Browsing by Author "Gupta, Bikram K."
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Publication A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia(Wolters Kluwer Medknow Publications, 2023) Lodhi, Mehershre; Sulakshana, Sulakshana; Singh, Anil P.; Gupta, Bikram K.Background and Aims: Intraoperative dexmedetomidine infusion decreases the concurrent anaesthetic and analgesic requirement. However, because of slow onset and offset, it is often used with other drugs. Opioids have a depressant effect on the cardiorespiratory system while ketamine has the opposite pharmacodynamics. Hence, it was hypothesised that ketamine will have a better intraoperative haemodynamic profile compared to fentanyl. This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively. Methods: A total of 80 patients (18-60 years) undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5 ?g/kg/h along with intravenous dexmedetomidine 0.5 ?g/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours. Results: Reduction in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-Anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group. Conclusion: Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl. � 2023 Wolters Kluwer Medknow Publications. All rights reserved.Publication A comparative study of sedo-analgesic effect of dexmedetomidine and dexmedetomidine with ketamine in postoperative mechanically ventilated patients(Wolters Kluwer Medknow Publications, 2022) Gupta, Bikram K.; Mhaske, Vanita R.; Pai, Vishal Krishna; Mishra, L.D.Background and Aims: To compare the sedoanalgesic effects of dexmedetomidine alone or with combination of ketamine. Material and Methods: After getting ethical approval and informed patient consent, 60 adult surgical patients, were randomly divided into two groups. Group KD (n = 30); received dexmedotomidine 0.5 ?g/kg/h mixed with ketamine 0.5 mg/kg/h and Group DEX (n = 30); received dexmedotomidine at 0.5 ?g/kg/h infusion only. In both the groups, study drugs were titrated (dexmedetomidine- 0.2-0.7 ?g/kg/h and ketamine 0.2-0.7 mg/kg/h) to achieve target sedation. Hemodynamic variables, pain scores, sedation scores, and patient satisfaction were recorded. Qualitative and Quantitative data were analyzed with Pearson Chi-squared test and analysis of variance test, respectively. All analyses were done by using statistical package for social sciences (SPSS) version 16.0. Results: Pain scores were higher in group DEX than in group KD at 2 h and 4 h which was statistically significant (P < 0.05). At the end of 2 h, sedation scores were higher in group KD than in group DEX and was statistically significant (P < 0.05). Length of intensive care unit stay was almost comparable in both groups, and the time to tracheal extubation was lesser in ketamine-dexmedetomidine group as compared to the dexmedetomidine alone group. However the difference was statistically non-significant. Conclusions: By combining dexmedetomidine with ketamine we observed lower incidence of hypotension and bradycardia. Dexmedetomidine with ketamine combination therapy could be used safely and effectively as sedo-analgesic agent. � 2022 Wolters Kluwer Medknow Publications. All rights reserved.Publication Airway Management in Failure Noninvasive Ventilation in High-Risk Infection(Springer International Publishing, 2023) Gupta, Bikram K.; Mhaske, Vanita R.; Naithani, Bhavya; Bhanuprakash, K.B.The COVID outbreak focused the attention of the medical community globally on highly contagious, aerosol-generating respiratory illnesses which were lurking on the horizon since the past decade but the gargantuan pandemic drew the attention of the entire world in management of respiratory diseases. All medical personnel used every ounce of their knowledge, expertise, and resourcefulness to combat the spread of the disease. In this chapter, we have concentrated our attention toward the discussion of management of airway in the scenario of failed noninvasive ventilation in high-risk infections. Intubation causes 6.6-fold increased risk of infection among healthcare workers (HCWs) which further increases in developing countries due to paucity of resources. The initial experiences on COVID-19-related acute hypoxemic respiratory failure (AHRF) from China or the United States showed higher mortality with invasive mechanical ventilation (IMV), prolonged stay on ventilator (ranging from 10 to 17 days), and longer time to wean (causing shortage of ventilators during surge of patients). Although NIV is not recommended for moderate-to-severe acute respiratory distress syndrome (ARDS), the task force of ERS/ATS led by Rochberg et al. (2016) published clinical practice guidelines for noninvasive ventilation in the setting of acute respiratory failure citing strong recommendations for hypercapnia with COPD exacerbation, cardiogenic pulmonary edema. We explored the effect of noninvasive ventilation in the backdrop of the COVID pandemic with conflicting preliminary reports of the use of NIV in COVID-19 with high failure rate in moderate-to-severe ARDS, the fact that it may improve oxygenation in AHRF, temporarily reduce work of breathing with the disadvantages of no effect on natural disease progression, delay in intubation, and IMV in nonexpert hands, a risk of further worsening of the lung injury, especially with higher tidal volumes generated spontaneously in case of inappropriate settings of NIV. In lieu of this, we discussed monitoring of NIV in AHRF, troubleshooting in NIV applications, approach to discontinuation of NIV, special concerns like potentially difficult airway, infection risk, contamination to healthcare personnel, physiologically deteriorating patient on noninvasive ventilation. � The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2014, 2023. All rights reserved.Publication Endotracheal Intubation in High-Risk Infections(Springer International Publishing, 2023) Gupta, Bikram K.; Tripathi, Sulakshana; Sachan, Sumit; Mhaske, Vanita R.Airway manipulation in high-risk infections poses significant threat to intensivists and anaesthesiologists. Proper precautions at the patient's or the healthcare provider's end with environmental modifications in the intensive care unit or operation theatre design are vital to prevent spread of infections. Pre-oxygenation should avoid positive pressure and cough and gag reflexes should be blunted by medicines before manipulating the airway. Use of personal protective equipment is a must and crash intubation should always be avoided. Airway management should be preferably be done by most experienced of the team and use of video laryngoscopes or video-assisted intubating stylets are suggested to minimise the proximity of airway handler to patient's face. Tube position confirmation should be by end-tidal capnography and auscultation should be avoided. Filters and closed suction should be used. Use of intubation boxes, plastic drapes or tents, negative airflow tents have been described for aerosol containment. All aerosol-generating procedures should ideally be performed in negative pressure (<-5 Pa) isolation rooms having at least 12 air exchanges per hour. Biomedical waste generated during intubation should be optimally disposed. Following proper protocols may help to minimise the chances of airway handler getting infected. However, regular review of protocols based on staff's feedback is vital for continuous quality improvement. � The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2014, 2023. All rights reserved.
