Browsing by Author "Pushkar Ranjan"

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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.
Comparison of dexmedetomidine and fentanyl as adjuvants to intrathecal levobupivacaine in lower segment cesarean section: A prospective, randomized double blind study
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2020) Kapil Rastogi; Alok Kumar Bharti; Yashpal Singh; Pushkar Ranjan
Background: Intrathecal bupivacaine is the most commonly used local anesthetic for lower segment cesarean section (LSCS) but there is constant endeavor for search of a local anesthetic (LA) which has improved safety profile for mother as well as the fetus. So far, many adjuvants like fentanyl, morphine or tramadol etc. have been used to prolong intraoperative anesthesia and postoperative analgesia. But the literature lacks information on the use of dexmedetomidine as adjuvants with isobaric levobupivacaine. So, we planned this study to compare dexmedetomidine and fentanyl added to 0.5% isobaric intrathecal levobupivacaine in spinal anesthesia for LSCS. Methodology: After institutional ethical committee approval and informed written consent, the patients were divided into three equal groups: Group L; to receive 2.5 ml of isobaric levobupivacaine 0.5%, Group LD to receive 2.5 ml of isobaric levobupivacaine and 5 µg dexmedetomidine and Group LF to receive 2.5 ml of isobaric levobupivacaine and 25 µg fentanyl intrathecally. Primary outcome was measured as duration of sensory and motor blockade from the time of intrathecal administered drugs. Statistical analysis was performed by using chi-square test or Fischer's exact test and One-way ANOVA or Kruskal Wallis test as applicable. A p-value of < 0.05 was considered as statistically significant. Results: Duration of sensory and motor blockade was significantly prolonged (p < 0.001) in Group LD as compared to Group LF or L. Onset of sensory and motor blockade was earlier in Group LF as compared to Group LD and L (p < 0.001). Time to first rescue analgesia was prolonged in Group LD than Group LF and L (p < 0.001). Conclusion: Intrathecal dexmedetomidine produces prolonged motor blockade as well as postoperative analgesia than fentanyl when used as an adjuvant to 0.5% isobaric levobupivacaine in elective cesarean section. © 2020 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Comparison of one-handed C-E technique and glass holding technique of mask ventilation in anesthetized, apnoeic paediatric patients
(College of Anaesthesiologists of Sri Lanka, 2019) Rahul Katiyar; Shashi Prakash; Sulakshana Tripathi; Rajesh Meena; Sandeep Loha; Pushkar Ranjan
Background: Successful and effective ventilation using a face mask is very basic, important and critical step in emergency resuscitation as well as in the operating room for preoxygenation of anesthetized apnoeic patients. Mask ventilation requires a good seal and a patent airway. Techniques for face mask ventilation include one-handed techniques and two-handed techniques. One-handed technique can be either classical C-E technique or glass holding technique. We aim to compare two one-handed techniques of mask holding in terms of delivered ventilation, mask leak and ease of performing. Method: All patients fulfilling inclusion and exclusion criteria were included after approval of the institutional ethics committee. After induction of general anaesthesia and confirming apnoea, patients with an odd serial number were first started with one-handed C-E technique then crossed over with glass holding technique while patients having even serial numbers were ventilated first with glass holding technique followed by the one-handed C-E technique. Expiratory tidal volume (VTe) and peak inspiratory pressure (PIP) and ease of ventilation for each breath in one minute were recorded. Results: VTe (mean ± SD) ml, Leak (mean ± SD) ml, PIP (mean ± SD) cmH2O was 94.94±25.22, 21.36±7.97, 18.05±2.99 and 101.78±28.18, 19.78±15.68, 16.52±1.95 for CE and Glass holding technique respectively. There is no significant difference between both the techniques in terms of analysed variables. (p-value > 0.05) Conclusion: Statistical analysis does not support that Glass holding technique is better than C-E technique in respect to studied variables. Still as results were comparable for both the groups, the Glass holding technique is a good alternative to C-E and other techniques of mask ventilation. Glass holding technique is very promising in view of ease of ventilation, decreasing procedural fatigue and reducing incidence and severity of tissue trauma, but further studies are required. © 2019, College of Anaesthesiologists of Sri Lanka. All rights reserved.