Browsing by Author "Sandeep Loha"

Now showing 1 - 9 of 9

A 2x1 oral care strategy (2% chlorhexidine + 1% sodium bicarbonate) significantly lowers VAP rates in mechanically ventilated CKD patients
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2025) Subash Sankaralingam; Arvind Bhalekar; Atul Kumar Singh; Sandeep Loha; Sanjeev Kumar; Aditya Prakash Nayak
Background & objective: Chronic kidney disease (CKD) patients in the ICU have elevated ventilator-associated pneumonia (VAP) risk. Chlorhexidine (CHX) oral care is standard, but efficacy may be enhanced by adding sodium bicarbonate (NaHCO₃) to alkalinize the oral environment and inhibit pathogenic colonization. We conducted this study to determine whether combining 2% CHX with 1% NaHCO₃ reduces VAP incidence versus CHX alone in mechanically ventilated CKD patients. Methodology: In this prospective, randomized, double-blind, placebo-controlled trial, 100 CKD patients (18–65 yrs) ventilated > 48 h were randomized to 2% CHX + 1% NaHCO₃ (n = 50) or 2% CHX + saline placebo (n = 50) twice daily for 5 days. Primary outcome: VAP incidence (CPIS ≥ 6 + clinical/radiological criteria). Secondary: oral pH, oropharyngeal colonization, microbiology, ventilation/ICU/hospital stay, mortality. Data analyzed with appropriate parametric/non-parametric tests; P < 0.05 significant. Results: Baseline characteristics were comparable. VAP incidence was halved with combination care (16.0% vs 32.0%; P = 0.048), with delayed onset (median 4.5 vs 3.0 days, P = 0.032) and higher Day-5 VAP-free survival (84% vs 68%). Oral pH rose significantly from Day 3 in the intervention arm (Day 5: 7.54 vs 7.29; P = 0.001). Heavy oral colonization was lower, but non-significant. MDRO rates (37.5% vs 56.3%) and carbapenem resistance were reduced. Ventilation duration (6.2 ± 2.1 vs 7.8 ± 2.5 days, P = 0.004) and ICU stay (8.9 ± 3.0 vs 10.5 ± 3.4 days, P = 0.011) were shorter. However, the mortality differences were non-significant. Conclusions: In high-risk CKD ICU patients, adding 1% NaHCO₃ to standard 2% CHX oral care halved VAP incidence, delayed onset, improved oral pH, reduced resistance rates, and shortened ventilation/ICU stays. This simple, low-cost measure warrants incorporation into VAP prevention bundles. © 2025, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
A comparative study of intraperitoneal ropivacaine and bupivacaine for postoperative analgesia in laparoscopic cholecystectomy: A randomized controlled trial
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2016) Rajesh Kumar Meena; Kavita Meena; Sandeep Loha; Shashi Prakash
Introduction: Laparoscopic cholecystectomy is now the gold standard for treatment of symptomatic gallstones. After this surgery patients suffer visceral and shoulder pain secondary to peritoneal insufflation. Use of intraperitoneal and port site instillation of local anaesthetics has been used to reduce postoperative pain and decreases the need for intravenous opioids. Studies regarding comparison of intraperitoneal use of ropivacaine and buplvacaine to reduce postoperative pain are few. This study compared the efficacy of ropivacaine and bupivacaine in reducing postoperative pain after laparoscopic cholecystectomy. j Methodology: After ethical committee's clearance and informed consent 100 patients with symptomatic cholelithiasis, aged 20-70 years, of either gender, ASA status I to III and within ± 20% of ideal body weight, scheduled for laparoscopic cholecystectomy were included. Patients were randomized into two groups with 50 patients in each group. Group-B: Patients received 0.5% buplvacaine in a dose of 2 mg/kg diluted in normal saline to make a solution of 50 ml. Group-R: Patients received 0.75% ropivacaine in a dose of 2 mg/kg diluted in normal saline to make a solution of 50 ml. Drug was instilled intra-peritoneal through in situ placed infra-umbilical trocar before extubation. NIBP, HR, SpOz, VAS, verbal rating scale (VRS) and rescue analgesia were recorded immediately postoperatively and then regularly every hour for the next 12 hours. Results: HR, SBP and DBP were comparatively lower in Group-R than in Group-B. The VAS score was significantly lower in Group-R from postoperative 5th hr to 12th hr. Rescue analgesia was given when VAS was > 40. VRS score was significantly lower in Group-R from postoperative 7th hr, showing longer duration of analgesia in this group. The rescue analgesia requirement was also less in Group-R. Conclusion: We conclude that the fnstillation of bupivacaine and ropivacaine intraperitonelly is an effective method of postoperative pain relief in laparoscopic cholecystectomy. It provides good analgesia in immediate postoperative period with ropivacaine providing longer duration of analgesia.
Comparative study of two ionotropes levosimendan and dobutamine in critically ill patients suffering from heart failure
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2018) Dharmendra Jain; Sandeep Loha; Dhirendra Chandrakar; Manimoy Debburma; Dinesh Kumar Singh
Objective: Acute heart failure frequently happens in critically ill patients due to myocardial injury, cardiac dysfunction, arrhythmias, and inflammatory mediators. Till now, the outcomes of studies comparing levosimendan with dobutamine for patients requiring inotropic support remain controversial and ambiguous. The present study was aimed to compare the effects of levosimendan and dobutamine in the management of critically ill patients in ICU and establish preference of one over the other drug. Methodology: In this study 100 critically ill patients with clinical diagnosis of heart failure or impending heart failure due to any cause of age between 21 years to 80 years (left ventricular ejection fraction < 35%) in ICU were included and randomly divided into 2 groups; Group-1 (n=50) received inj levosimendan and Group-2 (n=50) which received inj dobutamine. The parameters recorded during study were: heart rate (beats/min), systolic blood pressure (mmHg), stroke volume (ml), cardiac output (l/min), cardiac index (l/min/m2), brain natriuretic peptide (pg/ml), requirement of ionotropic agent and 7 day survival. Baseline parameters of the patient at “0” h was recorded, then the ionotrope (levosimendan or dobutamine) was started. After this the parameters were recorded at 24 h, 48 h and 5th day of study and follow-up of patient was done upto 7 days. SPSS for Windows version 16.0 software was used for statistical analysis. For non-continuous data Chi-square test was used. The mean and standard deviation of the parameters compared using student “t” test. The p < 0.05 was considered as significant. Results: The distribution of patients according to age, sex and body surface area was comparable (p > 0.05) in both the groups. Heart rate decreased significantly in both the groups at 24 h and 5th day, although it remained higher in Group-1 patients receiving levosimendan. Systolic blood pressure and Cardiac Index (CI) increased significantly in both the groups but was more in Group-1 patients receiving levosimendan at all times. Cardiac output increased significantly in Group-1 pts whereas in Group-2, after an initial increase for first 48 hrs ultimately decrease in cardiac output was observed on 5th day. 7 Day survival was more (56%) in Group-1 patients as compared to 52% in Group-2 patients. Conclusion: Based upon the results of our study, we conclude that levosimendan shows better results than dobutamine in maintaining hemodynamic stability in critically ill patients. Larger, multi-center studies may have to be done for confirming or discrediting our results. © 2018 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Comparison of caudal dexmedetomidine and fentanyl combined with bupivacaine in pediatric patients undergoing urogenital surgery
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2017) Umesh Kumar Kannojia; Rajesh Kumar Meena; Anil Kumar Paswan; Kavita Meena; Shashi Prakash; Sandeep Loha
Introduction: Caudal epidural block is one of the most popular, reliable, and safe techniques in pediatric patients that can provide analgesia for a variety of supra- and infra-umblical surgical procedures. This study aimed to compare the efficacy of dexmedetomidine–bupivacaine, fentanyl-bupivacaine mixture and bupivacaine alone on duration of postoperative analgesia, sedation, emergence agitation, duration of sensory and motor block, hemodynamic stability and side effects. Methodology: After approval from ethical committee 90 pediatric patients of age 2-7 y were enrolled. The children were randomly allocated to three equal groups of 30 each using a computer generated randomization list. Group BD (n=30) received 1 µg/kg dexmedetomidine with 0.5 ml/kg bupivacaine 0.25%; Group BF (n=30) received 1 µg/kg fentanyl with 0.5 ml/kg bupivacaine 0.25%, and Group B (n=30) received 0.5 ml/kg of bupivacaine 0.25% for caudal epidural analgesia. Caudal block was given after induction of general anesthesia for urogenital surgery. General anesthesia was maintained with sevoflurane at a concentration adjusted to maintain BIS between 40-60. Hemodynamic parameters, Pediatric Anaesthesia Emergence Delirium (PAED) score, Richmond agitation sedation scale (RASS), and Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) were recorded immediate postoperatively and then regularly every hour for the next 12 hours. Results: PAED score was less in group BD than group B and BF from baseline. RASS Score was less in Group BD than Group BF from base line to 12 h except at 240 min and Group BF is less than Group B from base line to 12 h. Group BD was less than B from base line to 12 h. CHEOP score was less in Group BD than Group BF and Group B from base line to 12 h. Conclusion: Dexmedetomidine (1 µg/kg) added to bupivacaine in caudal block increases the duration of postoperative analgesia, provides arousable sedation, and decreases emergence delirium with stable hemodynamics and minimal side effects in pediatric patients. © 2017, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Comparison of Erector Spinae Plane Block and Serratus Anterior Plane Block for Modified Radical Mastectomy: A Prospective Randomised Study; [Modifiye Radikal Mastektomi Hastalarında Erektör Spina Plan Bloğu ve Serratus Anterior Plan Bloğunun Karşılaştırılması: Prospektif Randomize Çalışma]
(Anestezi Dergisi, 2022) Saurabh Sagar; Sandeep Loha; Anil Paswan; Arvind Pratap; Shashi Prakash; Amrita Rath
Objective: Breast cancer is one of the most commonly diagnosed malignancies among females. In this study, we compared the analgesic efficacy of ultrasound-guided (USG) erector spinae plane block (ESPB) with serratus anterior plane block (SAPB) after modified radical mastectomy (MRM) for unilateral breast cancer. Methods: After obtaining clearance from the institute’s ethical committee, this prospective double-blinded clinical study was conducted from August 2021 to April 2022. Females aged between 18 and 65 years with body mass index ≤30 kg m-2 and ASA I and II who were scheduled for MRM for breast cancer were included in this study. Forty patients were randomly divided into two groups: Group E (USG-ESPB was administered) and Group S (USG-SAPB was administered). Both the groups received 0.4 mL kg-1 of 0.25% bupivacaine. Duration of analgesia of the patients, intra-operative and post-operative hemodynamic changes, intra-operative opioid & post-operative analgesic consumption, Numerical Rating Scale (NRS) pain scores and adverse effects like vascular puncture, hypotension, pleural puncture or pneumothorax or local anaesthetic toxicity were recorded. Results: The mean duration of analgesia was significantly prolonged in Group E as compared to Group S and was statistically significant (p<0.001). The mean NRS score was found to be significantly lower in Group E as compared to Group S at 2,4,8 and 12 hours which was statistically significant (p<0.005). Though the intraoperative opioid requirement was comparable among both groups, the postoperative analgesic consumption was significantly lower in the Group E compared to the Group S (p<0.05). Conclusion: In our study, we concluded that USG-ESPB is superior to USG-SAPB in the post-operative period in patients undergoing unilateral MRM. © 2022 Anestezi Dergisi. All rights reserved.
Comparison of incidence of oculocardiac reflex between hang-back and conventional rectus recession in horizontal strabismus surgery
(IP Innovative Publication Pvt. Ltd., 2020) Meghna Roy; Rajendra P. Maurya; Virendra P. Singh; Mahendra K. Singh; Sandeep Loha; Tej Bali Singh
Purpose: To compare the incidence of oculocardiac reflex(OCR) between hang-back and conventional method of rectus muscle recession in horizontal strabismus. Materials and Methods: In this prospective, randomized, double blind study, 40 consecutive patients of horizontal strabismus were evaluated. The patients were randomized into two groups based on the type of surgical recession technique employed for squint correction. Twenty patients were operated by Hang-back technique (group-1) and 20 by conventional rectus muscle recession where the muscle tendon was sutured directly to the globe (group-2). All patients underwent pre-operative evaluation which included refraction, keratometry and assessment of angle of deviation etc. ECG was monitored before surgery. During surgery heart rate (HR) was recorded as heart rate baseline (HRB), after 5 minutes of intubation (HR5), during muscle traction (HRT), Minimum heart rate during traction of muscle (HRMin), Maximum increase in heart rate (HRMax). OCR was defined as > 20% reduction in HR during muscle traction as compared to baseline HR. Results: Out of total 40 patients 17(42.50%) were having exotropia and 23 (57.50%) had esotropia. The overall incidence of OCR in conventional recession was found to be greater than that in hang-back recession. The mean baseline HR was 72.00± 7.391 beat/min in conventional recession group and 77.55± 7.494 beat/min in hang-back recession group. The mean HR reduction in conventional procedure was 56.05± 8.787 beat/min. and that in hang-back procedure 61.80 ± 9.317 beat/min., which was statistically significant (p<0.001).. This was probably attributed to the shorter duration of surgery and lesser manipulation during surgery in hang-back as compared to conventional procedure. Conclusion: OCR is a common complication encountered during manipulation of muscle during strabismus surgery. Hang-back recession is a safe and effective method of muscle recession as it offers a shorter surgical time and better exposure along with lesser incidence of OCR with similar success rates when compared to conventional muscle recession. © 2020 Innovative Publication, All rights reserved.
Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study
(SAGE Publications Inc., 2023) Chandan Singh; Sanjay Yadav; Sandeep Loha; Shashi Prakash; Anil Kumar Paswan
Study design: Prospective randomized clinical study. Purpose: To compare the effectiveness and safety of intra-articular platelet-rich plasma (PCP) and steroid along with radiofrequency ablation (RFA) in the treatment of chronic low back pain (LBP) due to facet joint arthropathy. Overview of literature: Facet joint pathology is an important cause of LBP—15–30% of all LBP cases. Lumbar intra-articular PRP is a relatively new method in the treatment of LBP. PRP stimulates the cells involved in regeneration. Hence, it seems a suitable option for the treatment of lumbar facet joint syndrome. Methods: We evaluated the efficacy and safety of facet joint injections in LBP secondary to facet joint arthropathy. Chronic LBP for ≥3 months (visual analogue scale (VAS) > 4), failed conservative treatment, no neurological deficit, unilateral facet joint pain, focal tenderness with hyperextension pain, and relief by diagnostic medial branch block were included. Patients were randomly allocated to Group S: Steroid (Triamcinolone) + RFA or Group P: PRP + RFA or Group R: 0.9% saline + RFA as control. Demographic, clinico-radiological, and outcome parameters were recorded till 6 months. Data were analyzed using SPSS and p < 0.05 was considered significant. Results: We studied 45 patients (n = 15 in each group) in the final analysis. Mean age was 45.7 ± 13.6 years and 60% were females in all groups. VAS decreased to 1.6 ± 0.8 (Group S) and 3.2 ± 0.8 (Group P) on day 1 (p < 0.05). At 3 and 6 months, VAS reduced more in Group P (0.47 ± 0.5; 0.07 ± 0.2) versus Group S (2.53 ± 0.5; 3.07 ± 0.2) (p < 0.001). Mean Oswestry Disability Index (ODI) score at baseline was 72.8 ± 7.6 (all groups). At 1 month, Group S (17.2 ± 3.2) showed better improvement than Group P (23.2 ± 3.1) (p < 0.05). At 6 months, Group P (8.9 ± 1.2) had more decrease in ODI than Group S (29.0 ± 2.1) (p < 0.001). NSAIDs usage and Patient Satisfaction Score (PSS) were significantly better at 6 months in Group P than Group S (p < 0.01; p < 0.05, respectively). Conclusion: Both PRP and corticosteroid injections were determined to be effective and safe for the treatment of lumbar facet joint syndrome after 6 months of follow-up. However, autologous PRP may be a superior treatment option for longer efficacy. © The Author(s) 2023.
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.
The effect of alkalinization of oral cavity by sodium bicarbonate mouth wash to decrease ventilator-associated pneumonia in traumatic brain injury patients: A prospective randomized controlled study
(Churchill Livingstone, 2022) Sandeep Loha; Suresh Kumar; Reena; Ghanshyam Yadav; Abhinay Jayanthi; Amrita Rath; Tuhina Banerjee; Ravi Shankar Yadav
Background: Traumatic brain injury is the leading cause of death and disability among trauma patients. They are often in need of mechanical ventilation and intensive care. Due to the lower immunity secondary to trauma, they acquire nosocomial infections quickly. Of them, ventilator-associated pneumonia (VAP) is very common. The microaspiration of the oral secretions containing the pathologic flora results in VAP. So, oral hygiene is of paramount importance. Various mouthwashes and rinses are available and are commonly used. We planned to compare the effectiveness of alkalization of oral cavity with 0.9% sodium bicarbonate on the incidence of VAP. Methods: After obtaining ethical committee clearance (IRB/Dean/2019/EC/1783) and written informed consent of the patient's attendants, one hundred eleven patients were randomized into two groups. Group CCC received 2% chlorhexidine mouth wash thrice daily whereas group CCS received 0.9% sodium bicarbonate oral rinse once with 2% chlorhexidine mouth wash twice daily. Our primary outcome was the incidence of VAP using the Clinical Pulmonary Infection Score (CPIS) from day one to day five. Comparison of Quantitative bacterial load and oral pH on day 1, day 3 and day 5 was our secondary outcome. Results: There was no statistical difference in the incidence of VAP among both groups from day one to day five (p > 0.05). We didn't find any difference in quantitative bacterial load among both groups on days one, three and five (p > 0.05). There was a statistical difference among both groups on oral pH on day three and day five with group CCS having higher oral pH than group CCC. (p = 0.03 on day 3 and 0.01 on day 5). Conclusion: The alkalization of oral cavity with 0.9% sodium bicarbonate oral rinse along with 2% chlorhexidine mouth wash lowered the incidence of VAP as compared to 2% chlorhexidine mouth wash alone but the difference was not statistically significant. © 2022 Elsevier Ltd