Browsing by Author "Sachan, Sumit"

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    Comparison of normal saline and balanced salt solution as a maintenance fluid on acids-base and electrolyte status in traumatic brain injury patients; a prospective randomized double-blind study
    (Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2022) Shephali; Singh, Yashpal; Mishra, Manjaree; Sachan, Sumit; Pathak, Naman M.; Shankar, Ravi
    Background & objective: Normal saline is the most commonly used fluid in traumatic brain injury (TBI) patients both in resuscitation and maintenance since long time but associated with hyperchloremic metabolic acidosis. Balanced salt solutions (BSS) are recently developed with favorable outcome in resuscitation and intraoperative as a maintenance fluid. We compared normal saline and BSS as maintenance fluids in TBI patients admitted to intensive care unit. Methodology: After institutional ethical committee approval and written informed consent from patients' relatives, 100 patients who meet inclusion criteria were randomly divided into two equal groups; Group NS: to receive normal saline as a maintenance fluids and Group BSS: to receive BSS as a maintenance fluid. Data of serum electrolyte and acid base status were collected on day 1, 3, 5, 7 and 14. Patient outcome was evaluated on day-8. Data was analyzed with appropriate statistical tests. The P < 0.05 indicated that the difference was significant. Results: In both groups pH gradually increased over time and was more alkaline in normal saline group. Base excess was comparable between two groups. In normal saline group, serum sodium and chloride increased gradually and reached on the higher side on day-14, while potassium level dropped to a lower side. Twenty-eight days mortality was more in Group NS than the Group BSS. Conclusion: Balanced salt solution causes lesser alterations in acid base and electrolyte status than the normal saline and is associated with more favorable outcome. � 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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    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.
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    Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study
    (Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2022) Shankar, Shiv; Gupta, Bikram Kumar; Singh, Madhup Kumar; Pandey, Arun Raj; Dwivedi, Vandana; Sachan, Sumit
    Background & objetives: Laparoscopic procedures are usually followed by postoperative pain of variable intensity. The pain occurs due to streching of the visceral organs and peritoneum. We compared the antinociceptive effect of intraperitoneal instillation of bupivacaine with a combination of bupivacaine and dexmedetomidine in laparoscopic surgery. We assessed the quality of analgesia, time to the first request of rescue analgesia and total analgesics required in the first 24 h. Methodology: After institutional ethical committee approval a total of 162 patients were selected, out of which 81 patients were allocated into two groups using table of randomization. Group B received 0.25 % bupivacaine 50 ml with 5 ml normal saline and Group BD received 0.25 % bupivacaine 50 ml plus dexmedetomidine 1 ?g/kg diluted in 5 ml of normal saline intraperitoneally. Results: We found a significant difference between mean VAS scores of the two groups in all time points (p < 0.05). There was significant difference between mean time to the first request for analgesia and the mean total dose for analgesic required (p < 0.05) in between both groups. Conclusion: We conclude that intraperitoneal instillation of dexmedetomidine 1 ?g kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and analgesic requirement in postoperative period when compared to bupivacaine 0.25% alone. � 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.