Browsing by Author "Mridul Dhar"

Now showing 1 - 7 of 7

A low cost, customised anaesthesia information management system: An evolving process
(Indian Society of Anaesthetists, 2016) Mridul Dhar; Deepak Kumar Sreevastava; Navdeep Singh Lamba
[No abstract available]
A novel manoeuvre in a case of foreign body esophagus: An unusual management of a usual presentation
(Central Society of Egyptian Anaesthesiologists, 2016) Mridul Dhar; Ram Badan Singh; Pushkar Ranjan; Shiv Prasad Sharma; Vishal Krishna Pai
Introduction Although considered to be a safe and uneventful procedure, retrieval of a foreign body from the esophagus can occasionally lead to complications such as perforation, fistula, and mediastinitis, especially with sharp objects such as pins or bones. Milder objects such as coins and marbles are usually managed conservatively but sometimes may require general anaesthesia for retrieval. Although less traumatic to the mucosa, a smooth round foreign body such as a marble is difficult to extract with routine grasping instruments like a Magill forceps. Case We describe a case of an eight year old male child, who presented to the emergency department with history of ingesting a marble, and a novel yet simple manoeuvre, to minimise chances of downward displacement and maximise chances of successful and atraumatic extraction with minimal manipulation of trachea and esophagus. © 2016
A prospective comparative study of arterial blood gas parameters in smoker versus non-smoker patients undergoing laparoscopic cholecystectomy
(Wolters Kluwer Medknow Publications, 2020) Amiya Barik; Ajit Kumar; Mridul Dhar; Pushkar Ranjan
Background and Aims: Smoking is a risk factor for postoperative pulmonary complications in patients undergoing general anaesthesia. These may get amplified with effects of pneumo-peritoneum and carbon dioxide (CO2) insufflation during laparoscopic surgeries. Our aim was to compare metabolic and blood gas analysis of smokers versus non-smoker patients during laparoscopic surgeries under general anaesthesia. Methods: After permission from institutional review board, 60 patients undergoing laparoscopic cholecystectomy were divided into two groups, smokers and non-smokers (30 each). Along with baseline haemo-dynamic parameters, arterial blood gas sampling was done to assess and compare PCO2, pH and bicarbonate (HCO3) values at various time intervals with respect to pneumo-peritoneum creation, between smokers and non smokers. Results: Baseline systolic blood pressure was higher and oxygen saturation was significantly lower in smoker group. PCO2and end-tidal CO2were significantly higher in smokers at all intervals (P < 0.001). pH was significantly lower and HCO3higher, in smokers after creation of pneumo-peritoneum. Increase in PCO2 due to pneumo-peritoneum was higher in the smoker group (3.49 ± 8.5) mmHg versus non smoker (0.56 ± 4.86) mmHg, although statistically not significant. Change in pH and HCO3was similar between smokers and non-smokers. Conclusion: There is a significant difference in baseline arterial blood gas characteristics between smokers and non-smokers. Metabolic effects of CO2insufflation and increased intraabdominal pressure appears to be more enhanced in smokers. © 2020 Indian Journal of Anaesthesia Published by Wolters Kluwer - Medknow.
Neonate with omphalocele and dextrocardia: Anaesthetic goals and challenges
(National Defense Medical Center, 2016) Vishal Krishna Pai; Mridul Dhar; Anil Prasad Singh; Atchya Arun Kumar
Omphalocele and gastroschisis are the two common congenital malformations of the anterior abdominal wall. Omphalocele can be associated with other congenital anomalies such as cardiac anomalies. Association of omphalocele with dextrocardia has been reported in few literatures previously. We describe here such a rare association of omphalocele, dextrocardia with patent ductus arteriosus with a brief review on the anesthetic challenges in the perioperative period. © 2016 Journal of Medical Sciences.
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]
Triple A to triple S: From diagnosis, to anesthetic management of Allgrove syndrome
(Elsevier Inc., 2016) Mridul Dhar; Nimisha Verma; Ram Badan Singh; Vishal Krishna Pai
Introduction Allgrove syndrome (AS) is a rare autosomal recessive disorder characterized by achalasia cardia, alacrimia, and adrenocorticotropic hormone-resistant adrenal insufficiency which is sometimes associated with autonomic dysfunction. It has also been referred to as the triple A syndrome in view of the cardinal symptoms described above. First described by Allgrove et al in 1978, the disorder usually presents mostly during the first decade of life. These patients have the threat of adrenal crisis, shock, and hypoglycemia and are usually on steroid supplementation. Case report The anesthesiologist's encounter with such patients, although rare, is mostly for repair of the achalasia cardia. We thus report a similar case of AS in a 2-year-old girl who was scheduled to undergo Heller myotomy along with the preoperative evaluation and intraoperative management of the same. Conclusion Being aware of the pathophysiology of AS gives useful insight about the disease and successful perioperative management in the form of the triple S strategy, that is, stress dose of steroids, slow induction and positioning, and finally maintenance of stable hemodynamics and euglycemia. © 2016 Elsevier Inc. All rights reserved.
Vaginal delivery in a case of mitral stenosis: Sevoflurane to the rescue
(National Defense Medical Center, 2017) Atchya Arun Kumar; Vishal Krishna Pai; Anil Prasad Singh; Mridul Dhar
Rheumatic heart disease is the most common cardiac disease associated with pregnancy in developing countries. In India, rheumatic mitral stenosis (MS) comprises 88% of heart diseases complicating pregnancy. Despite advances and improved anesthetic techniques, the management of parturients with cardiac valvular pathology can be challenging. Therefore, the anesthesiologist has to be vigilant and meticulous in planning the technique of anesthesia to aid in safe confinement. In this article, we present the anesthetic management of a parturient who presented to our hospital with a medical record of moderate MS, in active labor. We combined a technique most feasible at that moment, with tactful and detailed knowledge of the pathophysiology to guide our anesthetic management and facilitate a normal vaginal delivery. We have tried to highlight how clinically individualized and personalized care with sound pathophysiological knowledge of the patient’s cardiac condition can achieve optimal outcomes, especially when conventional modes and techniques are not feasible. © 2017 Journal of Medical Sciences.