elective and emergency upper limb surgeries were enrolled for a prospective, randomized, study. Patients were divided into two groups, the control group A and the study group B. In group A (n =30) patients were given general anaesthesia for the surgery and at the end of it, conventional analgesics were given and In group B (n = 30), after GA, 10 ml of 0.325% bupivacaine + normal saline were given ultrasound guided supraclavicular brachial plexus block. Quality and duration of post op analgesia and time to first rescue analgesia were recorded. Results. The onset times for pain was significantly shorter in A than B group (p < 0.05). The duration of analgesia (DOA) was significantly longer in B group than A group (p < 0.0001). Heart rate levels in group B were significantly lower 15 min after block (p< 0.001). SBP and DBP levels in B group were significantly lower than in A (p < 0.001). No major adverse effects were observed in either of the groups except for sedation 8 and respiratory depression in 6 patients of group A. Conclusion: Supraclavicular brachial plexus block significantly lengthens the onset time of pain and prolongs the duration of post op analgesia. Patients in group B had good quality analgesia with no adverse effects.
International Journal of Medical Research and Review, 2015
Introduction: Various techniques and pharmacologic interventions have come in practice to blunt t... more Introduction: Various techniques and pharmacologic interventions have come in practice to blunt the hemodynamic responses of laryngoscopy and intubation. Beta blocker Esmolol is the drug used in our study to attenuate the stress response of laryngoscopy and intubation. The aim of our study was to observe the efficacy of Esmolol hydrochloride on cardiovascular responses to laryngoscopy and intubation. Methods: Two groups of 25 patients each were taken as control group and Esmolol group and Esmolol 1.5 mgs per kg IV as bolus dose was administered to Esmolol group 3 minutes prior to induction of anaesthesia followed by laryngoscopy and intubation. The vital parameters were recorded every minute for five minutes Results: There were no significant differences in the basal parameters in both the groups before giving Esmolol and with respect to age, sex and ASA grading. There was significant reduction in heart rate (6.4 %) at the time of induction as compared to rise of heart rate (15.16%) in control group. This was highly significant. Same way-there was fall in systolic blood pressure (7.69%) in esmolol group in comparison to a rise of 14.28% in control group. Diastolic blood pressure in esmolol group showed a fall of 2.9% as compared to a rise of 21.2% in control group. The RPP was found to decrease by 13.1% in esmolol group in comparison to a rise of 31.2 % in control group which was also highly statistically significant. Conclusion: Esmolol hydrochloride is proved to be a very effective drug, ultrashort acting rapid onset and offset of action, easily titrable, so highly useful in reducing the stress response of laryngoscopy and intubation.
Aspirin is routinely used drug in patients with cardiac problems. When a patient on aspirin requi... more Aspirin is routinely used drug in patients with cardiac problems. When a patient on aspirin requires dental treatment that has the risk of bleeding, the physician or dental surgeon often advices the patient to stop aspirin for few days. This however can lead to thromboembolic events to recur that may cause myocardial infarction, stroke or even death. The decision to stop the medicine prior to dental extraction or oral surgical procedure is critical.
Uploads
Papers by Sudip Bhargava