Browsing by Author "Singh, Yashpal"

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    Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery
    (Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2022) Singh, Yashpal; Yadav, Adarsh Kumar; Bajpai, Vijeta; Diwedi, Priyanka; Verma, Shekhar; Verma, Ravi Kumar
    Background & Objective: Hyperbaric bupivacaine is the most commonly used local anesthetic for spinal anesthesia, alone or in combination with various adjuvants. Opioids are frequently used for their rapid onset and intense block characteristics. Fentanyl is the preferred intrathecal opioids with rapid onset of action but has a shorter duration of action. Buprenorphine is a mixed agonist-antagonist with high affinity at both mu and kappa opioid receptors. We compared administration of buprenorphine with fentanyl as adjuvants with intrathecal hyperbaric bupivacaine in gynecological surgeries. Methodology: After Institutional Ethical Committee approval and written informed consent, 60 patients aged 18-65 y, scheduled for lower abdominal gynecological surgery, were divided into two equal groups; Group F to receive 0.5% hyperbaric bupivacaine 2.5 ml with fentanyl 25 ?g intrathecal and Group B to receive 0.5% hyperbaric bupivacaine 2.5 ml with buprenorphine 75 ?g intrathecal. Block characteristics and associated side effects were compared between two groups. The data was analyzed using Chi square test and Fisher's exact test. For comparing two group of mean, independent student's t test was used. P-value < 0.05 was considered as statistically significant. Results: The mean onset of sensory and motor block was significantly earlier in Group F than Group B (p < 0.001). Mean duration of sensory block was significantly prolonged in Group B compared to Group F (p < 0.05). Whereas, the duration of motor was comparable in both of the groups (p > 0.05). Duration of analgesia was significantly prolonged in Group B than Group F (p < 0.001). Conclusion: We conclude that when a longer duration of postoperative pain relief is needed, buprenorphine can be a suitable drug to be used with intrathecal hyperbaric bupivacaine for gynecological surgeries because of prolonged duration of action. � 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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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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    Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials
    (Elsevier Editora Ltda, 2023) Bajpai, Vijeta; Patel, Tejas K.; Dwivedi, Priyanka; Bajpai, Amrita; Gupta, Astha; Gangwar, Pradeepika; Singh, Yashpal; Agarwal, Richa; Kishore, Surekha
    Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02?208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55?185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25?238.58; I2 = 99%; GRADE approach evidence- high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60?2.41; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63?10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than clonidine. � 2022 Sociedade Brasileira de Anestesiologia
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    Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials; [Efficacit� et innocuit� de la k�tamine intranasale compar�e � la dexm�d�tomidine intranasale comme pr�m�dication avant une anesth�sie g�n�rale chez les patients p�diatriques : revue syst�matique et m�ta-analyse d��tudes randomis�es contr�l�es]
    (Springer, 2022) Dwivedi, Priyanka; Patel, Tejas K.; Bajpai, Vijeta; Singh, Yashpal; Tripathi, Alka; Kishore, Suerkha
    Purpose: To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures. Source: We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle�Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach. Principal findings: Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group. Conclusion: The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles. Study registration: PROSPERO (CRD42021262516); registered 22 July 2021. � 2022, Canadian Anesthesiologists' Society.
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    Scientific characterization methods for better utilization of cattle dung and urine: a concise review
    (Springer Science and Business Media B.V., 2023) Singh, Yashpal; Rani, Jyoti; Kushwaha, Jeetesh; Priyadarsini, Madhumita; Pandey, Kailash Pati; Sheth, Pratik N.; Yadav, Sushil Kumar; Mahesh, M.S.; Dhoble, Abhishek S.
    Cattle are usually raised for food, manure, leather, therapeutic, and draught purposes. Biowastes from cattle, such as dung and urine, harbor a diverse group of crucial compounds, metabolites/chemicals, and microorganisms that may benefit humans for agriculture, nutrition, therapeutics, industrial, and other utility products. Several bioactive compounds have been identified in cattle dung and urine, which possess unique properties and may vary based on agro-climatic zones and feeding practices. Therefore, cattle dung and urine have great significance, and a balanced nutritional diet may be a key to improved quality of these products/by-products. This review primarily focuses on the scientific aspects of biochemical and microbial characterization of cattle biowastes. Various methods including genomics for analyzing cattle dung and gas chromatography-mass spectroscopy for cattle urine have been reviewed. The presented information might open doors for the further characterization of cattle resources for heterogeneous applications in the production of utility items and addressing research gaps. Graphical Abstract: Methods for cattle�s dung and urine characterization [Figure not available: see fulltext.] � 2023, The Author(s), under exclusive licence to Springer Nature B.V.
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    Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials
    (Elsevier Editora Ltda, 2023) Dwivedi, Priyanka; Singh, Pratibha; Patel, Tejas K.; Bajpai, Vijeta; Kabi, Ankita; Singh, Yashpal; Sharma, Santosh; Kishore, Surekha
    Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with �very low� to �moderate� quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707. � 2023 Sociedade Brasileira de Anestesiologia