Browsing by Author "Ankit Agarwal"

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Bronchoscopic topical steroid instillation in prevention of tracheal stenosis
(2014) Ankit Agarwal; D.K. Singh
Corrosive acid poisoning commonly results in chemical injuries to respiratory and upper gastrointestinal tract. Corrosive mucosal erosion of the larynx and trachea may occur if the patient aspirates acid. We successfully used local anti-inflammatory action of dexamethasone instilled through a fiber-optic bronchoscope for regression of mucosal edema and prevention of subsequent development of stricture in a young female.
Is fibreoptic percutaneous tracheostomy in ICU a breakthrough
(2010) Ankit Agarwal; D.K. Singh
Background: In ICUs, bedside percutaneous tracheostomy (pet) is commonly performed, but it is associated with certain drawbacks as paratracheal placement, posterior tracheal wall injury and tracheoesophageal fistula. To address these fibreoptic bronchoscope (FOB) guided PCT was introduced. We aimed to compare both these methods. Patients & Methods: We compared 60 age & sex matched patients into two groups of 30 each. In group 1 tracheostomy was performed by the conventional Ciaglia's method. In group 2, a fibreoptic bronchoscope was used in addition with the aid of an assistant. Results: The fiberoptic method took more time than the conventional method. (18±3min vs 15±2min (p=0.001)). The average no. of attempts at insertion of needle was 2.4 in group 1 and 1.2 in group 2 (p=0.001). The fall in SpO2 to <90% was seen in 1 patient in group 1 and in 6 patients in group 2, so much so that the procedure had to be abandoned in 2 patients. Conclusion: FOB though definitely advantageous over CPCT in terms of lesser complications and being highly useful in the obese, short necked, and those with scar marks, is not without drawbacks such as requirement of additional staff and increased expenditure. The main being inability to be used in patients with low respiratory reserve. Overall it would be complimentary for any ICU to have FOB facility and must be used in select group of patients.
Non-conventional emergency airway management
(Universidade de Sao Paulo, 2010) Lal Dhar Mishra; Surya Kumar Dubey; Ankit Agarwal; Sujit Kumar Pradhan
[No abstract available]
Nonconventional way of securing endotracheal tube in bearded individuals
(2011) Ankit Agarwal; D.K. Singh; C. Dinesh; C. Pradhan
[No abstract available]
Paving the way to environment-friendly greener anesthesia
(Wolters Kluwer Medknow Publications, 2024) Lal Dhar Mishra; Ankit Agarwal; Atul K. Singh; Kamath Sriganesh
Health-care settings have an important responsibility toward environmental health and safety. The operating room is a major source of environmental pollution within a hospital. Inhalational agents and nitrous oxide are the commonly used gases during general anesthesia for surgeries, especially in the developing world. These greenhouse gases contribute adversely to the environmental health both inside the operating room and in the outside atmosphere. Impact of these anesthetic agents depends on the total consumption, characteristics of individual agents, and gas flows, with higher levels increasing the environmental adverse effects. The inimical impact of nitrous oxide is higher due to its longer atmospheric half-life and potential for destruction of the ozone layer. Anesthesiologist of today has a choice in the selection of anesthetic agents. Prudent decisions will help in mitigating environmental pollution and contributing positively to a greener planet. Therefore, a shift from inhalational to intravenous-based technique will reduce the carbon footprint of anesthetic agents and their impact on global climate. Propofol forms the mainstay of intravenous anesthesia technique and is a proven drug for anesthetic induction and maintenance. Anesthesiologists should appreciate growing concerns about the role of inhalational anesthetics on the environment and join the cause of environmental responsibility. In this narrative review, we revisit the pharmacological and pharmacokinetic considerations, clinical uses, and discuss the merits of propofol-based intravenous anesthesia over inhalational anesthesia in terms of environmental effects. Increased awareness about the environmental impact and adoption of newer, versatile, and user-friendly modalities of intravenous anesthesia administration will pave the way for greener anesthesia practice. © 2023 Journal of Anaesthesiology Clinical Pharmacology.
Ropivacaine- the latest local anaesthetic in the indian market
(2010) Ankit Agarwal; R.K. Verma; Shivika Srivastava
[No abstract available]
Simulators in anaesthesia and healthcare
(College of Anaesthesiologists of Sri Lanka, 2010) Ankit Agarwal; D.K. Singh; L.D. Mishra
[No abstract available]
The future of anaesthesiology
(2012) Ankit Agarwal
There was an era when bark of mandrake plant, boiled in wine was used to administer anesthesia. Ether, after reigning the kingdom of anaesthesiology for more than a century, came to be superseded by newer and newer agents. Anaesthesiology has witnessed tremendous developments since infancy. The introduction of advanced airway adjuncts, labour analgesia, patient controlled analgesia, fbreoptics, Bispectral Index monitors, workstations, simulators and robotic surgeries are only to name a further few. Anaesthesia for robotic surgery received much impetus and is still a dream to come true in many countries. But then, the rapid spin in technology and fast sophistication of medical feld has even surpassed this. The next event to venture is entry of robots into human body made possible by a culmination of intricate medicine and fne technology that is Nanotechnology. This article briefy introduces the feld of nanotechnology in relation to its potential benefts to the feld of anaesthesiology. As with any new tecnique or application, nanotechnology as applied to anaesthesiology has tremendous potential for research and exploration. This article therefore orients the reader's mind towards the immense potential and benefts that can be tapped by carrying out further studies and experimentations.The literature was searched using databases, peer reviewed journals and books for over a period of one year (till December 2011). The search was carried out using keywords as nanotechnology, robotics, anesthesiology etc. Initially a master database was formed including human as well as animal studies. Later on the broad topic area was narrowed down to developments in nanotechnology as applied to anesthesiology. Further filtering of search results were done based on selection of researches and developments relating to local, regional and general anesthesia as well as critical care and pain and palliative care.
Ultrasonography: A novel approach to central venous cannulation
(Wolters Kluwer Medknow Publications, 2009) Ankit Agarwal; Dinesh Singh; Anil Singh
Background: Portable ultrasound machines are highly valuable in ICUs, where a patient′s condition might not permit shifting the patient to the USG department for imaging. Traditionally central lines are put blindly using anatomical landmarks, which often result in complications such as difficulty in access, misplaced lines, pneumothorax, bleeding from inadvertent arterial punctures, etc. Ultrasonography provides "real time" imaging, i.e., the needle can be visualized entering the vein. Aims: We performed a study to compare USG guided central venous cannulation (CVC) and conventional anatomical landmark approach to CVC, in terms of ease of cannulation, time consumed, and associated complications. Settings and Design: The study was performed in a 16-bed open ICU. Eighty patients were randomly divided in two groups. Materials and Methods: The right internal jugular vein (IJV) was cannulated in all. In Group I, a portable ultrasound machine was used during cannulation. The vessels were visualized in the transverse section with the internal carotid artery (ICA) identified as a circular pulsatile structure, while the IJV as a lateral, oval nonpulsatile structure). The needle was inserted perpendicular to the skin under visualization on the US screen. Central venous line was then inserted by the Seldinger technique. In Group II, CVC was performed by the conventional landmark approach. The parameters studied included time for insertion, attempts required, and complications encountered. Statistical Analysis: The database of all parameters was analyzed using SPSS software version 10.5. Results: The mean time to successful insertion was 145 and 176.4 sec in groups I and II, respectively (p = 0.00). An average of 1.2 attempts per cannulation was required for group I, while 1.53 for group II (p = 0.03): 10% witnessed arterial puncture and 2.5% pneumothorax in group I and none in group II. Conclusion: USG-guided CVC is thus easier, quicker, and safer than landmark approach.