Journal of Anaesthesiology Clinical Pharmacology, 2011
Patients with genetic disorders associated with multiple congenital anomalies present unique chal... more Patients with genetic disorders associated with multiple congenital anomalies present unique challenges to the anesthesiologist. We report the successful perioperative management of a child with biliary atresia, situs inversus totalis, and Kartegener syndrome scheduled for corrective biliary surgery. We recommend that patients with multiple congenital anomalies need to be thoroughly and cautiously evaluated. The perioperative management should be individualized based on associated anomalies along with appropriate monitoring.
We describe for the first time, the perioperative care of a patient with a rare combination of Ei... more We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
This is an open access journal, and articles are distributed under the terms of the Creative Comm... more This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Physicians, health care workers, members of the clergy, and laypeople throughout the world have a... more Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her brain is dead. Although the widespread use of mechanical ventilators and other advanced critical care services have transformed the course of terminal neurologic disorders. Vital functions can now be maintained artificially for a long period of time after the brain has ceased to function. There is a need to diagnose brain death with utmost accuracy and urgency because of an increased awareness amongst the masses for an early diagnosis of brain death and the requirements of organ retrieval for transplantation. Physicians need not be, or consult with, a neurologist or neurosurgeon in order to determine brain death. The purpose of this review article is to provide health care providers in India with requirements for determining brain death, increase knowledge amongst health care practitioners about the clinical evaluation of brain death, a...
The diagnosis of ventilator-associated pneumonia (VAP) is a challenge because the clinical signs ... more The diagnosis of ventilator-associated pneumonia (VAP) is a challenge because the clinical signs and symptoms lack both sensitivity and specificity. Further confirmation of the diagnosis of VAP can be done by other diagnostic procedures such as bronchoscopic and blind endotracheal aspiration, but the selection of either diagnostic procedure is debatable. The aim is to study and compare the role of bronchoscopic protected specimen brush biopsy (PSBB) and blind endotracheal aspiration for diagnosis of VAP. This prospective comparative study was conducted in multidisciplinary Intensive Care Unit of a tertiary care hospital. Thirty patients clinically diagnosed to have VAP were further evaluated by bronchoscopic and blind endotracheal aspiration. The value of PSBB and blind aspiration techniques was calculated, taking clinical pulmonary infection score of ≥6 as reference standard. Statistical analysis was done using Chi-square and -test. Our study shows that for the diagnosis of VAP, PS...
Journal of Neuroanaesthesiology and Critical Care, 2015
Cardiogenic oscillation during mechanical ventilation can auto-trigger the ventilator resembling ... more Cardiogenic oscillation during mechanical ventilation can auto-trigger the ventilator resembling patient initiated breadth. This gives a false sense of intact respiratory drive and determination brain death, even if other tests are positive, is not appropriate in such a situation. It will prolong the ICU stay and confound the brain-death determination. In this case report, we describe a 35 year old man who was brought to the hospital after many hours of critical delay following multiple gun shot injuries. The patient suffered a cardiac arrest while on the way from another hospital. After an emergency laparotomy, patient was shifted to Intensive Care Unit (ICU) with Glasgow Coma Scale (GCS) score of E1VTM1 and was mechanically ventilated. Despite absence of brainstem reflexes, the ventilator continued to be triggered on continuous positive airway pressure (CPAP) mode and the patient maintained normal oxygen saturation and acceptable levels of carbon dioxide. An apnoea test confirmed ...
... Correspondence: Dr. Ajay Kumar Goila, E-mail: ajaygo/at/ndf.vsnl.net.in. This is an open-acce... more ... Correspondence: Dr. Ajay Kumar Goila, E-mail: ajaygo/at/ndf.vsnl.net.in. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original ...
We describe for the first time, the perioperative care of a patient with a rare combination of Ei... more We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
Journal of Anaesthesiology Clinical Pharmacology, 2011
Patients with genetic disorders associated with multiple congenital anomalies present unique chal... more Patients with genetic disorders associated with multiple congenital anomalies present unique challenges to the anesthesiologist. We report the successful perioperative management of a child with biliary atresia, situs inversus totalis, and Kartegener syndrome scheduled for corrective biliary surgery. We recommend that patients with multiple congenital anomalies need to be thoroughly and cautiously evaluated. The perioperative management should be individualized based on associated anomalies along with appropriate monitoring.
We describe for the first time, the perioperative care of a patient with a rare combination of Ei... more We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
This is an open access journal, and articles are distributed under the terms of the Creative Comm... more This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Physicians, health care workers, members of the clergy, and laypeople throughout the world have a... more Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her brain is dead. Although the widespread use of mechanical ventilators and other advanced critical care services have transformed the course of terminal neurologic disorders. Vital functions can now be maintained artificially for a long period of time after the brain has ceased to function. There is a need to diagnose brain death with utmost accuracy and urgency because of an increased awareness amongst the masses for an early diagnosis of brain death and the requirements of organ retrieval for transplantation. Physicians need not be, or consult with, a neurologist or neurosurgeon in order to determine brain death. The purpose of this review article is to provide health care providers in India with requirements for determining brain death, increase knowledge amongst health care practitioners about the clinical evaluation of brain death, a...
The diagnosis of ventilator-associated pneumonia (VAP) is a challenge because the clinical signs ... more The diagnosis of ventilator-associated pneumonia (VAP) is a challenge because the clinical signs and symptoms lack both sensitivity and specificity. Further confirmation of the diagnosis of VAP can be done by other diagnostic procedures such as bronchoscopic and blind endotracheal aspiration, but the selection of either diagnostic procedure is debatable. The aim is to study and compare the role of bronchoscopic protected specimen brush biopsy (PSBB) and blind endotracheal aspiration for diagnosis of VAP. This prospective comparative study was conducted in multidisciplinary Intensive Care Unit of a tertiary care hospital. Thirty patients clinically diagnosed to have VAP were further evaluated by bronchoscopic and blind endotracheal aspiration. The value of PSBB and blind aspiration techniques was calculated, taking clinical pulmonary infection score of ≥6 as reference standard. Statistical analysis was done using Chi-square and -test. Our study shows that for the diagnosis of VAP, PS...
Journal of Neuroanaesthesiology and Critical Care, 2015
Cardiogenic oscillation during mechanical ventilation can auto-trigger the ventilator resembling ... more Cardiogenic oscillation during mechanical ventilation can auto-trigger the ventilator resembling patient initiated breadth. This gives a false sense of intact respiratory drive and determination brain death, even if other tests are positive, is not appropriate in such a situation. It will prolong the ICU stay and confound the brain-death determination. In this case report, we describe a 35 year old man who was brought to the hospital after many hours of critical delay following multiple gun shot injuries. The patient suffered a cardiac arrest while on the way from another hospital. After an emergency laparotomy, patient was shifted to Intensive Care Unit (ICU) with Glasgow Coma Scale (GCS) score of E1VTM1 and was mechanically ventilated. Despite absence of brainstem reflexes, the ventilator continued to be triggered on continuous positive airway pressure (CPAP) mode and the patient maintained normal oxygen saturation and acceptable levels of carbon dioxide. An apnoea test confirmed ...
... Correspondence: Dr. Ajay Kumar Goila, E-mail: ajaygo/at/ndf.vsnl.net.in. This is an open-acce... more ... Correspondence: Dr. Ajay Kumar Goila, E-mail: ajaygo/at/ndf.vsnl.net.in. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original ...
We describe for the first time, the perioperative care of a patient with a rare combination of Ei... more We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
Uploads
Papers by Ajay Goila