Browsing by Author "Manjaree Mishra"

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An introduction of tertiary peritonitis
(Medknow Publications, 2014) Shashi Prakash Mishra; Satyendra Kumar Tiwary; Manjaree Mishra; Sanjeev Kumar Gupta
Intraperitoneal infection known as peritonitis is a major killer in the practice of clinical surgery. Tertiary peritonitis (TP) may be defined as intra-abdominal infection that persists or recurs 48 h following successful and adequate surgical source control. A planned or on-demand relaparotomy after an initial operation is probably most frequent way to diagnose TP, but is a late event to occur. Hence it is desirable to have timely and nonoperative diagnosis of TP after the initial operation and subsequent initiation of an appropriate therapy to reduce the complications and to improve the outcome.
Clonidine versus nitroglycerin infusion in laparoscopic cholecystectomy
(Society of Laparoendoscopic Surgeons, 2014) Manjaree Mishra; Shashi Prakash Mishra; Sharad Kumar Mathur
Background and Objectives: Laparoscopic surgery offers the advantages of minimally invasive surgery; however, pneumoperitoneum and the patient’s position induce pathophysiological changes that may complicate anesthetic management. We studied the effect of clonidine and nitroglycerin on heart rate and blood pressure, if any, in association with these drugs or the procedure, as well as the effect of these drugs, if any, on end-tidal carbon dioxide pressure and intraocular pressure. Methods: Sixty patients (minimum age of 20 years and maximum age of 65 years, American Society of Anesthesiologists class I or II) undergoing laparoscopic cholecystectomy were randomized into 3 groups and given an infusion of clonidine (group I), nitroglycerin (group II), or normal saline solution (group III) after induction and before creation of pneumoperitoneum. We observed and recorded the following parameters: heart rate, mean arterial blood pressure, end-tidal carbon dioxide pressure, and intraocular pressure. The mean and standard deviation of the parameters studied during the observation period were calculated for the 3 treatment groups and compared by use of analysis of variance tests. Intragroup comparison was performed with the paired t test. The critical value of P, indicating the probability of a significant difference, was taken as _.05 for comparisons. Results: Statistically significant differences in heart rate were observed among the various groups, whereas comparisons of mean arterial pressure, intraocular pressure, and end-tidal carbon dioxide pressure showed statistically significant differences only between groups I and III and between groups II and III. Conclusion: We found clonidine to be more effective than nitroglycerin at preventing changes in hemodynamic parameters and intraocular pressure induced by carbon dioxide insufflation during laparoscopic cholecystectomy. It was also found not to cause hypotension severe enough to stop the infusion and warrant treatment. © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
Comparing semi-recumbent lateral position vs semi-recumbent position in preventing VAP and ARDS in traumatic brain injury patients requiring mechanical ventilation
(Churchill Livingstone, 2024) Neelesh Anand; S.K. Mathur; Manjaree Mishra
Background and aims: Ventilator-associated pneumonia is a common nosocomial infection in the intensive care unit among traumatic brain injury patients, resulting in increased morbidity and mortality. We have assessed the effectiveness of semi-recumbent lateral positioning in comparison with semi-recumbent positioning to prevent ventilator-associated pneumonia and acute respiratory distress syndrome in traumatic brain injury patients requiring mechanical ventilation. Methods: In a single-blind prospective randomised clinical trial, 100 patients were recruited in the intensive care unit and randomly assigned to the control group (n = 50) and intervention group (n = 50). Patients in control group maintained semi-recumbent position with 30–45° head of bed elevation and intervention group maintained semi-recumbent lateral position with lateral turning ≥45° and head of bed elevation 30–45° every 4 h. Bronchoalveolar lavage for diagnosis of ventilator-associated pneumonia, Glasgow Coma Score, clinical pulmonary infection score, duration of mechanical ventilation, PaO2/FiO2 ratio and incidence of acute respiratory distress syndrome were investigated for 10 days. Results: Comparing semi-recumbent position with semi-recumbent lateral position, the latter showed significant decrease in ventilator-associated pneumonia with lower clinical pulmonary infection score at day 3 (6.5 ± 2.9; 1.8 ± 2.1; p < 0.001), day 7 (6.6 ± 2.6; 2.6 ± 2.3; p < 0.001) and day 10 (7.7 ± 2.9; 2.3 ± 2.3; p = 0.001) and decreased incidence of positive bronchoalveolar lavage cultures at day 3 (p = 0.02), day 7 (p < 0.001) and day 10 (p = 0.001). Duration of mechanical ventilation was significantly reduced at day 7 (p = 0.04) and day 10 (p < 0.001). The incidence of acute respiratory distress syndrome was not different. Conclusion: Semi-recumbent lateral position results in significant less incidence of ventilator-associated pneumonia and reduced duration of mechanical ventilation. Trial registration number: ICMR-NIMS CTRI/2019/01/016829. © 2024 Elsevier Ltd
Comparison of normal saline and balanced salt solution as a maintenance fluid on acids-base and electrolyte status in traumatic brain injury patients; a prospective randomized double-blind study
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2022) Shephali; Yashpal Singh; Manjaree Mishra; Sumit Sachan; Naman M. Pathak; Ravi Shankar
Background & objective: Normal saline is the most commonly used fluid in traumatic brain injury (TBI) patients both in resuscitation and maintenance since long time but associated with hyperchloremic metabolic acidosis. Balanced salt solutions (BSS) are recently developed with favorable outcome in resuscitation and intraoperative as a maintenance fluid. We compared normal saline and BSS as maintenance fluids in TBI patients admitted to intensive care unit. Methodology: After institutional ethical committee approval and written informed consent from patients' relatives, 100 patients who meet inclusion criteria were randomly divided into two equal groups; Group NS: to receive normal saline as a maintenance fluids and Group BSS: to receive BSS as a maintenance fluid. Data of serum electrolyte and acid base status were collected on day 1, 3, 5, 7 and 14. Patient outcome was evaluated on day-8. Data was analyzed with appropriate statistical tests. The P < 0.05 indicated that the difference was significant. Results: In both groups pH gradually increased over time and was more alkaline in normal saline group. Base excess was comparable between two groups. In normal saline group, serum sodium and chloride increased gradually and reached on the higher side on day-14, while potassium level dropped to a lower side. Twenty-eight days mortality was more in Group NS than the Group BSS. Conclusion: Balanced salt solution causes lesser alterations in acid base and electrolyte status than the normal saline and is associated with more favorable outcome. © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Efficacy and safety of a generic remifentanil formulation versus fentanyl and Ultiva during general anaesthesia: A phase III, prospective, multi-centric, observer-blind, randomised controlled trial
(Wolters Kluwer Medknow Publications, 2024) Indrani Hemantkumar; Ashok Kumar Swain; Manjaree Mishra; Swati Singh; Challakere Lakshminarain Gurudatt; Janampet Bekkam Giridhar
Background and Aims: Remifentanil and fentanyl are potent opioid analgesics commonly used during surgery due to their distinct pharmacological profiles. This study aimed to compare the efficacy and safety of a generic remifentanil (test drug) with fentanyl and Ultiva (innovator formulation) during general anaesthesia in the Indian population. Methods: This phase III, multi-centre (n = 13), randomised, three-arm, comparative study was conducted from 24 November 2021 to 31 March 2022. Eligible subjects scheduled for elective therapeutic and diagnostic surgical procedures (n = 314) were randomised into generic remifentanil, Ultiva, and fentanyl groups. An independent anaesthetist blinded to treatment allocation assessed efficacy and safety parameters. The primary efficacy endpoint was haemodynamic response during specific activities (endotracheal intubation, skin incision, skin closure, and extubation). Results: The study groups exhibited no significant differences in demographic and baseline characteristics. Heart rate was similar between the remifentanil and Ultiva groups measured during laryngeal intubation, skin incision, skin closure, and extubation (P > 0.05 in all four procedures). Heart rate was significantly higher in the fentanyl group in comparison to the remifentanil group during laryngeal intubation (P = 0.035), skin incision (P = 0.017), skin closure (P = 0.001), and extubation (P = 0.026). The need for vasopressor and anti-cholinergic drugs was similar between groups, and no subject required naloxone administration. Conclusion: Our study's findings demonstrated that generic remifentanil is non-inferior to fentanyl and equivalent to Ultiva for general anaesthesia in Indian patients undergoing various surgical and diagnostic procedures. Remifentanil offers advantages in terms of optimum haemodynamic stability, fast equilibrating analgesia, and rapid emergence from sedation, making it a suitable alternative to fentanyl. © 2024 Indian Journal of Anaesthesia.
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).
Management of traumatic flail chest in intensive care unit: An experience from trauma center ICU
(Wolters Kluwer Medknow Publications, 2019) Shashi Mishra; Manjaree Mishra; Noor Bano; Mohammad Hakim
Background/Aim: The thoracic injury and related complications are responsible for upto 25% of blunt trauma mortality. This study is designed to compare these two popular ventilation modes in traumatic flail chest. Materials and Method: A total of 30 patients with thoracic trauma, aged 18-60 years, were enrolled in this study for a period of 1 year. The Thoracic Trauma Severity Score (TTSS) was used for assessing the severity of chest injury. Patients were divided into two treatment groups: one recieved endotracheal intubation with mechanical ventilation (ET group, n = 15) and another recieved noninvasive ventilation (NIV group, n = 15). All patients were observed for the duration of ventilatory days, complications such as pneumonia and sepsis, length of the stay in ICU, and mortality. Statistical analysis was done using statistical software SPSS for windows (Version 16.0). Results: There were no significant differences in age, sex, weight, and length of the stay in ICU in between the two groups. Rate of complications was significantly higher in ET group. Oxygenation was significantly improved in NIV group within 24 hr, later it become equivalent to the ET group patients while the pCO2level was significantly lower in ET group compared with NIV group. Analgesia in both the groups is maintained to keep the visual analog scale (VAS) score below 2 and was comparable in both the groups. Conclusions: The endotracheal intubation is also associated with serious complications as compared to NIV. The use of NIV in appropriate patients decreases complications, mortality, length of the stay in ICU, the use of resources, and cost. © 2019 Medknow Publications. All rights reserved.
Postoperative Cognitive Dysfunction: A Review
(2024) Neelesh Anand; Reetika Gupta; Shashi Prakash Mishra; Manjaree Mishra
Elderly patients are more vulnerable to cognitive dysfunction in the postoperative period. Patients who are apparently well in cognitive functions in the preoperative period after undergoing anesthesia in noncardiac surgery will develop symptoms of cognitive dysfunction. Postoperative cognitive dysfunction (POCD) doesn't continue for a long duration and usually undergoes self-resolution. Proper definitions and congruous tests for diagnosis are absent. Rigorous preoperative assessment of cognitive function and distinguishing risk factors are indispensable for recognizing the range of POCD and its association with surgery and anesthesia. Recent studies haven't revealed any anesthesia technique or drug which can significantly reduce the incidence of POCD. Therefore, giving accurate information to patients can be challenging.
Transversus abdominis plane block: The new horizon for postoperative analgesia following abdominal surgery
(Central Society of Egyptian Anaesthesiologists, 2016) Manjaree Mishra; Shashi Prakash Mishra
Post operative pain management is the key factor to decide the outcome of the patient. TAP block is relatively newer method for management of postoperative pain after abdominal surgery. Technique involves the injection of local anesthesia into the plane between the internal oblique and transversus abdominis muscle and thus giving pain relief. The technique when performed under ultrasound guidance improves the yield. TAP block provides good analgesia between T10 and L1 level hence very useful for lower abdominal and gynecological procedures. This significantly reduces the analgesic requirement in postoperative period and hence reduces the side effects of analgesics. © 2016 Production and hosting by Elsevier B.V.
Unveiling the molecular mechanisms of hemorrhagic shock and acute lung injury: An integrative RNA-Seq and network analysis
(Elsevier Inc., 2025) Manjaree Mishra; Shivangi Agrawal; Shashi Prakash Mishra; Rajiv Kumar; Katyayani Mishra; Ekta Pathak; Rajeev Kumar Mishra
Acute lung injury (ALI), especially when resulting from trauma-associated hemorrhagic shock (THS), is a life-threatening condition with limited treatment options and high mortality. Understanding the molecular mechanisms driving ALI in this context is essential to identify reliable biomarkers and therapeutic targets. This study aimed to explore the transcriptomic alterations and protein interaction networks in a rat model of THS-induced ALI using RNA sequencing and bioinformatics tools. RNA-seq analysis was performed on lung tissues from five THS-induced and five normal rats. Analysis revealed 1003 differentially expressed genes, including 365 upregulated and 638 downregulated. Functional enrichment pointed to significant involvement of pathways related to oxidative stress, hypoxia response, neutrophil degranulation, ferroptosis, and immune activation. Protein-protein interaction network analysis identified four key gene modules, with Module 3 notably associated with iron metabolism and neutrophilic inflammation. Hub genes such as Cd163, Nqo1, Gclc, Lcn2, and Mmp8 were identified as central regulators and validated in independent samples (three THS-induced and three controls). Lcn2 and cathepsins (CTSS, CTSK, CTSL) emerged as particularly relevant for their multifaceted roles in inflammation, iron homeostasis, and matrix remodeling. These findings provide novel insights into the immunometabolic dysregulation underlying THS-induced ALI and suggest promising molecular targets for future therapeutic interventions aimed at mitigating lung injury in critically injured trauma patients. © 2025