Browsing by Author "Shashi Prakash"

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A case report on anaesthetic challenges in Patau syndrome: Navigating craniofacial and cardiac defects
(IP Innovative Publication Pvt. Ltd., 2023) Abha Singh; Pragya Shukla; Amrita Rath; Shashi Prakash; Sanjay Bhaskar
The anaesthetic management of paediatric patients with Patau syndrome presents unique challenges, particularly when combined with craniofacial and cardiac defects and limited airway resources. This case report highlights our experience in managing a syndromic child with a difficult airway in a resource-constrained environment. The inability to secure the airway adequately can pose significant perioperative risks. In this case, we successfully utilized an oesophageal bougie as an alternative technique to secure the airway. This report emphasizes the importance of adapting to limited resources and employing innovative approaches to ensure optimal patient care in challenging situations. © 2023 Author(s), Published by Innovative Publication.
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.
A comparative study of two methods of nasal tracheal fiberoptic intubation
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2018) Rajesh Kumar Meena; Ronak Rajen Mankodi; Kavita Meena; Dinesh Kumar Singh; Shashi Prakash
Introduction: Conventional fiberoptic intubation in a well anesthetized and prepared airway is found difficult with success rates of around 68%. The difficulty presents in the form of longer duration taken for intubation, coughing and bleeding. This study aimed to compare two facilitated methods designed to reduce time taken, complication rate, ease of insertion and hemodynamic stability. Methodology: After institute ethical committee clearance and a written informed consent, patients were randomly divided into two groups. Both groups were prepared, as per current standards. In Group-A (endotracheal tube group), the endotracheal tube was first inserted till 18 cm mark at the alae of nose. Fiberscope was passed through the tube, and navigated to pass through the true vocal cords and its adequate placement was confirmed. In the other group - Group-B (nasopharyngeal airway group), a spirally split Rusch nasopharyngeal airway of adequate size was warmed, lubricated and inserted in the nasal cavity. Fiberscope was passed through the airway, vocal cords were visualized, and the nasopharyngeal airway was removed before railroading the preloaded tube through the vocal cords and correct placement was confirmed. Time taken to intubate, cough episodes, bleeding and hemodynamic parameters were recorded. Results: The time taken for intubation in Group-A was 79.76 sec as compared to 44.15 sec in Group-B (p < 0.001). The increase in heart rate and mean arterial blood pressure were found to be significantly higher Group-A than those in Group-B. Conclusion: We conclude that split nasopharyngeal airway is better in assisting awake fiberoptic nasal intubation than through the endotracheal tube in terms of less time taken and better hemodynamic parameters. © Anaesthesia, Pain & Intensive Care, 2010-2013.
A Randomized Controlled Trial Comparing the Effect of Two-Time Durations of Balloon Compression During Percutaneous Balloon Compression in Resistant Trigeminal Neuralgia
(American Society of Interventional Pain Physicians, 2024) M. Madivanan; Nimisha Verma; Anil K. Paswan; Shashi Prakash; Arvind Bhaleka
Background: Percutaneous balloon compression of the trigeminal nerve’s gasserian ganglion for the treatment of trigeminal neuralgia is an interventional pain procedure with results comparable to microvascular decompression surgery. The procedure is safe in experienced hands and has less morbidity associated with it. However, there is a lack of clear-cut guidelines about the details of the technique like balloon shape, inflation pressure, and duration of inflation. So, keeping the inflation pressure and shape of the balloon constant, we studied the effect of the duration of inflation of the balloon and its effect on pain relief in refractory trigeminal neuralgia cases. Objectives: To study the outcome with 2 different durations of balloon inflation times in terms of pain relief and complications after percutaneous balloon compression. Study Design: Prospective parallel design randomized, controlled trial. Setting: The study was conducted in a tertiary care hospital in North Eastern India after obtaining approval from the Institutes’ ethics committee (Dean/2018/EC/449). The study was also registered with the Clinical Trials Registry of India (CTRI no. CTRI/2019/03/018166). All patients referred to a pain clinic for unilateral facial pain were screened for the study over 2 years from April 2019 to March 2021. Methods: Forty patients who met the diagnosis of trigeminal neuralgia and who did not respond satisfactorily to medications were included in the study. They underwent routine blood investigations and a magnetic resonance image of the brain to rule out any medical or surgical conditions. Percutaneous balloon compression was conducted under C-arm guidance using a 12 gauge cannula and a 4 Fr Fogarty balloon was used for compressing the gasserian rootlets. Results: Patients who underwent 90 seconds as well as 120 seconds showed good pain relief. The 2 groups did not show any significant difference in pain relief based on the duration of compression. Visual analog scale scores were reduced from 7-8 to 0-3. Masseter muscle weakness was present in 47.5% of patients post-procedure and recovered in all except one patient. Limitations: We have followed up with our patients for a short period of 6 months only. We could not measure the intra-luminal compression pressure of the balloon. Conclusion: There is no difference in the pain relief obtained by the 2 different durations of compressions. A longer duration of compression, however, has more incidence of side effects. © 2024, American Society of Interventional Pain Physicians. All rights reserved.
A randomized, double blind study comparing fentanyl with ketamine for transient chest discomfort/pain during LSCS under spinal anesthesia
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2017) Yashpal Singh; Shashi Prakash; Neeraj Kumar; Atul Kumar Singh; Bikram Kumar Gupta; Ram Badan Singh
Objective: Intraoperative transient chest discomfort/pain is a common problem during lower segment cesarean section (LSCS), incidence ranging from 30-60 %. Only a few drugs are available to treat it due to concerns regarding maternal and fetal safety. Fentanyl is commonly used but has limited or no availability in most of India especially in rural areas. So we planned this study to compare ketamine as alternative to fentanyl to treat this chest discomfort/pain. Methodology: This prospective, randomized, double blind study was carried out on sixty patients aged above 18 years, of American Society of Anesthesiologist (ASA) grade I or II scheduled for elective LSCS under spinal anesthesia, who complained of chest discomfort/pain within 15 min of delivery of baby. The parturients were randomly divided into two groups. Group F to receive inj fentanyl 1 μg/kg and Group K to receive inj ketamine 0.25 mg/kg intravenously immediately after complaining of chest discomfort/pain. Duration of surgery, time of onset of pain, time required to relieve pain, hemodynamic parameters, adverse event and duration of postoperative analgesia were observed. The drugs were compared by using equivalence test; Two-One-Sided-Test (TOST). Results: There was no difference in demographic profile and baseline parameter in both groups. After drug administration chest discomfort/pain was relieved in both groups effectively in 1.15±0.83 min vs. 1.23±0.48 min in Group F and Group K respectively, without any significant adverse event. Conclusion: Low dose ketamine can be used as alternative to fentanyl for transient retrosternal chest discomfort/pain during LSCS.
Anti-voltage-gated potassium channel antibody syndrome: A rare cause of hyponatremia in intensive care unit
(Wolters Kluwer Medknow Publications, 2018) Sulakshana Sulakshana; Shashi Prakash
Hyponatremia causing seizure is a common cause for admission in the critical care unit. Here, we describe a peculiar case of seizure due to hyponatremia, associated with anti-voltage-gated potassium channel antibody syndrome. This case emphasizes that how a proper workup can unveil unusual but potentially treatable causes of hyponatremia. The hallmark of this syndrome is that neurological symptoms may relapse or progress if the disorder is not recognized in time. This case report emphasizes the point that how a keen observation may decode subtle signs of the grave but potentially treatable pathologies. © 2018 Medknow Publications. All rights reserved.
Automated percutaneous lumbar discectomy in > patients suffering from prolapsed intervertebral disc: A prospective study
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2016) Anil K. Paswan; Shalini Gupta; Shashi Prakash; Rajeev K. Dubey; Sandcep Khuba; Virendra Rastogi
Background: A variety of minimally invasive techniques (chemonucleolysis, laser, automated' percutaneous discectomy, percutaneous manual nucleotomy) have been invented over the year as treatment of low hack pain related to disc disease. Automated percutaneous lumbar dissectomy (APLD)| being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal. pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as 'automated' since it involves, a mechanical, probe, working by a 'suction and cutting action for removal of the nucleus pulposus. Methodology: After meeting the inclusion criteria, minimal invasive procedure APLD, pdrformed'in /no between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by,MR1 and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance. Result: Based on patient satisfaction, 72 (60%) patients had excellent pain relief,{75. -100%), 3.4(28.3%) had good pain relief (51-74%) whereas 14 (11.7%) patients had poor pain, relief Two (1.6%)patient developed discitis, which was the only complication and it resolved within fifteen days without sequelae. Conclusion: Percutaneous decompression (APLD) techniques for intervertebral dis hernition are safe and cost-effective techniques with significant and long lasting results concerning pain reduction.and. mobility improvement. They can be proposed as initial treatment or attractive prior to major surgery..
Cardiac tamponade by hydatid pericardial cyst: A rare case report
(Brieflands, 2014) Anil Kumar Paswan; Shashi Prakash; Rajeev K. Dubey
Introduction: Hydatid cysts are most commonly found in the liver and lungs but they are rarely found in pericardium. Case Presentation: We present a rare case of isolated hydatid cyst in pericardium of heart of a 70 year old female presented in casualty with unusual features like, dyspnea, palpitation and chest pain mimicking acute coronary syndrome. Discussion: Hydatid cyst in Pericardium represents only 0.5-2% of cases of systemic echinoccocal infection. Isolated pericardial cyst is very rare in endemic region and may present mimicking acute coronary syndrome. Cardiac hydatid cysts should always be considered in presence of eosinophilia as present like acute coronary syndrome in endemic area. © 2014, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM).
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 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.
Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis
(2013) Ajay K. Khanna; Susanta Meher; Shashi Prakash; Satyendra Kumar Tiwary; Usha Singh; Arvind Srivastava; V.K. Dixit
Background. Multifactorial scorings, radiological scores, and biochemical markers may help in early prediction of severity, pancreatic necrosis, and mortality in patients with acute pancreatitis (AP). Methods. BISAP, APACHE-II, MOSS, and SIRS scores were calculated using data within 24 hrs of admission, whereas Ranson and Glasgow scores after 48 hrs of admission; CTSI was calculated on day 4 whereas IL-6 and CRP values at end of study. Predictive accuracy of scoring systems, sensitivity, specificity, and positive and negative predictive values of various markers in prediction of severe acute pancreatitis, organ failure, pancreatic necrosis, admission to intensive care units and mortality were calculated. Results. Of 72 patients, 31 patients had organ failure and local complication classified as severe acute pancreatitis, 17 had pancreatic necrosis, and 9 died (12.5%). Area under curves for Ranson, Glasgow, MOSS, SIRS, APACHE-II, BISAP, CTSI, IL-6, and CRP in predicting SAP were 0.85, 0.75, 0.73, 0.73, 0.88, 0.80, 0.90, and 0.91, respectively, for pancreatic necrosis 0.70, 0.64, 0.61, 0.61, 0.68, 0.61, 0.75, 0.86, and 0.90, respectively, and for mortality 0.84, 0.83, 0.77, 0.76, 0.86, 0.83, 0.57, 0.80, and 0.75, respectively. Conclusion. CRP and IL-6 have shown a promising result in early detection of severity and pancreatic necrosis whereas APACHE-II and Ranson score in predicting AP related mortality in this study. © 2013 Ajay K. Khanna et al.
Neonatal Epignathus with hypoplastic left heart syndrome: Anaesthetic challenges and peri-operative implications
(Churchill Livingstone, 2023) Amrita Rath; Reena; Khushbu Karoo; Shashi Prakash; Ruchira Nandan
Epignathus is the rare congenital oro-pharyngeal teratoma which can be associated with respiratory or digestive tract obstruction. We are describing a case of 10 days old neonate with epignathus and hypoplastic left heart syndrome, with complains of feeding difficulty and failure to thrive. She was posted for surgical excision under general anesthesia. The major anaesthetic challenges were maintaining intra-operative hemodynamic stability and securing the airway. We used sevoflurane for inhalational induction while maintaining the spontaneous ventilation and intubation was done nasally with gentle direct laryngoscopy, while an assistant was suspending the mass away from airway throughout the airway manipulation. The patency of patent ductus arteriosus was ensured with prostaglandin E1 infusion. Too our knowledge, this is the first case report of anaesthesic management of neonatal epignathus with hypoplastic left heart syndrome. A good patient outcome can be expected with strict adherence to planning, proper technique and utilizing expert's help as early as possible. © 2023 Elsevier Ltd
Penetrating injury of ascending aorta with arrow in situ
(2012) Siddharth Lakhotia; Shashi Prakash; Dinesh Kumar Singh; Ashok Kumar; Debasish Panigrahi
Penetrating injuries of the aorta are rare and highly lethal; very few patients are able to reach the hospital alive. We report a case of penetrating injury into the ascending aorta with the arrow still in situ, shot by a bow in a tribal region of India. The wound of entry into the aorta was sealed by the arrow itself. The patient came to us walking and supporting the arrow with his left hand. He was operated on, and the arrow was successfully removed from the aorta. © 2012 The Society of Thoracic Surgeons.
Sedation with propofol during combined spinal epidural anesthesia: Comparison of dose requirement of propofol with and without BIS monitoring
(2013) R.K. Verma; Anil K. Paswan; Shashi Prakash; Surender K. Gupta; P.K. Gupta
Background: Bispectral (BIS) monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. Sedation has been shown to increase patient satisfaction during regional anesthesia. Propofol is extensively being used as a sedative, providing sedation while patients remain cooperative and can be easily aroused. In this study, we sought to determine whether BIS is a useful adjunctive manoeuvre to reduce the sedative dose of propofol by using BIS. Methodology: Forty patients of ASA grade I and II, weighing between 30 to 60 kg, undergoing elective gynecological surgery of about 60 minutes duration were included in the study, and randomly divided into two groups. All patients received combined spinal epidural anesthesia (CSEA). The patients in Group-P (n=20) received propofol without BIS monitoring and those in Group-PB (n=20), received propofol under BIS monitoring. Total doses of propofol consumed in all patients were calculated and compared using paired t-test. A p-value <0.05 was considered to be significant. Results: The mean total dose of propofol consumed was 130.25 mg ± 46.95 without BIS monitoring (Group-P) compared to 68.49 mg ± 12.59 in patients (Group-PB) in which BIS was used to monitor the desired sedation level (P< 0.001). Mean dose to reach required level of sedation was also reduced (68.35 ± 21.10 vs 29.01 ± 9.45, P< 0.001). Conclusion: Use of BIS during propofol infusion reduces requirement of propofol for sedation during regional anesthesia.
Tensors of the type (0,4) on an almost unified para-norden contact metric manifold
(2010) Shashi Prakash; S.D. Singh
In this paper, we have defined two new manifolds V n* n and V n** n. Some useful algebraic identities for curvature and Ricci curvature have also been obtained in V n** n. Further four curvature tensors of the type (0, 4) defined by Pokhariyal in 1970, 1982 have been studied in V n** n.