Browsing by Author "Amrita Rath"

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A case report on anaesthetic challenges in Patau syndrome: Navigating craniofacial and cardiac defects
(IP Innovative Publication Pvt. Ltd., 2023) Abha Singh; Pragya Shukla; Amrita Rath; Shashi Prakash; Sanjay Bhaskar
The anaesthetic management of paediatric patients with Patau syndrome presents unique challenges, particularly when combined with craniofacial and cardiac defects and limited airway resources. This case report highlights our experience in managing a syndromic child with a difficult airway in a resource-constrained environment. The inability to secure the airway adequately can pose significant perioperative risks. In this case, we successfully utilized an oesophageal bougie as an alternative technique to secure the airway. This report emphasizes the importance of adapting to limited resources and employing innovative approaches to ensure optimal patient care in challenging situations. © 2023 Author(s), Published by Innovative Publication.
A Comparative study of the effectiveness of lumbar steroid injection in kambin s triangle versus conventional transforaminal approach for the treatment of lumbar radicular pain: A prospective randomised study; [Lomber radikuler agri tedavisinde kambin ucgeni yaklasimi ile uygulanan steroid enjeksiyonunun etkinliginin konvansiyonel transforaminal yaklasimla karsilastirilmasi: prospektif randomize calisma]
(Anestezi Dergisi, 2022) Gauresh Singh; Reena; Anil Kumar Paswan; Amrita Rath
Objective: Low back pain is a very troublesome and common issue among patients irrespective of age and sex and is very difficult to manage with conservative management. It can lead to disability and mental issues. Methods: After ethical committee approval, a prospective, randomised, double-blind comparative study on 40 patients aged 20-70 years, suffering from lumbar radicular pain was carried out by two different approaches i.e., conventional transforaminal and Kambin s triangle approach and epidural steroids were administered. Change in pain intensity using the Verbal Numerical Rating Scale was recorded as our primary outcome. Change in functional status using Oswestry Disability Index and Patient Satisfaction Score were our secondary outcomes. Any adverse event, complication, failure was also noted. Results: Multiple logistic regression showed no difference in pain relief or improvement of functional status due to variable differences like the age, sex, disc level or the type of approach. Conclusion: Both approaches of transforaminal epidural steroid injection were effective in reducing pain and increasing functional status significantly. There was no significant difference in their effectiveness and neither was superior to the other. © 2022 Anestezi Dergisi. All rights reserved.
A comparative study of transdiscal versus transaortic celiac plexus neurolytic block for upper gastrointestinal cancer patients. A prospective, randomized control study
(BeSARPP, 2021) Amrita Rath; Reena; Anil Kumar Paswan; Mallika Tewari
Aim: To compare transdiscal and transaortic techniques of neurolytic celiac plexus block for upper gastrointestinal cancer patients. Methods: In this prospective randomized study 60 patients with upper gastrointestinal malignancies were included and randomly divided into two groups, group TD and group TA, receiving neurolytic celiac plexus blocks via transdiscal and transaortic techniques, respectively. The primary outcome was quality of life (QoL) as assessed by WHOQOL BREF questionnaire and secondary outcomes were pain relief using visual analogue scale (VAS), and occurrence of complications like hypotension, loose motion, bleeding and discitis. Result: QoL and VAS score were significantly improved in both groups post procedure. Transdiscal approach is more effective in improving VAS score than transaortic approach (1 vs 3) after 1 week and the relief of pain was better in TD group (3 vs 6) at the end of 2 months. Transdiscal approach was found to be more effective in improving QoL (227.00±28.85 vs 191.17±35.78) as compared to transaortic approach. However, postprocedural QoL improved in both groups when compared to pre-procedural QoL (p<0.05). Hypotension, diarrhea and bleeding from aorta were higher in TA group; however, no serious complications were seen in any of the groups. Conclusion: Transdiscal technique is better in terms of adequate pain relief and improving QoL as compared to transaortic technique of NCPB in patients of upper GI malignancies and is associated with lesser incidences of complications. © Acta Anæsthesiologica Belgica, 2021.
A Laryngeal web with tracheo-esophageal fistula: Anaesthesiologist skating on a thin ice; [Trakeo-ozofageal fistullu bir laringeal web: ince bir buz uzerinde paten yapan anestezist]
(Anestezi Dergisi, 2022) Amrita Rath; Abha Singh; Reena; Pragya Shukla; Sarita Choudhary; Shiv Prasad Sharma; Kairi Dibo
Tracheo-esophageal fistula (TEF) in association with subglottic laryngeal web is a rare entity. Often the diagnosis of laryngeal web in the presence of TEF is missed and it is identified during intubation attempts. The triad of neonatal age, TEF and laryngeal web can even cause the most experienced anaesthetists concern about the mortality and morbidity that may develop due to the inability to secure the airway. In this case report, we aimed to share our experience on the airway management of a newborn with laryngeal web. © 2022 Anestezi Dergisi. All rights reserved.
Anesthetic considerations in COVID-associated mucormycosis in a patient with autoimmune disorders
(Edizioni Minerva Medica, 2022) Amrita Rath; Reena Reena; Shibin Jose
[No abstract available]
Comparison of different head positions for ease of intubation in obese patients using videolaryngoscopy
(Churchill Livingstone, 2024) Tara Mati; Reena; Amrita Rath; Rajiv Kumar Dubey; Sonu Kumar Kashyap
Background: In direct laryngoscopy ramping is a recommended technique in obese patients to improve success of intubation. Recently 25° back up position has also been described for the same purpose. The effect of change in head neck positions have not been much studied in obese patients, while using videolaryngoscopy (VL). Methods: This prospective randomized study included 150 adult obese surgical patients (BMI >30 kg/m2), requiring intubation using VL. Patients were randomly assigned one of the three groups: sniffing position, ramped up position and 25° back up position. The time taken for intubation was the primary outcome. Other parameters assessed were Cormack-Lehane grading, time to achieve best glottic view, ease and attempts required for intubation. Results: The study shows that, 25° back up position has reduced time taken for successful intubation 161.80 s as compared to ramped up position (172.56 s) and sniffing position (171.84 s) with p value of <0.0001. Mean time for best glottic view was 18.82 s in group C, compared to 38.24 s for group B, and 39.66 s in group A (p < 0.0001). The ease of intubation score was also very easy/easy in 9/28 patients in group C compared to 3/16 and 3/17 patients respectively in groups A and B (p = 0.007). First attempt at intubation was successful in 47 patients in group C compared to 32 and 40 patients in groups A and B respectively (p = 0.001). There was no significant difference in Cormack and Lehane grading in different positions. Conclusions: The 25° back up position is a simple and useful technique in improving glottic view and intubation success rate with reduction in intubation time compared to ramped up and sniffing positions. © 2024 Elsevier Ltd
Comparison of Erector Spinae Plane Block and Serratus Anterior Plane Block for Modified Radical Mastectomy: A Prospective Randomised Study; [Modifiye Radikal Mastektomi Hastalarında Erektör Spina Plan Bloğu ve Serratus Anterior Plan Bloğunun Karşılaştırılması: Prospektif Randomize Çalışma]
(Anestezi Dergisi, 2022) Saurabh Sagar; Sandeep Loha; Anil Paswan; Arvind Pratap; Shashi Prakash; Amrita Rath
Objective: Breast cancer is one of the most commonly diagnosed malignancies among females. In this study, we compared the analgesic efficacy of ultrasound-guided (USG) erector spinae plane block (ESPB) with serratus anterior plane block (SAPB) after modified radical mastectomy (MRM) for unilateral breast cancer. Methods: After obtaining clearance from the institute’s ethical committee, this prospective double-blinded clinical study was conducted from August 2021 to April 2022. Females aged between 18 and 65 years with body mass index ≤30 kg m-2 and ASA I and II who were scheduled for MRM for breast cancer were included in this study. Forty patients were randomly divided into two groups: Group E (USG-ESPB was administered) and Group S (USG-SAPB was administered). Both the groups received 0.4 mL kg-1 of 0.25% bupivacaine. Duration of analgesia of the patients, intra-operative and post-operative hemodynamic changes, intra-operative opioid & post-operative analgesic consumption, Numerical Rating Scale (NRS) pain scores and adverse effects like vascular puncture, hypotension, pleural puncture or pneumothorax or local anaesthetic toxicity were recorded. Results: The mean duration of analgesia was significantly prolonged in Group E as compared to Group S and was statistically significant (p<0.001). The mean NRS score was found to be significantly lower in Group E as compared to Group S at 2,4,8 and 12 hours which was statistically significant (p<0.005). Though the intraoperative opioid requirement was comparable among both groups, the postoperative analgesic consumption was significantly lower in the Group E compared to the Group S (p<0.05). Conclusion: In our study, we concluded that USG-ESPB is superior to USG-SAPB in the post-operative period in patients undergoing unilateral MRM. © 2022 Anestezi Dergisi. All rights reserved.
CRITICAL EVALUATIONS OF INTRA-ARTICULAR PLATELET RICH PLASMA ALONE OR COMBINATION WITH MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN PATIENTS WITH LUMBAR FACET JOINT ARTHROPATHY: A PROSPECTIVE OUTCOME STUDY
(World Scientific, 2023) Anil Kumar Paswan; Amrita Rath
Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period (p < 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP (p < 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. (p < 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome. © World Scientific Publishing Company.
Duloxetine in Reducing Catheter-Related Bladder Discomfort: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
(2023) Amrita Rath; Reena; Ghanshyam Yadav
Objective: The excessive desire to void with discomfort in the supra-pubic region, which is experienced postoperatively by patients who underwent urinary catheter-ization, is known as catheter-related bladder discomfort. In this study, we evaluated duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, in preventing catheter-related bladder discomfort. Material and methods: Around 64 adults (18-60 years), of either sex, with American Society of American Society of Anesthesiologists (ASA) physical status I and II, sched-uled to undergo elective gastrointestinal carcinoma surgeries under general anesthesia were analyzed in the final assessment of 2 comparative groups C and D of 32 patients each. Group D received 1 ranitidine tablet of 150 mg and 1 duloxetine tablet of 60 mg, while group C patients received 2 tablets of ranitidine of 75 mg 2 hours prior to induction. A 16 F Foley catheter was used to catheterize bladder intra-operatively, and 10 mL of distilled water was used to fill the balloon. At 0, 1, 2, and 6 hours, the catheter-related bladder discomfort was evaluated, and categorized into none, mild, moderate, and severe. The study drug's adverse effects, if any, were reported. Results: At all-time intervals, group D had lower incidence and severity of catheter-related bladder discomfort than group C (P < .05). Compared to group C, patients in group D had a higher incidence of nausea, dizziness, and vomiting; nevertheless, the difference was statistically insignificant (P > .05). Conclusion: Duloxetine of 60 mg given orally 2 hours before induction decreases the incidence and severity of catheter-related bladder discomfort. © Author(s).
Efficacy of prophylactic enteral bromocriptine in reducing the neurogenic fever in severe traumatic brain injury patients in the trauma intensive care unit - A randomized placebo-controlled study
(Wolters Kluwer Medknow Publications, 2025) M. Rajesh; Dikshitha Kshirasagar Chetty; Amrita Rath; Reena; Somsubhra Pal; Ghanshyam Yadav
Introduction: Neurogenic fever (NF) is a noninfectious, centrally mediated hyperthermia seen in patients with traumatic brain injury (TBI) and other neurological conditions. Fever exacerbates secondary brain injury, increases metabolic demand, and worsens patient outcomes. Dopamine agonists such as bromocriptine, which modulate hypothalamic thermoregulation, have been proposed as potential therapeutic agents. This study evaluates the efficacy of prophylactic bromocriptine in preventing NF in patients with severe TBI. Methods: In this randomized, double-blind, placebo-controlled trial, 100 adult patients with isolated severe TBI admitted within 24 h of injury were assigned to receive either bromocriptine (5 mg twice daily, n = 50) or placebo (n = 50) through enteral administration. NF was defined as a temperature >38.3°C for at least one episode over 2 consecutive days after excluding infectious causes. The primary outcome was NF incidence. Secondary outcomes included fever severity, frequency, onset, mortality, and heart rate-temperature correlation. Data were analyzed using parametric and nonparametric statistical methods. Results: After exclusions and dropouts, 43 patients in the bromocriptine group and 45 in the placebo group were analyzed. NF incidence was lower in the bromocriptine group (41.86%) compared to placebo (55.56%), but the difference was not statistically significant (P = 0.199). No differences were observed in fever onset, mortality, or heart rate-temperature correlation. Bromocriptine was associated with a reduction in peak temperature on day 5 (P < 0.05). Conclusion: Prophylactic bromocriptine did not significantly reduce NF incidence in severe TBI but showed trends toward lower fever severity. Further research with larger cohorts and optimized dosing is warranted. © 2025 International Journal of Critical Illness and Injury Science.
Expert’s tips on regional blocks in neonates and infants
(Korean Society of Anesthesiologists, 2024) Vrushali Chandrashekhar Ponde; Amrita Rath; Neha Singh
Pediatric regional anesthesia (RA) has emerged as a rapidly advancing dimension within pediatric anesthesia, demanding a continual commitment to knowledge acquisition. This review underscores the contemporary significance of this specialty, focusing on its application in neonates and infants. The primary objective of RA is to address perioperative pain effectively while preserving the delicate physiological balance, thereby enhancing overall patient care. This review explores the advantages offered by RA in this age group. Furthermore, con-ventional, and recently introduced techniques of RA are examined by exploring the advantages and disadvantages of these methods. The aim is to provide clinicians with a nuanced understanding of their applicability in different clinical scenarios. Additionally, the review elu-cidates the unique considerations associated with pediatric RA, acknowledging pediatric pa-tients’ distinctive anatomical and physiological characteristics. The exceptional cases of congenital anomalies and their implications for the choice of RA are considered. An aspect of the review is its focus on dosages of local anesthetics and the volumes required for various blocks in neonates and infants. The dosages for continuous infusion and practical is-sues with infusions are considered. Complications associated with RA are described, along with their prevention and treatment. The review offers pragmatic insights into the selection criteria for various regional blocks, aiding anesthesiologists in making informed decisions tailored to individual patient needs. © The Korean Society of Anesthesiologists, 2024.
Intractable post dural puncture headache in a patient with undiagnosed intrathoracic meningocele
(Turkish Society of Algology, 2025) Reena; Subash Sankaralingam; Swati Singh; Amrita Rath; J. Manikandan; Ashutosh Vikram
Post dural puncture headache (PDPH) is a troublesome complication of dural puncture. Although its risk factors and management have been extensively discussed in the literature, the underlying cause may sometimes remain unclear, making treatment challenging for anaesthesiologists. We describe a noteworthy case of PDPH following spinal anaesthesia administered for an emergency cesarean section in a patient with known neurofibromatosis. Despite conservative and pharmacological treatment, followed by an autologous epidural blood patch, no symptomatic relief was achieved. Neuroimaging of the brain and spine revealed a large intrathoracic meningocele (IM). Although rare, intrathoracic meningocele should be considered in patients with neurofibromatosis who develop intractable PDPH after dural puncture, with neuroimaging being the most effective diagnostic tool. © 2025 Turkish Society of Algology.
Mysterious alarming mucormycosis: Anesthetic challenges in a series of four cases
(Wolters Kluwer Medknow Publications, 2022) Neville Jf; Abhinay Jayanthi; Reena; Amrita Rath
The sudden epidemic of mucormycosis amid COVID‑19 pandemic has significantly challenged our understanding of the disease while affecting the whole medical and surgical management. Overzealous use of steroids in the management of covid‑19 and uncontrolled diabetes mellitus has resulted in a tremendous rise in mucormycosis cases further burdening the already strained health care infrastructure and health care workers, especially the anesthesiologists.While working in a tertiary care institute of the country, we have been facing multiple challenges in its anesthetic management on a daily basis.This article is a case series involving four different patients who were operated for rhino‑orbito‑cerebral mucormycosis with a brief discussion on various aspects of this multisystem epidemic. © 2022 National Journal of Maxillofacial Surgery.
Neonatal Epignathus with hypoplastic left heart syndrome: Anaesthetic challenges and peri-operative implications
(Churchill Livingstone, 2023) Amrita Rath; Reena; Khushbu Karoo; Shashi Prakash; Ruchira Nandan
Epignathus is the rare congenital oro-pharyngeal teratoma which can be associated with respiratory or digestive tract obstruction. We are describing a case of 10 days old neonate with epignathus and hypoplastic left heart syndrome, with complains of feeding difficulty and failure to thrive. She was posted for surgical excision under general anesthesia. The major anaesthetic challenges were maintaining intra-operative hemodynamic stability and securing the airway. We used sevoflurane for inhalational induction while maintaining the spontaneous ventilation and intubation was done nasally with gentle direct laryngoscopy, while an assistant was suspending the mass away from airway throughout the airway manipulation. The patency of patent ductus arteriosus was ensured with prostaglandin E1 infusion. Too our knowledge, this is the first case report of anaesthesic management of neonatal epignathus with hypoplastic left heart syndrome. A good patient outcome can be expected with strict adherence to planning, proper technique and utilizing expert's help as early as possible. © 2023 Elsevier Ltd
Plexiglass under the pediatric glottis: A linear illusion
(Wolters Kluwer Medknow Publications, 2023) Amrita Rath; Reena; Khushbu Karoo; Vaibhav Pandey; Sunil Gaur; Rajat Singh
[No abstract available]
Re: Comment on “Prehospital Cricothyrotomy: A Narrative Review of Technical, Educational, and Operational Considerations for Procedure Optimization”: Ways to Explore Further
(Elsevier Inc., 2025) Neha Singh; Amrita Rath; Supriya Muduli; Vrushali Chandrashekhar Ponde
[No abstract available]
Scorpion bite and failed spinal anesthesia: is ropivacaine the answer?
(Edizioni Minerva Medica, 2023) Amrita Rath; Reena Reena
[No abstract available]
Septic Emboli
(Springer Nature, 2023) Amrita Rath; Abhinay Jayanthi
Septic embolism (SE) constitutes an important yet often under-reported class of infectious complications. The incidence of septic embolism is on the rise now a days secondary to widespread use of injectable drugs and indwelling catheters. Septic embolism is typically caused by occlusion of a blood vessel by an infected thrombus which travels in bloodstream from a distant infectious source. Septic embolism as was classically described results from infective endocarditis. Osler nodes (the tender, purplish-coloured papules), which are pathognomonic of infective endocarditis, are indeed evidence of embolism [1]. SE can be associated with a wide range of both early and late sequelae. Among immediate complications is the occlusion of the downstream vascular tree, including devastating sequelae such as cerebral, bowel, or myocardial infarction [2]. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.
Shamrock fetus in fetu: An anesthetic enigma
(Elsevier B.V., 2025) Amrita Rath; Abha Singh; Reena; Ritwik Mohan; M. Rajesh; Rajat Arora; Ruchira Nandan
Fetus in fetu (FIF) is a rare congenital anomaly with an incidence of 1 in 5 lakh live births. Till date, only 200 cases have been reported, with the majority having a single FIF. We report an interesting case of FIF with 3 interlinked fetuses inside giving the appearance of Shamrock leaf. The FIF was causing compression of the common bile duct causing obstructive jaundice as well as was associated with moderate hydronephrosis, presenting unique anesthetic challenges. Our purpose to write this case report was to add to the existing knowledge of this rare entity besides discussing its anesthetic implications. © 2024
Shamrock fetus in fetu: An anesthetic enigma
(Elsevier B.V., 2024) Amrita Rath; Abha Singh; Reena; Ritwik Mohan; M. Rajesh; Rajat Arora; Ruchira Nandan
Fetus in fetu (FIF) is a rare congenital anomaly with an incidence of 1 in 5 lakh live births. Till date, only 200 cases have been reported, with the majority having a single FIF. We report an interesting case of FIF with 3 interlinked fetuses inside giving the appearance of Shamrock leaf. The FIF was causing compression of the common bile duct causing obstructive jaundice as well as was associated with moderate hydronephrosis, presenting unique anesthetic challenges. Our purpose to write this case report was to add to the existing knowledge of this rare entity besides discussing its anesthetic implications. © 2024