Browsing by Author "Ghanshyam Yadav"

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A modification in the tube guide to facilitate retrograde intubation: A prospective, randomised trial
(2011) Gaurav Jain; Dinesh K Singh; Ghanshyam Yadav; Surender K Gupta; Santosh Tharwani
Background: The technique of anterograde over a retrograde guide is considered to be more reliable and preferable in comparison to only retrograde one, for improving the success rate of retrograde intubation. As the prior technique requires a lengthy guidewire to negotiate the whole channel of a tube guide, we designed a side eye at one end of tube guide, which obviated the above requirement while maintaining the integrity of the whole channel assembly. The efficacy of this modified technique was compared with the conventional one for retrograde intubation procedure. Methods: In a prospective, randomised fashion, 98 cases posted for surgery of carcinoma buccal mucosa were included in this trial. These cases were randomised to the conventional (Group I) or the modified technique (Group II) for retrograde intubation. Intubation time (first attempt), total number of successful intubations, cause of failures and any associated side effects were recorded and compared between the groups. Results: The total number of successful intubations were significantly higher in group II (95.83%, 46/48 cases) as compared to group I (66.66%, 31/48 cases) (P<0.001). Mean intubation time was 118±22 second in group I versus 124±26 second in group II (P=0.39). The side effects did not differ significantly between the groups. Conclusions: Improvising the tube guide resulted in a significant rise in the number of successful intubations through a modified retrograde intubation technique, with no side effects. This should encourage the use of retrograde intubation technique as a first option for difficult airway management. © 2011.
A prospective, randomized, double blind and placebo-control study comparing the additive effect of oral midazolam and clonidine for postoperative nausea and vomiting prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystecomy
(2013) Ghanshyam Yadav; Biranchi Narayan Pratihary; Gaurav Jain; Anil Kumar Paswan; Lal Dhar Mishra
Background: Reduction of postoperative nausea and vomiting (PONV) continues to be a major challenge in perioperative care in spite of introduction of newer antiemetics with better efficacy and safety profiles. Therefore, we evaluated the additive effect of oral midazolam and clonidine for PONV prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystectomy. Materials and Methods: In a prospective, randomized fashion, 120 selected cases were randomized into three groups: I, II or III to receive a tablet of midazolam (15 mg, n = 36), clonidine (150 mcg, n = 40), or glucose as placebo (5 g, n = 44) orally, 1 h before anesthesia. Occurrence of PONV along with need for rescue antiemetic during the first postoperative day was compared between groups as a primary outcome. Results: Episodes of PONV reduced significantly in Group II (15%) as compared to group I and III (22.2%, 59%) at various time points during the period of observation (P = 0.002). Need for rescue antiemetic was significantly lower in group I (13.88%) and II (5%) as compared to group III (52.27%, P < 0.001). Conclusion: Oral clonidine is better adjuvant for PONV prophylaxis, as compared to midazolam, in granisetron premedicated patients undergoing laparoscopic cholecystectomy.
Adaptations of carbapenem resistant Acinetobacter baumannii (CRAB) in the hospital environment causing sustained outbreak
(Microbiology Society, 2021) Swati Sharma; Arghya Das; Tuhina Banerjee; Hiranmay Barman; Ghanshyam Yadav; Ashok Kumar
Introduction. Carbapenem resistance in Acinetobacter baumannii (A. baumannii) is an emerging global threat. Gap statement. The adaptation strategies of A. baumannii for this emergence as a nosocomial pathogen has been less studied. Aim. This prospective study analysed a sustained outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) in the intensive care unit (ICU) with reference to antimicrobial resistance and virulence in the colonizing and pathogenic isolates under carbapenem stress. Results. The CRAB isolates from initial and sustained outbreak were found harbouring multiple carbapenemase genes. These genes included blaOXA-23,blaIMP, blaVIM and blaNDM. From NICU environment three phenotypically carbapenem susceptible isolates were found carrying blaOXA-23, blaIMP, blaVIM genes. Prior imipenem therapy was one of the risk factors (P=0.0016). The outbreak was polyclonal. Under imipenem stress, outbreak isolates showed no loss of carbapenemase genes against stress free conditions (23.7±1.33 days). Biofilm formation increased with imipenem concentration, with outbreak isolates producing highest biomass. While the pathogens showed a slow growth rate on imipenem exposure, the colonisers grew rapidly (P <0.0001). Methods. Sustained outbreak of CRAB was identified in the ICU (July 2015 to December 2017). Risk factors for acquisition of CRAB was studied. A. baumannii isolates were also collected from the environments of ICU and neonatal ICU (NICU) and blood cultures of septic neonates. Isolates were characterized based on antimicrobial susceptibility, genetic profile, integrons carriage and clonality. Biofilm formation and growth kinetics were studied under varying carbapenem stress. Conclusion. Intense carbapenem exposure in the ICU facilitates persistence of CRAB by several adaptations causing sustained outbreaks. © 2021 The Authors.
Cancer surgery during COVID increased the patient mortality and the transmission risk to healthcare workers: results from a retrospective cohort study (NCT05240378)
(BioMed Central Ltd, 2022) Kishan Soni; J.F. Neville; Roli Purwar; Tarun Kumar; Ghanshyam Yadav; Nimisha Verma; Manoj Pandey
Background: India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. Method: The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. Results: A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly higher. A total of 71 patients had COVID-19, of which 62 were preoperative and 9 postoperative, while 30/38 healthcare workers contracted COVID-19, of which 7 had the infection twice and 3 were infected after two doses of vaccination; there was no mortality in healthcare workers. Conclusion: The present study demonstrates higher mortality rates after surgery in cancer patients, with no significant change in morbidity rates. A substantial proportion of HCWs were also infected though there was no mortality among this group. The results suggest higher mortality in cancer patients despite following the guidelines and protocols. © 2022, The Author(s).
Challenges during prolonged mechanical ventilation of a morbidly obese lady with hypothyroidism and sleep apnea syndrome
(2013) Saurabh Kumar Das; D.K. Singh; Sujali Choupoo; Ghanshyam Yadav
Obesity, sleep apnea syndrome and hypothyroidism cause management of mechanical ventilation and weaning a difficult task. We report management of mechanical ventilation and subsequent weaning of a morbidly obese lady of BMI 42 kg/m2 with hypothyroidism and sleep apnea for 52 days. To make the matter worse, she had accidental extubations, multiple cardiac arrests, pneumonia and renal dysfunction during her ICU stay.
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.
Comparative study of phenotypic and genotypic expression of virulence factors in colonizing and pathogenic carbapenem resistant Acinetobacter baumannii (CRAB)
(BioMed Central Ltd, 2025) Swati Sharma; Kamal Singh; Ashish Chaurasiya; Banerjee Tuhina; Royana Singh; Ghanshyam Yadav; Ashok Kumar
Abstract: Carbapenem resistant Acinetobacter baumannii has evolved as the most troublesome microorganism with multiple virulence factors. Biofilm formation, porins, micronutrient capturing mechanism and quorum sensing, provide protection against desiccation, host-pathogen killing and enhance its persistence. The conservation of these factors between colonizing and pathogenic carbapenem resistant A. baumannii has been barely investigated. We studied biofilm formation, desiccation survival, motility and hemolysis in pathogenic carbapenem resistant A. baumannii and colonizer carbapenem resistant A. baumannii from the hospital environment. The virulent genes pgaA, csuE, bap, ompA, abaI, pilA and bauA were detected by simplex-PCR and Quantitative Real-Time PCR was done for expressional studies. In-vivo survival percentage was studied by Galleria mellonella (wax moth) killing assay. Phenotypic characterization revealed that the biofilm formation and desiccation survival proportion was significantly higher in colonizer carbapenem resistant A. baumannii (p < 0.05). Twitching motility was found comparable (mean 0.5 to 1.5 cm). Surface associated motility varied widely. None showed hemolysis. The csuE, bap, ompA, abaI, pilA and bauA genes were detected in almost all the pathogenic and colonizer carbapenem resistant A. baumannii isolates while none harboured pgaA gene. The expression of bap, ompA and bauA gene was found significantly higher in pathogenic carbapenem resistant A. baumannii while expression of csuE and abaI gene was comparable in both. Overexpression of pilA gene was seen in those with higher surface associated motility. Pathogenic carbapenem resistant A. baumannii showed significantly higher pathogenicity in-vivo, as 100% of larvae died on 4th day post-infection. In conclusion high level expression of outer membrane proteins (ompA) and siderophores is significantly associated with the pathogenicity in carbapenem resistant A. baumannii isolated from infections, which can be a differentiating point from the colonizers. Clinical Trial: Not Applicable © The Author(s) 2024.
Comparison of sedative efficacy of epidural bupivacaine 0.5% with lignocaine 2% plus adrenaline by measuring BIS guided propofol requirement in gynaecological surgery
(2012) Ghanshyam Yadav; Chandra Sekhar Pradhan; Surendra Kumar Gupta; Gaurav Jain; Sandeep Khuba; Dinesh Kumar Singh
Objectives: This study was conducted to compare the sedative efficacy of bupivacaine 0.5% with lignocaine 2% plus adrenaline in epidural anaesthesia by using BIS monitor. Study design: A randomized, double blind study. Methodology: Sixty patients, ASA physical status I or II, of age group 20-65 yrs, undergoing elective gynaecological surgery under epidural anaesthesia, were randomly but equally placed into two groups (group-B and group-L). Patients received (2ml/segment) bupivacaine 0.5% or lignocaine 2% with adrenaline in group-B and group-L respectively, to achieve a sensory block up to T8 level. After confirmation of sensory blockade, propofol infusion was started at a rate of 100 μg/kg/min to get a BIS value of ≤ 80 and the time was measured (onset time). Surgery was allowed to start immediately after the onset time. Propofol infusion was titrated to maintain the BIS value at 60-80. Infusion was stopped at the end of surgery. The time taken to reach the BIS of ≥90 was recorded as 'recovery time'. The amount of propofol consumed for onset of sedation and total amount consumed during the surgery were noted and compared. Results: There was no significant difference regarding demographic data and onset time in both groups (P>0.05). Recovery time was significantly prolonged in group-B than group-L 5.57+1.25 min and 4.38+0.94 min respectively (P<0.05). Dose of propofol consumed for onset of sedation was significantly low in group-B than group-L, 17.13+4.22 mg vs. 27.77+8.39 mg respectively (P<0.05). Total amount of propofol consumed was also significantly low in group-B than group-L, 140.33+34.59 vs. 184.80+38.21 respectively (P<0.05). Conclusion: We conclude that epidural block with 0.5% bupivacaine is associated with less propofol consumption as compared with 2% lignocaine with adrenaline to maintain BIS 60-80 and hence is more effective.
Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery
(2012) Gaurav Jain; Pranav Bansal; Girdhari L Garg; Dinesh K Singh; Ghanshyam Yadav
Background: To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA) using lignocaine (1%), bupivacaine (0.25%) and ropivacaine (0.5%) for thyroid surgery. Methods: In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications. Results: Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups. Conclusion: We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine.
Correlation of the changing trends of red cell distribution width and serum lactate as a prognostic factor in sepsis and septic shock
(Wolters Kluwer Medknow Publications, 2020) Mukesh Gupta; Ghanshyam Yadav; Yashpal Singh; Arvind Bhalekar
Background and Aims: Various biomarkers are used for predicting outcome from sepsis and septic shock but single value doesn't give clear-cut picture. Changing trends of serum lactate and red cell distribution width (RDW) gives more accurate information of patient outcome. So, aim of this prospective observational study was to identify the correlation, for initial and changing trend of blood lactate level and RDW, with 28-day mortality in sepsis and septic shock. Material and Methods: Patient who fulfills the criteria of sepsis and septic shock, according to the consensus conference published in 2016, were included in this study. All patients were resuscitated and managed according to institutional protocol for sepsis and septic shock. Serum lactate and RDW was obtained from arterial blood gas and complete blood count, respectively. Serum lactate and RDW were recorded at 0 h, 6 h, 24 h, day 2, day 3, day 7, week 2, and week 3. Mean between two groups were compared with student t-test. Pearson and Spearman correlation coefficient was used for establishing correlation between two continuous data. P value < 0.05 indicates significant difference between two groups. Results: There is positive correlation between serum lactate and RDW at all-time point in non-survival group while negative correlation was found in survival group except on day1 and 2. Conclusion: Changing trends of serum lactate and RDW can be used as a prognostic marker in patient of sepsis and septic shock. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
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).
Effect of the perioperative infusion of dexmedetomidine on chronic pain after breast surgery
(2012) Gaurav Jain; Pranav Bansal; Bashir Ahmad; Dinesh Singh; Ghanshyam Yadav
Background: This prospective double-blind trial was undertaken to analyze the role of perioperatively administered dexmedetomidine on the occurrence of chronic pain in cases undergoing surgery for breast cancer. Subjects and Methods: Eighty-six cases were randomly assigned to two groups to receive either dexmedetomidine (2 g/ml) in group D or saline in group C, in a loading dose of 0.5 ml/kg, intravenous (IV), 30 min prior to induction, followed by a continuous infusion of 0.25 ml/kg/h IV till the completion of surgery, and then the dose tapered to 0.1 ml/kg/h for up to 24 h. The standardized questionnaires that measured chronic pain (Brief Pain Inventory, BPI; Short Form McGill Pain Questionnaire, SF-MPQ2) and quality of life (Quality of Life Scale, QOLS) were gathered after 3 months of surgery as a primary outcome. Pain (verbal numerical score, VNS), sedation scores (Ramsay scoring), and analgesic requirements were also assessed for 72 h postoperatively. Results: In total, 84 cases (n=42) were analyzed for acute pain and 69 (34 in group D and 35 in group C) for chronic pain. The consumption of isoflurane/fentanyl intra-operatively and paracetamol postoperatively was significantly lower in Group D. The sedation scores were non-significant between the groups. The VNS at rest and after movement was significantly lower in group D at corresponding times (except at 60 min) throughout the assessment period. The BPI and SF-MPQ2 scores were significantly lower in group D in most of the factors. The QOLS score was significantly better in group D in all items except for relationships, friends, and learning. Conclusion: The perioperative infusion of dexmedetomidine has a pivotal role in attenuating the incidence and severity of chronic pain and improving the quality of life in cases undergoing breast cancer surgery.
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.
Emergence of drug-resistant Klebsiella pneumoniae phylogroups (K. quasipneumoniae and K. variicola) causing human infections
(American Society for Microbiology, 2025) Kajal Mishra; Banerjee Tuhina; Ghanshyam Yadav; Ashok Kumar; Arvind Pratap; Sandhya Chaurasiya; Pue Rakshit
This prospective, cross-sectional study was undertaken to identify the emerging K. pneumoniae phylogeny groups (KpI, KpII, KpIII) and characterize their drug resistance. Phylogeny groups of 150 clinical isolates of biochemically identified K. pneumoniae were detected by targeting their chromosomal class A, β-lactamase genes blaSHV, blaLEN, and blaOKP, respectively, and their flanking gene (deoR). Antimicrobial susceptibility testing was done by disk diffusion and broth microdilution methods and statistically analyzed. Carbapenemases (Classes A, B, and D) were detected by multiplex PCR. Colistin resistance mechanisms to detect alteration in PhoP/PhoQ, pmrAB two-component signaling pathways, and mgrB were done by PCR and sequencing. Of the total, KpI, K. pneumoniae were 93 (62%), KpII, K. quasipneumoniae were 36 (24%), and KpIII, K. variicola were 21 (14%). Carbapenem resistance was in 77 (51.3%); 52 (55.9%), 17 (47.2%), and 8 (38%) in KpI, KpII, and KpIII, respectively. Colistin resistance was in 16 (10.6%), 11 (68.75%) in KpI and 5 (31.25%) in KpIII. K. variicola was resistant to polymyxin B as compared with KpI (P = 0.0008). blaNDM (63, 81.8%) was the commonest. Co-harboring of multiple carbapenemase genes was significant in all the phylogroups (P < 0.001). The majority of the cases of K. variicola were males (P = 0.0139) and in the intensive care unit (P = 0.0091). Several non-synonymous mutations were observed in the colistin-resistant isolates in PhoP and PhoQ genes, with the phylogenetic tree revealing different evolutionary relationships among the isolates. There is considerable emergence of K. quasipneumoniae and K. variicola as prominent human pathogens along with drug resistance, which requires attention. © © 2025 Mishra et al.
Evaluating the role of flupirtine for postcraniotomy pain and compare it with diclofenac sodium: A prospective, randomized, double blind, placebo-controlled study
(2014) Ghanshyam Yadav; Sujali Choupoo; Saurabh K. Das; Susanta K. Das; Shailaja S. Behera; Sandeep Khuba; Lal D. Mishra; Dinesh K. Singh
BACKGROUND:: Patients undergoing craniotomy, experience moderate to severe pain in postoperative period. Flupirtine does not have side effects like sedation and increase postoperative bleeding, so it may be a useful analgesic in neurosurgical patients. We designed this prospective, randomized, double blind, placebo-controlled study to evaluate the role of flupirtine for postcraniotomy pain and compare it with diclofenac sodium. MATERIALS AND METHODS:: A total of 390 adults (18 to 70 y), American Society of Anaesthesiologists I and II, of either sex, undergoing elective craniotomy, were randomly divided into 3 equal groups of 130 each. Group 1 (control) received placebo, group 2 (diclofenac) received tablet diclofenac 50 mg, and group 3 (flupirtine) received capsule flupirtine 100 mg. All medications were given 8 hourly on second postoperative day for 48 hours. Visual Analogue Scale score, level of sedation and incidence of side effects were observed. RESULTS:: Nineteen patients were dropped from the study and therefore subsequent analysis was carried out for 371 patients only. There was significant reduction of Visual Analogue Scale score in flupirtine and diclofenac group when compared to control (P<0.0001). Pain relief observed in control, flupirtine, and diclofenac group was 69.8%, 90.2%, and 90.5%, respectively. Need of rescue analgesia was significantly less in flupirtine and diclofenac group as compared to control (P<0.0001). No significant difference was observed among the groups in regards to adverse effects. CONCLUSION:: We conclude that oral flupirtine 100 mg is safe and as effective as oral diclofenac sodium 50 mg in reducing postcraniotomy pain. © 2013 by Lippincott Williams and Wilkins.
Evaluation of demographic, clinical characteristics and risk factors in patients with persistent hiccups due to traumatic brain injury: A trauma-ICU based study
(IP Innovative Publication Pvt. Ltd., 2024) Manjaree Mishra; Ghanshyam Yadav; Ravi Shankar Prasad; Shashi Prakash Mishra; Ashish Kumar Yadav
Background: Persistent hiccups in neurocritical care patients can lead to negative outcomes, including exhaustion, sleep deprivation, malnutrition, depression, and even death. This study aims to evaluate demographic and clinical characteristics, risk factors, and management in trauma intensive care unit patients. Materials and Methods: This study investigates persistent hiccups in traumatic brain injury (TBI) patients admitted to the Trauma ICU at Banaras Hindu University, Varanasi, from July 2020 to January 2024. The study involved monitoring and recording hiccups during patients’ ICU stays. Exclusion criteria included not participating, having GERD, advanced cancer, spinal cord injury, other CNS pathologies, deranged liver and renal profile, or on drugs causing hiccups, on sedative and neuro-muscular blocking agents. Results: The study involved 59.8% of patients aged <40 years, with a mean age of 41.75±17.16 years. Most patients were male, with a male-to-female ratio of 1.88:1. Road traffic accidents (RTAs) were present in 60.3% of patients, followed by falls from height (17.5%). 75.7% of patients had severe type TBI, while the remaining had moderate type TBI. Out of 189 patients, 86 (45.5%) died and 103 (54.5%) survived. Age was a significant factor in TBI-related persistent hiccups, with severe TBI significantly associated with female gender and ventilator-associated pneumonia and the need for mechanical ventilation. The type of TBI (moderate or severe) and length of ICU stay were also associated with TBI-related persistent hiccups. A strong relationship was observed between severe TBI patients who fall from height and were not responsive to drugs for hiccups compared to moderate TBI. The length of ICU stay was also associated with TBI-related persistent hiccups, with patients with a length of ICU stay of >14 days having a higher risk of hiccups. Conclusion: Severe TBI is linked to female gender, ventilator-associated pneumonia, and mechanical ventilation. The type of TBI and length of ICU stay are also linked to persistent hiccups. Patients with severe TBI who fell from height are less responsive to hiccup drugs. Patients with over 14 days of ICU stay have a higher risk of developing persistent hiccups. © 2024 Author(s).
Extensive outbreak of colistin resistant, carbapenemase (bla OXA-48, bla NDM) producing Klebsiella pneumoniae in a large tertiary care hospital, India
(BioMed Central Ltd, 2022) Swati Sharma; Tuhina Banerjee; Ashok Kumar; Ghanshyam Yadav; Sriparna Basu
Background: Extensive drug resistance in Klebsiella pneumoniae (K. pneumoniae) causing major outbreaks in large hospitals is an emerging challenge. We describe a near fatal outbreak of colistin resistant, carbapenem resistant K. pneumoniae (CRKp) producing metallo beta-lactamases (blaNDM) and blaOXA-48 in the neonatal intensive care unit (NICU) at the background of a larger outbreak involving multiple parts of the hospital and the challenges in its containment. Methods: Following identification of an outbreak due to colistin resistant CRKp between April to June 2017 in the NICU, a thorough surveillance of similar cases and the hospital environment was performed to trace the source. All the isolated K. pneumoniae were tested for susceptibility to standard antibiotics by disc diffusion and microbroth dilution methods. Molecular detection of extended spectrum beta lactamases (ESBLs) and carbapenemases (classes A, B, D) genes was done. Enterobacterial repetitive intergenic consensus (ERIC) PCR and multi-locus sequence typing (MLST) was done to determine the genetic relatedness of the isolates. Characteristics of different sequence types were statistically compared (Student’s t-test). Results: A total of 45 K. pneumoniae isolates were studied from NICU (14 cases of neonatal sepsis), ICU (18 cases), other wards (7 cases) along with 6 isolates from hospital environment and human colonizers. The primary case was identified in the ICU. All the K. pneumoniae from NICU and 94.4% from the ICU were colistin resistant CRKp. Majority (59.37% and 56.25%) harbored blaSHV/blaCTXM and blaOXA-48 genes, respectively. Two distinct sequence types ST5235 and ST5313 were noted with colistin resistance, distribution within the NICU and mortality as significant attributes of ST5235 (p < 0.05). The outbreak was contained with strengthening of the infection control practices and unintended short duration closure of the hospital. Conclusion: Large hospital outbreaks with considerable mortality can be caused by non-dominant clones of colistin resistant CRKp harboring blaOXA-48 and blaNDM carbapenemases in endemic regions. The exact global impact of these sequence types should be further studied to prevent future fatal outbreaks. © 2022, The Author(s).
Macintosh blade entrapment during direct laryngoscopy
(Indian Society of Anaesthetists, 2014) Ghanshyam Yadav; Gaurav Jain
[No abstract available]
Malignant hyperthermia in endosulfan poisoning
(2012) Gaurav Jain; Dinesh K. Singh; Ghanshyam Yadav
We are reporting a case of endosulfan poisoning, admitted in a state of altered consciousness, vomiting, and seizure. The diagnosis was based on history, physical examination and positive reports from toxicological screening. After 8 hrs of admission, a sudden rise in EtCO 2 , respiratory rate, heart rate, blood pressure, and body temperature was noted. Masseter spasm was there and patient's elbow/knees could not be bent upon manipulation. Caffeine halothane contraction test later confirmed it to be malignant hyperthermia (MH). We suggest that if there is a sudden rise in body temperature, stiffness in limbs or massater spasm in a case of endosulfan poisoning, the diagnosis of MH should be considered as one possibility when etiology is not certain.
Medication errors: A matter of serious concern
(2013) Joseph D. Tobias; Ghanshyam Yadav; Surender Kumar Gupta; Gaurav Jain
The incidence of medications errors is increasing and the exact incidence is likely greatly underestimated and under-reported. Although the majority of these errors occur due to lack of knowledge of or failure to follow accepted protocols, look alike medication containers are the primary cause in many cases of drug error related morbidity or even mortality. With the number of drugs and the number of pharmaceutical companies manufacturing the same drug on an increase, the incidence is likely to increase. It is a universal problem that can be found in any operating room throughout the world, as demonstrated by the multi-national representation of many reports on this subject in the literature. This editorial supplements a case report, the 'Clinipics®' page and a special article on the topic of hazards of look-alike drug containers published in this issue of Anaesthsia, Pain & Intensive Care. The authors also attempt to present strategies to reduce these medication errors. The development of a non-blame environment where errors are openly reported and discussed and regulations for labeling the drug containers, vials and ampoules is stressed.