Browsing by Author "Bikram Kumar Gupta"

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A randomized, double blind study comparing fentanyl with ketamine for transient chest discomfort/pain during LSCS under spinal anesthesia
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2017) Yashpal Singh; Shashi Prakash; Neeraj Kumar; Atul Kumar Singh; Bikram Kumar Gupta; Ram Badan Singh
Objective: Intraoperative transient chest discomfort/pain is a common problem during lower segment cesarean section (LSCS), incidence ranging from 30-60 %. Only a few drugs are available to treat it due to concerns regarding maternal and fetal safety. Fentanyl is commonly used but has limited or no availability in most of India especially in rural areas. So we planned this study to compare ketamine as alternative to fentanyl to treat this chest discomfort/pain. Methodology: This prospective, randomized, double blind study was carried out on sixty patients aged above 18 years, of American Society of Anesthesiologist (ASA) grade I or II scheduled for elective LSCS under spinal anesthesia, who complained of chest discomfort/pain within 15 min of delivery of baby. The parturients were randomly divided into two groups. Group F to receive inj fentanyl 1 μg/kg and Group K to receive inj ketamine 0.25 mg/kg intravenously immediately after complaining of chest discomfort/pain. Duration of surgery, time of onset of pain, time required to relieve pain, hemodynamic parameters, adverse event and duration of postoperative analgesia were observed. The drugs were compared by using equivalence test; Two-One-Sided-Test (TOST). Results: There was no difference in demographic profile and baseline parameter in both groups. After drug administration chest discomfort/pain was relieved in both groups effectively in 1.15±0.83 min vs. 1.23±0.48 min in Group F and Group K respectively, without any significant adverse event. Conclusion: Low dose ketamine can be used as alternative to fentanyl for transient retrosternal chest discomfort/pain during LSCS.
Comparative evaluation of interscalene and interscalene plus infraclavicular brachial plexus block for elbow surgery using nerve stimulator
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2016) Bikram Kumar Gupta; Ghanshyam Yadav; Neeraj Kumar; Vanita Mhaske; Sarvana Babu; Gyanendra Singh Gautam
Objective: This study was conducted to compare interscalene block and interscalene plus infraclavicular brachial plexus block for elbow surgery using nerve stimulator. Methodology: Sixty male patients, age 20-60 years, ASA physical status I or II, scheduled for above right elbow surgery under brachial plexus block, were included in this prospective, randomized study. Patients were randomly allocated into two groups. Block was performed via the interscalene approach in the Group I and combined approach of interscalene with infraclavicular approach in the Group II, using a peripheral nerve stimulator. Total volume of 0.25% bupivacaine was kept 40 ml in both the groups. Onset and duration of sensory and motor blocks, quality of block and complications were noted. Evaluation of sensory and motor blockade onset were performed every 5 min after needle withdrawal and then up to 30 min. Primary outcome was satisfactory block (in terms of complete block, partial failure of block and complete failure of blocks). All statistical analyses were performed using INSTAT for windows. Continuous variables were tested for normal distribution by the Kolmogorov-Smirnov test. Data was expressed as either mean and standard deviation or numbers and percentages. Demographic data were compared using student's unpaired t test. The monitored and calculated parameters were analyzed using Student's t-Test and x2 test. A p value < 0.05 was considered significant. Results: There was quick onset of sensory (C7-T1 dermatome) and motor block as well as prolonged sensory and motor block was observed in Group II as compared to Group I (P < 0.05). Number of rescue analgesic requirement in Group I was significantly higher than Group II. Incidence of hoarseness of voice was more in Group I. Conclusions: We conclude that combined approach of interscalene and infraclavicular brachial plexus block is clinically and statistically superior as compared to interscalene brachial plexus block alone in elbow surgery.
Dexmedetomidine as an antiepileptic in super refractory status epilepticus
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2019) Bikram Kumar Gupta; Arun Raj Pandey; Shardendu Singh; Madhup Kumar Singh
Refractory and super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency, associated with very high morbidity and mortality. Treatment should be aimed to stop seizure and to avoid cerebral damage and morbidity related to it. The term SRSE is reserved for the patients who continue to have seizures despite the use of general anesthetic agents, or for whom seizures recur when therapy is tapered or withdrawn. A variety of treatment modalities are present, almost entirely based upon open observational studies or case reports. Therapy includes anesthesia, antiepileptic drug therapy, hypothermia, ketogenic diet, other medical, immunological, and physical therapies. In our case the patient’s seizure subsided after starting dexmedetomidine infusion while other antiepileptics had been completely stopped except valproic acid. © 2019 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2022) Shiv Shankar; Bikram Kumar Gupta; Madhup Kumar Singh; Arun Raj Pandey; Vandana Dwivedi; Sumit Sachan
Background & objetives: Laparoscopic procedures are usually followed by postoperative pain of variable intensity. The pain occurs due to streching of the visceral organs and peritoneum. We compared the antinociceptive effect of intraperitoneal instillation of bupivacaine with a combination of bupivacaine and dexmedetomidine in laparoscopic surgery. We assessed the quality of analgesia, time to the first request of rescue analgesia and total analgesics required in the first 24 h. Methodology: After institutional ethical committee approval a total of 162 patients were selected, out of which 81 patients were allocated into two groups using table of randomization. Group B received 0.25 % bupivacaine 50 ml with 5 ml normal saline and Group BD received 0.25 % bupivacaine 50 ml plus dexmedetomidine 1 μg/kg diluted in 5 ml of normal saline intraperitoneally. Results: We found a significant difference between mean VAS scores of the two groups in all time points (p < 0.05). There was significant difference between mean time to the first request for analgesia and the mean total dose for analgesic required (p < 0.05) in between both groups. Conclusion: We conclude that intraperitoneal instillation of dexmedetomidine 1 μg kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and analgesic requirement in postoperative period when compared to bupivacaine 0.25% alone. © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Palatal pressure necrosis due to inappropriate size of guedel’s airway?
(Indian Society of Anaesthetists, 2016) Neeraj Kumar; Bikram Kumar Gupta; Prakash Kumar Dubey; Alok Kumar Bharti
[No abstract available]
Peri-operative management of a neonate with tracheo‑oesophageal fistula and anorectal malformation: Survival of the fittest
(Indian Society of Anaesthetists, 2016) Mridul Dhar; Ram Badan Singh; Bikram Kumar Gupta; Vishal Krishna Pai
[No abstract available]
Position Statement of ISCCM on Intrahospital Transport of Critically Ill Patients
(Jaypee Brothers Medical Publishers (P) Ltd, 2025) Kapil Gangadhar Zirpe; Anand Mohanlal Tiwari; Atul Prabhakar Kulkarni; Deepak Govil; Srinivas Samavedam; Jeetendra Sharma; Subhal Bhalchandra Dixit; Manish Munjal; Sharmili Sinha; Yogendra Pal Singh; Sumalatha Arunachala; Swarna D. Kaurgayala; Shweta Ram Chandankhede; Syed Moied Ahmed; Susruta Bandyopadhyay; Sunil Karanth; Vijay Kumar Mishra; Anand Paikuji Dongre; Bikram Kumar Gupta; Pragyan Kumar Routray; Rajesh Singh Nongthombam; Bharat G. Jagiasi; Pradip Kumar Bhattacharya; Subhash Kumar Todi
Background and purpose: Intrahospital transport (IHT) of critically ill patients is essential for diagnostic and therapeutic indications, requiring thorough assessment and careful preparation of patients, staff, and equipment throughout the process. Variability in practices among hospitals can affect patient safety and may result in adverse events (AEs). This position statement is designed to provide guidance to multidisciplinary critical care teams in the adoption of evidence-based recommendations aimed at mitigating risks and improving safety during patient transport. Method: This position statement has been drafted by an expert committee on IHT constituted by the Indian Society of Critical Care Medicine. The process involved thorough review of literature from electronic database using PubMed services. Recommendations made are tailored with considerations for Indian setting; the units may further modify these as per local needs and equipment and staffing available. The final manuscript was written after achieving consensus among members, and final draft was accepted by all the committee members. Results: This position statement offers a compilation of 38 strategic recommendations, which are comprehensive and deal with all aspects of IHT of the critically ill. Recommendations provided in this document are, therefore, applicable for routine use during the IHT. They cover all phases of transport and answer questions pertaining to pre-, intra-, and post-transport considerations. It will help to achieve uniformity, minimize AEs, and enhance safety. Conclusions: This is a standard set of 38 evidence-based recommendations to ensure safety for IHT, tailored for implementation in various criticalcare settings across India. Science is ever-changing, and periodic review will be needed to keep it up to date with emerging evidence and standards. © The Author(s). 2025.
Role of procalcitonin, interleukin-6 and interleukin-10 as a predictive marker for the use of perioperative steroid in maxillofacial trauma patients
(Churchill Livingstone, 2024) Preeti Tiwari; Rathindra Nath Bera; Nishtha Chauhan; Chandresh Jaiswara; Ragini Srivastava; Bikram Kumar Gupta
Maxillofacial trauma often brings significant challenges for surgeons in terms of preoperative oedema. Steroids offer oedema reduction, yet potentially increase the risks of postoperative infection. This study explores procalcitonin (PCT), as a marker for bacterial infection risk, and interleukins IL-6 and IL-10, which respectively signify pro-inflammatory and anti-inflammatory responses, as potential indicators of infection and inflammation in these trauma cases and thereby aid in refining perioperative guidelines for the use of steroids. A prospective study was conducted at a tertiary public hospital in India from 2019 to 2022 on patients >18 years with facial trauma. After specific exclusions, patients were randomised into steroid (Group A) and non-steroid (Group B) groups. Various parameters including oedema, PCT, IL-6, and IL-10 levels were measured and analysed using SPSS software. Out of 80 patients, 44 were in Group A and 36 in Group B. Post-24 hours, Group A showed significant oedema reduction, with 25 patients displaying a decline to mild oedema, versus 10 patients in Group B (p = 0.034). However, Group A witnessed a higher infection risk, with 20 patients showing positive wound cultures versus three in Group B. Subgroup analysis revealed a link between higher PCT levels and infections (p = 0.039). Additionally, Group A showed less intraoperative bleeding and reduced operating time. While perioperative steroids mitigate swelling, they might increase postoperative infection risk. Elevated PCT levels indicate potential wound infections, suggesting those patients should avoid perioperative steroids. IL-6 and IL-10 trends during perioperative phases can predict pronounced oedema outcomes. © 2024 The British Association of Oral and Maxillofacial Surgeons
The role of levosimendan in acute aluminum phosphide induced myocardial toxicity
(Informatics Publishing Limited and The Society of Toxicology, 2015) Bikram Kumar Gupta; Ghanshyam Yadav; Amiya Kumar Barik; Shailaja Shankar Behera; Dinesh Kumar Singh; Neeraj Kumar
Acute aluminum phosphide poisoning (AAlPP) or celphos is one of the most commonly used poisons for suicidal purpose. Number of cases reported to the hospital represents only the tip of an iceberg. Most of the patients succumb to this poison due to inadequate or lack of treatment. In our case, we added levosimendan to the already established treatment guidelines for AAlPP poisoning and we got surprising result as we could discharge the patient from our Intensive Care Unit in just 2 days with all vitals stable.