Effective post-operative pain management is crucial for patient comfort and recovery following lo... more Effective post-operative pain management is crucial for patient comfort and recovery following lower abdominal gynaecological surgeries. This study protocol outlines a randomised control trial designed to compare the efficacy and safety of two intrathecal adjuvants, nalbuphine and fentanyl, in conjunction with hyperbaric levobupivacaine for postoperative analgesia. The study will be conducted at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, DMIMS (DU), and affiliated institutions. Sixty eligible patients aged 35-75 years undergoing lower abdominal gynaecological surgeries under subarachnoid block will be randomly assigned to one of two groups. Group A will receive nalbuphine with levobupivacaine, while Group B will receive fentanyl with levobupivacaine. Patients will be monitored for the duration of post-operative analgesia, onset of sensory and motor block, hemodynamic effects, and side effects.
This comprehensive review explores the intricate landscape of prone ventilation in the intensive ... more This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in implementation, psychosocial impacts, technological innovations, economic considerations, barriers to adoption, and implications for clinical practice. The physiological benefits of prone positioning, including improved oxygenation and lung compliance, are discussed alongside the challenges of patient selection and technical complexities. The psychosocial impact on patients and caregivers, as well as the economic implications for healthcare systems, adds a crucial dimension to the analysis. The review also delves into innovative technologies, such as advanced monitoring and automation, shaping the landscape of prone ventilation. Moreover, it addresses the barriers to widespread adoption and outlines strategies to overcome resistance, emphasizing the need for a comprehensive and collaborative approach. The implications for clinical practice underscore the importance of evidence-based guidelines, ongoing education, and a holistic patient-centered care approach. The conclusion highlights the call to action for further research to refine protocols and technology, ultimately optimizing the application of prone ventilation in critical care settings.
A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following low... more A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.
This comprehensive review explores the multifaceted role of the transversus abdominis plane (TAP)... more This comprehensive review explores the multifaceted role of the transversus abdominis plane (TAP) block in contemporary pain management. Beginning with a definition and historical evolution, the article elucidates the mechanism of action, emphasizing local anesthesia, interference with pain signal transmission, and its impact on visceral and somatic pain. The review systematically investigates the diverse indications for TAP block, ranging from its applications in various surgical procedures to postoperative pain management and chronic pain conditions. Noteworthy abdominal wall block variations, including rectus sheath block and quadratus lumborum block, underscore the adaptability of TAP block in diverse clinical scenarios. The implications for clinical practice highlight its pivotal role in enhancing recovery after surgery, reducing opioid reliance, and providing patient-centered care. Furthermore, the article outlines recommendations for further research, addressing ongoing trials, technological innovations, and potential expansions into nonsurgical settings. In conclusion, TAP block emerges as a dynamic and indispensable tool in pain management, potentially redefining paradigms and optimizing patient outcomes across a spectrum of medical contexts.
Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the... more Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the alcohol drinkers are usually males. There is a rise in the incidence of road traffic accidents under the influence of alcohol due to locomotor and cerebral dysfunction. Alcohol is a significant cause and contributing factor for domestic violence, family disharmony, and displeasure in families. Research studies have shown that after the lockdown of COVID-19, the consumption of alcohol decreased in India. This study was conducted to assess the behavioral and personality changes in alcohol dependence syndrome. This study was conducted at a rural tertiary care hospital in Wardha, Maharashtra, Central India. Sixty-two males participated in the study. Out of which, 56 were included in the study. There were urban and rural participants in the study. The study was conducted for a period of six months. The participants who were being treated for alcohol withdrawal and alcohol dependence syndrome were included in the study. The individuals unwilling to participate in the research and those admitted to the intensive care unit were excluded from this study. The primary outcome measure of the study was to assess the behavioral and personality changes in alcohol dependence syndrome. Participants were screened using the Cut-Down, Annoyed, Guilty, and Eye-Opener (CAGE) and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires. The diagnosis of alcohol dependence syndrome was made according to the International Classification of Diseases, Tenth Revision, (ICD-10) criteria. The participants were assessed using a selfreport questionnaire. The parameters of assessment were aggressive behavior, domestic violence, workplace violence, verbal abuse, and variables including the forensic aspects of alcohol consumption, such as road traffic accidents, etc. Previous research and similar studies on factors related to alcohol dependence syndrome were compared to establish a conclusion for the study. Participants reported to have decreased psychomotor function upon alcohol consumption compared to the time they were not under the influence of alcohol. Aggressive behavior associated with irritability and agitation was observed in 89.28% (50 out of 56) participants. A total of 76.78% (43 out of 56) had road traffic accidents at least once under the influence of alcohol. Of the sample, 85.71% (48 out of 56) committed verbal abuse at the workplace and home as a result of aggression under the influence of alcohol. And 69.64% (39 out of 56) of the sample had memory loss after consumption of alcohol.
Assessment of the Efficacy of Nalbuphine as an Adjuvant to Intrathecal Bupivacaine in Endoscopic Urological Surgeries for the Prolongation of Postoperative Analgesia
Anesthesiologists often use benzodiazepines (BZDs) due to their remarkable amnestic and anxiolyti... more Anesthesiologists often use benzodiazepines (BZDs) due to their remarkable amnestic and anxiolytic capabilities. Because of this, they are perfect for use during the perioperative phase, when patients' anxiety levels are already high. Remimazolam has replaced certain commonly used intravenous (IV) anesthetics due to its excellent safety profile, rapid onset of action, and short half-life. The four classes of BZDs, 2-ketobenzodiazepines, 3-hydroxy-benzodiazepines, triazolobenzodiazepines, and 7-nitro-benzodiazepines based on chemical structure, provide various levels of drowsiness, forgetfulness, and anxiolysis. Based on their elimination half-life, short-acting BZDs typically have a half-life ranging from one to 12 hours, e.g., oxazepam; intermediate-acting BZDs have an average elimination half-life of 12 to 40 hours, e.g., alprazolam; and long-acting BZDs have an average elimination half-life of more than 40 hours, e.g., diazepam. The chloride ion channel is conformationally shifted by the benzodiazepine molecule resulting in central nervous system (CNS) inhibition and hyperpolarization. Each type of benzodiazepine has a favored use. For example, diazepam is used to treat anxiety. Midazolam is used for its anxiolytic and anterograde amnestic effects during the perioperative phase. Anxiety and epilepsy are two conditions that lorazepam effectively treats. There are now phase II and III clinical studies investigating remimazolam. It is not sensitive to alterations in its surroundings and has a brief half-life so that it may be removed rapidly, even after extensive infusion. Being a soft drug means the body easily breaks it down via metabolism, which explains many features. Remimazolam is hydrolyzed into methanol and its carboxylic acid metabolite CNS 7054 by esterase metabolism. Therefore, remimazolam has a shorter onset time and faster recovery than other BZDs. Remimazolam is metabolized independently of any particular organ. Patients with hepatic and renal problems will not see any changes in metabolism or excretion since the drug's ester moiety makes it a substrate for general tissue esterase enzymes. Like its predecessor, midazolam, it has a high potential for addiction. Some side effects that could occur during infusion include headaches and drowsiness. In clinical trials, hypotension, respiratory depression, and bradycardia were noted in participants. BZDs are helpful when used in conjunction with anesthesia. Remimazolam stands out, thanks to its unique pharmacokinetics, pharmacodynamics, safety profile, and potential medical applications. Its desirable properties make it a potential surgical premedication and sedative in the critical care unit. Anesthesiologists and other doctors could have access to more consistent and safer medication. However, additional comprehensive clinical trials are necessary to understand remimazolam's advantages and disadvantages.
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that poses un... more Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that poses unique challenges during pregnancy. We present a case of a 36-year-old pregnant woman with a history of type 1 diabetes mellitus who developed severe DKA at 33.5 weeks of gestation, necessitating an emergency cesarean section. Despite a known history of diabetes, the patient's infrequent clinic attendance and suboptimal disease management contributed to her critical condition. DKA was promptly diagnosed, and a multidisciplinary team comprising obstetricians, endocrinologists, anesthesiologists, and neonatologists collaborated to provide comprehensive care. The preoperative assessment revealed dehydration and electrolyte imbalances, necessitating meticulous planning for IV fluid administration and hemodynamic stability during the cesarean section. Regional anaesthesia was chosen as the anaesthetic approach, and close postoperative monitoring was initiated. The neonate, delivered with satisfactory Apgar scores, was transferred to the neonatal ICU for observation. The patient's gradual clinical improvement over 48 hours demonstrated the importance of ongoing care. This case highlights the significance of early recognition, multidisciplinary teamwork, and meticulous perioperative care in managing DKA during pregnancy, ensuring favourable outcomes for both the mother and the neonate.
Journal of pharmaceutical research international, Dec 28, 2021
Background-Desmoplastic ameloblastoma (DA) is an uncommon variety of ameloblastoma that accounts ... more Background-Desmoplastic ameloblastoma (DA) is an uncommon variety of ameloblastoma that accounts for 4-13% of all cases, with notable differences in anatomical location, imaging, and histologic appearance. It is classified as a variety of ameloblastoma in the WHO classification of head and neck tumours (WHO-2005). Because it commonly occurs in the anterior region of the jaws as a mixed radio-opaque-radiolucent lesion, the tumour resembles a benign fibro-osseous lesion. Case report-We present a case of desmoplastic ameloblastoma in a 51-year-old female with a painless swelling in the lower right region of mandible. Fine needle aspiration revealed no fluid. Both panoramic radiographs and a computed tomography scan revealed a mixed lesion with a multilocular appearance. Desmoplastic ameloblastoma was confirmed after an incisional biopsy. From teeth 41 to the angle of the jaw, a composite resection of the lesion was performed with segmental mandibulectomy. With a peek implant, it was repaired. The possibility for a problematic airway is emphasised in this case, with great surgical results. Conclusion: Desmoplastic ameloblastoma is a kind of ameloblastoma with unique clinic radiographic and histologic characteristics. Despite its rarity, the tumour necessitates a thorough examination due to the challenges it poses with airway ventilation and intubation.
Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It req... more Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It requires less local anesthetic and has a reduced rate of failed blocks hence the preferred anesthetic method for lower abdomen procedures is spinal anesthesia. Intrathecal local anesthetics benefit from adjuvant medications by extending postoperative analgesia and thus improving the sensory blockade's duration and quality. Intrathecal opioids and local anesthetics work together synergistically to increase the sensory block while decreasing the sympathetic block. Adjuvants to local anesthetics for intrathecal administration have certain benefits, including lowered local anesthetic medication dose, improved hemodynamic stability, and fewer adverse effects. The opioid medication nalbuphine has a kappa agonist and mu antagonist action that reduces pain without having many negative side effects. It acts on opoid receptor as both an agonist and an antagonist to offer visceral nociception with...
Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in childr... more Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in children. Single step corrective surgery, early on in life, provides a fair expectation of favourable outcome in these individuals. However, complex, and skilled anaesthetic management is required by experienced team of healthcare providers. Preoperative surgical preparation, intraoperative key anaesthesia principles and postoperative care intensive care unit are all perioperative considerations in these patients. This article reports challenges faced in the perioperative anaesthesic management of a 3-year-old child having uncorrected TOF, who underwent Waterston shunt and later Intracardiac Repair (ICR). He presented with postoperative complication like cyanotic spell, gastrointenstinal bleeding, sepsis; but later recovered successfully.
Intrathecal Adjuvant Midazolam Versus Fentanyl With Hyperbaric Bupivacaine for Post-operative Analgesia in Women Undergoing Total Abdominal Hysterectomy
The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia
Journal of Datta Meghe Institute of Medical Sciences University
Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is link... more Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome o... more Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome of the cystic type has been linked to difficulties with anaesthesia because of the abdominal pressure the tumour exerts on the thorax. There haven't been any reports of this kind of ovarian tumour associated with ascites and bilateral pleural effusion in a paediatric age group. Here, we describe our anaesthetic experience in a case of developing solid-type ovarian teratoma syndrome with deranged lung status and haemodynamics. The patient was a 15-year-old female who was diagnosed with ovarian teratoma. She was scheduled for surgery when she arrived at our hospital with a 13 cm solid mass and respiratory distress. The patient's liver profile was abnormal; she had ascites, pleural effusion and a severely worsened lung condition. The patient was planned for an exploratory laparotomy and debulking surgery after preoperative optimisation. To prevent the re-expansion pulmonary oedema (RPO) following the excision of the tumour, a volumerestricted postoperative ventilation strategy was planned. Following enhanced recovery after surgery (ERAS) protocol and specific anaesthetic measures, we successfully managed the anaesthesia in a case of teratoma syndrome with a large abdominal tumour with successful recovery and early discharge from hospital.
Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the las... more Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the last month of pregnancy or upto five months after delivery. In this condition, the heart chamber enlarges and the muscle weakens. This case report is about a 30- year-old primigravida,with oligohydramnios, at 32.3 weeks of gestation. She visited for a caesarean section, and was diagnosed with PPCM on the basis of clinical findings of growing fatigability, troubled breathing and severe dyspnoea and on echocardiography ejection fraction of 64% with mild mitral regurgitation, moderate dilated left ventricle, tricuspid regurgitation was found. These patients require vigilantanaesthetic intervention for management of painless labour and/or either vaginal or operative delivery. The basic haemodynamic goals should always be kept in mind for favorable maternal as well as foetal outcomewhile selecting the drug dose and mode of anaesthesia. Various studies showed thatboth general and regional anaesth...
The management of a problematic airway is one of the most critical tasks for an anaesthesiologist... more The management of a problematic airway is one of the most critical tasks for an anaesthesiologist. Airway issues are one of the most common causes of anaesthesia-related morbidity and mortality. Poor airway management has been recognised as a serious patient safety issue for nearly three decades, emphasising the significance of a comprehensive airway assessment before to anaesthesia induction.Mask ventilation and endotracheal intubation are considered challenging in patients with osteosarcoma of the jaw, where the mass protrudes from the mouth. Video laryngoscopic equipment, retrograde intubation, the laryngeal mask airway, Fibreoptic bronchoscope-guided intubation, and the pliable fibre optic stylet are among the procedures and equipment used to facilitate tracheal intubation in patients who are expected to have a difficult intubation. Anesthetists as well as surgeon prefer awake fibreoptic endotracheal intubation. Fiberoptic intubation with sedatives and local anaesthetics is a safe procedure for securing the airway in a difficult situation; even if the patient does not consent to an awake intubation. Here we report airway management of a 17 years old patient with osteosarcoma of jaw.
Comparison of Intrathecal Adjuvant Midazolam and Fentanyl with Hyperbaric Bupivacaine for Post-Operative Analgesia in Patient Undergoing Total Abdominal Hysterectomy
Annals of the Romanian Society for Cell Biology, Feb 1, 2021
Due to the unique anatomical and physiological variations of the airway of a child with cleft lip... more Due to the unique anatomical and physiological variations of the airway of a child with cleft lip and palate, anesthesiologists may find it difficult to manage it properly. As a result, cleft lip and palate surgery in children will necessitate careful attention, detailed understanding, and practical application in anaesthetic preparation. While the majority of individuals have isolated CLP, a considerable percentage of them also have related abnormalities. Other issues with the formation of the branchial arch are the most noticeable (e.g. ear or upper airway defects). Anomalies of the heart, kidneys, and skeleton are among them. Associated anomalies could be part of a defined pattern, indicating which flaws to expect; the number of such disorders, including CLP, is growing by the day, ranging from the obvious, such as Trisomy 21, to the more subtle, such as Velocardiofacial Syndrome. Here we report anaesthetic management of a 13 old girl with congenital complete cleft of soft palate with kyphoscoliosis posted for surgical repair of soft palate under general anesthesia.
Effective post-operative pain management is crucial for patient comfort and recovery following lo... more Effective post-operative pain management is crucial for patient comfort and recovery following lower abdominal gynaecological surgeries. This study protocol outlines a randomised control trial designed to compare the efficacy and safety of two intrathecal adjuvants, nalbuphine and fentanyl, in conjunction with hyperbaric levobupivacaine for postoperative analgesia. The study will be conducted at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, DMIMS (DU), and affiliated institutions. Sixty eligible patients aged 35-75 years undergoing lower abdominal gynaecological surgeries under subarachnoid block will be randomly assigned to one of two groups. Group A will receive nalbuphine with levobupivacaine, while Group B will receive fentanyl with levobupivacaine. Patients will be monitored for the duration of post-operative analgesia, onset of sensory and motor block, hemodynamic effects, and side effects.
This comprehensive review explores the intricate landscape of prone ventilation in the intensive ... more This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in implementation, psychosocial impacts, technological innovations, economic considerations, barriers to adoption, and implications for clinical practice. The physiological benefits of prone positioning, including improved oxygenation and lung compliance, are discussed alongside the challenges of patient selection and technical complexities. The psychosocial impact on patients and caregivers, as well as the economic implications for healthcare systems, adds a crucial dimension to the analysis. The review also delves into innovative technologies, such as advanced monitoring and automation, shaping the landscape of prone ventilation. Moreover, it addresses the barriers to widespread adoption and outlines strategies to overcome resistance, emphasizing the need for a comprehensive and collaborative approach. The implications for clinical practice underscore the importance of evidence-based guidelines, ongoing education, and a holistic patient-centered care approach. The conclusion highlights the call to action for further research to refine protocols and technology, ultimately optimizing the application of prone ventilation in critical care settings.
A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following low... more A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.
This comprehensive review explores the multifaceted role of the transversus abdominis plane (TAP)... more This comprehensive review explores the multifaceted role of the transversus abdominis plane (TAP) block in contemporary pain management. Beginning with a definition and historical evolution, the article elucidates the mechanism of action, emphasizing local anesthesia, interference with pain signal transmission, and its impact on visceral and somatic pain. The review systematically investigates the diverse indications for TAP block, ranging from its applications in various surgical procedures to postoperative pain management and chronic pain conditions. Noteworthy abdominal wall block variations, including rectus sheath block and quadratus lumborum block, underscore the adaptability of TAP block in diverse clinical scenarios. The implications for clinical practice highlight its pivotal role in enhancing recovery after surgery, reducing opioid reliance, and providing patient-centered care. Furthermore, the article outlines recommendations for further research, addressing ongoing trials, technological innovations, and potential expansions into nonsurgical settings. In conclusion, TAP block emerges as a dynamic and indispensable tool in pain management, potentially redefining paradigms and optimizing patient outcomes across a spectrum of medical contexts.
Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the... more Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the alcohol drinkers are usually males. There is a rise in the incidence of road traffic accidents under the influence of alcohol due to locomotor and cerebral dysfunction. Alcohol is a significant cause and contributing factor for domestic violence, family disharmony, and displeasure in families. Research studies have shown that after the lockdown of COVID-19, the consumption of alcohol decreased in India. This study was conducted to assess the behavioral and personality changes in alcohol dependence syndrome. This study was conducted at a rural tertiary care hospital in Wardha, Maharashtra, Central India. Sixty-two males participated in the study. Out of which, 56 were included in the study. There were urban and rural participants in the study. The study was conducted for a period of six months. The participants who were being treated for alcohol withdrawal and alcohol dependence syndrome were included in the study. The individuals unwilling to participate in the research and those admitted to the intensive care unit were excluded from this study. The primary outcome measure of the study was to assess the behavioral and personality changes in alcohol dependence syndrome. Participants were screened using the Cut-Down, Annoyed, Guilty, and Eye-Opener (CAGE) and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires. The diagnosis of alcohol dependence syndrome was made according to the International Classification of Diseases, Tenth Revision, (ICD-10) criteria. The participants were assessed using a selfreport questionnaire. The parameters of assessment were aggressive behavior, domestic violence, workplace violence, verbal abuse, and variables including the forensic aspects of alcohol consumption, such as road traffic accidents, etc. Previous research and similar studies on factors related to alcohol dependence syndrome were compared to establish a conclusion for the study. Participants reported to have decreased psychomotor function upon alcohol consumption compared to the time they were not under the influence of alcohol. Aggressive behavior associated with irritability and agitation was observed in 89.28% (50 out of 56) participants. A total of 76.78% (43 out of 56) had road traffic accidents at least once under the influence of alcohol. Of the sample, 85.71% (48 out of 56) committed verbal abuse at the workplace and home as a result of aggression under the influence of alcohol. And 69.64% (39 out of 56) of the sample had memory loss after consumption of alcohol.
Assessment of the Efficacy of Nalbuphine as an Adjuvant to Intrathecal Bupivacaine in Endoscopic Urological Surgeries for the Prolongation of Postoperative Analgesia
Anesthesiologists often use benzodiazepines (BZDs) due to their remarkable amnestic and anxiolyti... more Anesthesiologists often use benzodiazepines (BZDs) due to their remarkable amnestic and anxiolytic capabilities. Because of this, they are perfect for use during the perioperative phase, when patients' anxiety levels are already high. Remimazolam has replaced certain commonly used intravenous (IV) anesthetics due to its excellent safety profile, rapid onset of action, and short half-life. The four classes of BZDs, 2-ketobenzodiazepines, 3-hydroxy-benzodiazepines, triazolobenzodiazepines, and 7-nitro-benzodiazepines based on chemical structure, provide various levels of drowsiness, forgetfulness, and anxiolysis. Based on their elimination half-life, short-acting BZDs typically have a half-life ranging from one to 12 hours, e.g., oxazepam; intermediate-acting BZDs have an average elimination half-life of 12 to 40 hours, e.g., alprazolam; and long-acting BZDs have an average elimination half-life of more than 40 hours, e.g., diazepam. The chloride ion channel is conformationally shifted by the benzodiazepine molecule resulting in central nervous system (CNS) inhibition and hyperpolarization. Each type of benzodiazepine has a favored use. For example, diazepam is used to treat anxiety. Midazolam is used for its anxiolytic and anterograde amnestic effects during the perioperative phase. Anxiety and epilepsy are two conditions that lorazepam effectively treats. There are now phase II and III clinical studies investigating remimazolam. It is not sensitive to alterations in its surroundings and has a brief half-life so that it may be removed rapidly, even after extensive infusion. Being a soft drug means the body easily breaks it down via metabolism, which explains many features. Remimazolam is hydrolyzed into methanol and its carboxylic acid metabolite CNS 7054 by esterase metabolism. Therefore, remimazolam has a shorter onset time and faster recovery than other BZDs. Remimazolam is metabolized independently of any particular organ. Patients with hepatic and renal problems will not see any changes in metabolism or excretion since the drug's ester moiety makes it a substrate for general tissue esterase enzymes. Like its predecessor, midazolam, it has a high potential for addiction. Some side effects that could occur during infusion include headaches and drowsiness. In clinical trials, hypotension, respiratory depression, and bradycardia were noted in participants. BZDs are helpful when used in conjunction with anesthesia. Remimazolam stands out, thanks to its unique pharmacokinetics, pharmacodynamics, safety profile, and potential medical applications. Its desirable properties make it a potential surgical premedication and sedative in the critical care unit. Anesthesiologists and other doctors could have access to more consistent and safer medication. However, additional comprehensive clinical trials are necessary to understand remimazolam's advantages and disadvantages.
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that poses un... more Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that poses unique challenges during pregnancy. We present a case of a 36-year-old pregnant woman with a history of type 1 diabetes mellitus who developed severe DKA at 33.5 weeks of gestation, necessitating an emergency cesarean section. Despite a known history of diabetes, the patient's infrequent clinic attendance and suboptimal disease management contributed to her critical condition. DKA was promptly diagnosed, and a multidisciplinary team comprising obstetricians, endocrinologists, anesthesiologists, and neonatologists collaborated to provide comprehensive care. The preoperative assessment revealed dehydration and electrolyte imbalances, necessitating meticulous planning for IV fluid administration and hemodynamic stability during the cesarean section. Regional anaesthesia was chosen as the anaesthetic approach, and close postoperative monitoring was initiated. The neonate, delivered with satisfactory Apgar scores, was transferred to the neonatal ICU for observation. The patient's gradual clinical improvement over 48 hours demonstrated the importance of ongoing care. This case highlights the significance of early recognition, multidisciplinary teamwork, and meticulous perioperative care in managing DKA during pregnancy, ensuring favourable outcomes for both the mother and the neonate.
Journal of pharmaceutical research international, Dec 28, 2021
Background-Desmoplastic ameloblastoma (DA) is an uncommon variety of ameloblastoma that accounts ... more Background-Desmoplastic ameloblastoma (DA) is an uncommon variety of ameloblastoma that accounts for 4-13% of all cases, with notable differences in anatomical location, imaging, and histologic appearance. It is classified as a variety of ameloblastoma in the WHO classification of head and neck tumours (WHO-2005). Because it commonly occurs in the anterior region of the jaws as a mixed radio-opaque-radiolucent lesion, the tumour resembles a benign fibro-osseous lesion. Case report-We present a case of desmoplastic ameloblastoma in a 51-year-old female with a painless swelling in the lower right region of mandible. Fine needle aspiration revealed no fluid. Both panoramic radiographs and a computed tomography scan revealed a mixed lesion with a multilocular appearance. Desmoplastic ameloblastoma was confirmed after an incisional biopsy. From teeth 41 to the angle of the jaw, a composite resection of the lesion was performed with segmental mandibulectomy. With a peek implant, it was repaired. The possibility for a problematic airway is emphasised in this case, with great surgical results. Conclusion: Desmoplastic ameloblastoma is a kind of ameloblastoma with unique clinic radiographic and histologic characteristics. Despite its rarity, the tumour necessitates a thorough examination due to the challenges it poses with airway ventilation and intubation.
Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It req... more Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It requires less local anesthetic and has a reduced rate of failed blocks hence the preferred anesthetic method for lower abdomen procedures is spinal anesthesia. Intrathecal local anesthetics benefit from adjuvant medications by extending postoperative analgesia and thus improving the sensory blockade's duration and quality. Intrathecal opioids and local anesthetics work together synergistically to increase the sensory block while decreasing the sympathetic block. Adjuvants to local anesthetics for intrathecal administration have certain benefits, including lowered local anesthetic medication dose, improved hemodynamic stability, and fewer adverse effects. The opioid medication nalbuphine has a kappa agonist and mu antagonist action that reduces pain without having many negative side effects. It acts on opoid receptor as both an agonist and an antagonist to offer visceral nociception with...
Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in childr... more Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in children. Single step corrective surgery, early on in life, provides a fair expectation of favourable outcome in these individuals. However, complex, and skilled anaesthetic management is required by experienced team of healthcare providers. Preoperative surgical preparation, intraoperative key anaesthesia principles and postoperative care intensive care unit are all perioperative considerations in these patients. This article reports challenges faced in the perioperative anaesthesic management of a 3-year-old child having uncorrected TOF, who underwent Waterston shunt and later Intracardiac Repair (ICR). He presented with postoperative complication like cyanotic spell, gastrointenstinal bleeding, sepsis; but later recovered successfully.
Intrathecal Adjuvant Midazolam Versus Fentanyl With Hyperbaric Bupivacaine for Post-operative Analgesia in Women Undergoing Total Abdominal Hysterectomy
The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia
Journal of Datta Meghe Institute of Medical Sciences University
Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is link... more Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome o... more Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome of the cystic type has been linked to difficulties with anaesthesia because of the abdominal pressure the tumour exerts on the thorax. There haven't been any reports of this kind of ovarian tumour associated with ascites and bilateral pleural effusion in a paediatric age group. Here, we describe our anaesthetic experience in a case of developing solid-type ovarian teratoma syndrome with deranged lung status and haemodynamics. The patient was a 15-year-old female who was diagnosed with ovarian teratoma. She was scheduled for surgery when she arrived at our hospital with a 13 cm solid mass and respiratory distress. The patient's liver profile was abnormal; she had ascites, pleural effusion and a severely worsened lung condition. The patient was planned for an exploratory laparotomy and debulking surgery after preoperative optimisation. To prevent the re-expansion pulmonary oedema (RPO) following the excision of the tumour, a volumerestricted postoperative ventilation strategy was planned. Following enhanced recovery after surgery (ERAS) protocol and specific anaesthetic measures, we successfully managed the anaesthesia in a case of teratoma syndrome with a large abdominal tumour with successful recovery and early discharge from hospital.
Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the las... more Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the last month of pregnancy or upto five months after delivery. In this condition, the heart chamber enlarges and the muscle weakens. This case report is about a 30- year-old primigravida,with oligohydramnios, at 32.3 weeks of gestation. She visited for a caesarean section, and was diagnosed with PPCM on the basis of clinical findings of growing fatigability, troubled breathing and severe dyspnoea and on echocardiography ejection fraction of 64% with mild mitral regurgitation, moderate dilated left ventricle, tricuspid regurgitation was found. These patients require vigilantanaesthetic intervention for management of painless labour and/or either vaginal or operative delivery. The basic haemodynamic goals should always be kept in mind for favorable maternal as well as foetal outcomewhile selecting the drug dose and mode of anaesthesia. Various studies showed thatboth general and regional anaesth...
The management of a problematic airway is one of the most critical tasks for an anaesthesiologist... more The management of a problematic airway is one of the most critical tasks for an anaesthesiologist. Airway issues are one of the most common causes of anaesthesia-related morbidity and mortality. Poor airway management has been recognised as a serious patient safety issue for nearly three decades, emphasising the significance of a comprehensive airway assessment before to anaesthesia induction.Mask ventilation and endotracheal intubation are considered challenging in patients with osteosarcoma of the jaw, where the mass protrudes from the mouth. Video laryngoscopic equipment, retrograde intubation, the laryngeal mask airway, Fibreoptic bronchoscope-guided intubation, and the pliable fibre optic stylet are among the procedures and equipment used to facilitate tracheal intubation in patients who are expected to have a difficult intubation. Anesthetists as well as surgeon prefer awake fibreoptic endotracheal intubation. Fiberoptic intubation with sedatives and local anaesthetics is a safe procedure for securing the airway in a difficult situation; even if the patient does not consent to an awake intubation. Here we report airway management of a 17 years old patient with osteosarcoma of jaw.
Comparison of Intrathecal Adjuvant Midazolam and Fentanyl with Hyperbaric Bupivacaine for Post-Operative Analgesia in Patient Undergoing Total Abdominal Hysterectomy
Annals of the Romanian Society for Cell Biology, Feb 1, 2021
Due to the unique anatomical and physiological variations of the airway of a child with cleft lip... more Due to the unique anatomical and physiological variations of the airway of a child with cleft lip and palate, anesthesiologists may find it difficult to manage it properly. As a result, cleft lip and palate surgery in children will necessitate careful attention, detailed understanding, and practical application in anaesthetic preparation. While the majority of individuals have isolated CLP, a considerable percentage of them also have related abnormalities. Other issues with the formation of the branchial arch are the most noticeable (e.g. ear or upper airway defects). Anomalies of the heart, kidneys, and skeleton are among them. Associated anomalies could be part of a defined pattern, indicating which flaws to expect; the number of such disorders, including CLP, is growing by the day, ranging from the obvious, such as Trisomy 21, to the more subtle, such as Velocardiofacial Syndrome. Here we report anaesthetic management of a 13 old girl with congenital complete cleft of soft palate with kyphoscoliosis posted for surgical repair of soft palate under general anesthesia.
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