Background and Objective: Various risk factors have been evaluated to predict the mortality assoc... more Background and Objective: Various risk factors have been evaluated to predict the mortality associated with COVID-19. We aim to explore and compare the clinical and laboratory risk factors with various outcomes of the disease between survivors and non-survivors amongst patients with moderate to severe COVID-19 disease. Methods: All COVID-19 adult (≥ 18 years old) ICU in-patients with a definite outcome i.e. either death or discharge were included. The demographic, clinical, laboratory, treatment, and outcome data were retrieved. To explore the association between factors, univariate and multivariate logistic regression were done. Results: A total of 163 patients were included out of which eight patients were shifted to other hospitals. Finally, a total of 145 patients were included in the study. Out of 145, 47 patients didn’t survive and 98 survived. A significant proportion (85%) of non-survivors were current smokers and were observed to have COPD, HT, and CAD as comorbidities when...
Journal of Anaesthesiology Clinical Pharmacology, 2018
Direct laryngoscopy and tracheal intubation is one of the basic and the most important skills in ... more Direct laryngoscopy and tracheal intubation is one of the basic and the most important skills in anesthetic practice. This requires proper positioning of head and neck to adequately visualize the glottis and easily negotiate the tracheal tube through the glottic opening. The position traditionally recommended and taught to all learners of airway management is the “sniffing position” (SP). This involves neck flexion (head elevation) by putting a pillow under the head and then extending the head at atlanto‐occipital joint. The SP is thought to help by allowing the line of vision to fall straight on the laryngeal inlet by aligning oral, pharyngeal, and laryngeal axes. This is the three‐axes alignment theory (TAAT) that describes alignment of pharyngeal and laryngeal axes by flexion of neck and alignment of oral axis with the other two axes by extension of the head.[1]
Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative peri... more Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. Aim: The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. Settings and Design: This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. Patients and Methods: Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. Statistical Analysis: Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. Results: Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). Conclusion: Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS.
Objectives We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting orga... more Objectives We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting organ dysfunctions and mortality in pregnancy associated sepsis (PAS). Methods The study included 85 pregnant, post-abortal, and postpartum women with PAS, diagnosed using the quick Sequential Organ Failure Assessment criteria. Median interquartile range PCT levels were documented at admission and 48 hours later. Statistical comparisons were performed between the groups with non-severe and severe (≥1 organ failure) PAS, and between the survivor and mortality groups. The relationship between PCT and the number of organ failures was also assessed. Results Most of the subjects with PAS were young and in the postpartum period (mean age 26 years; postpartum 55%). Sixteen (19%) patients died due to PAS. Sixty-two patients (74%) had severe PAS at presentation. Bacteria were isolated on culture in 64% of the subjects. PCT levels at admission were higher in patients with severe PAS than in those who did not have severe PAS. At 48 hours, this difference was significant (P=0.014; severe PAS 2.23 ng/mL vs. non-severe PAS 0.20 ng/mL). Furthermore, the number of organ failures increased at 48 hours. The PCT levels were significantly higher in the mortality group than in the survivors' group at admission (8.31 ng/mL vs. 1.72 ng/mL), and the difference increased further at 48 hours (9.54 ng/mL vs. 1.37 ng/mL). Conclusion Repeat PCT estimation at 48 hours could complement the clinical findings and enhance the prognostic value for PAS.
Background and Aims: Regional analgesic techniques are difficult to use in tubercular spine patie... more Background and Aims: Regional analgesic techniques are difficult to use in tubercular spine patients due to distorted spinal anatomy and presence of infection. This study was conducted with the aim to evaluate analgesic efficacy of local wound infiltration before wound closure in tubercular spine patients. Methods: This pilot randomised double-blind controlled study was conducted in 32 American Society of Anesthesiologists I-III patients, age ≥15 years, undergoing elective surgery for spinal tuberculosis. All the patients received general anaesthesia using standard technique and intravenous morphine for intraoperative analgesia. They received wound infiltration with either normal saline (group C) or local infiltration analgesia with 0.375% ropivacaine 3 mg/kg, adrenaline 5 μg/mL and dexmedetomidine 1 μg/kg in a total volume of 0.8 mL/kg (group LIA) before wound closure. Patient-controlled analgesia using intravenous morphine provided postoperative analgesia. The primary objective was to study 24-h morphine consumption, whereas the secondary objectives included pain scores, complications and patient satisfaction. Repeated measures analysis of variance, Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: Morphine requirement was lower in group LIA (6.7 ± 2.7 mg) than in group C (27.7 ± 7.9 mg);P < 0.001. Group LIA also had lower pain scores (P < 0.001), longer time to rescue analgesic (P < 0.001), better patient satisfaction to pain relief (P = 0.001) and lower incidence of postoperative nausea and vomiting than group C. Conclusion: Wound infiltration with ropivacaine, adrenaline and dexmedetomidine before wound closure provided good postoperative analgesia with lower morphine requirement.
International Journal of Obstetric Anesthesia, 2018
Background: Phenylephrine, although considered the vasopressor of choice, can cause reflex bradyc... more Background: Phenylephrine, although considered the vasopressor of choice, can cause reflex bradycardia and a fall in cardiac output. Norepinephrine, due to its direct positive chronotropic and reflex negative chronotropic actions, is expected to overcome this problem. However, limited information about its effective dose for management of post-spinal hypotension, and its potency compared to phenylephrine, is available. Methods: One hundred consecutive patients who developed post-spinal hypotension were treated with a predetermined dose of either phenylephrine or norepinephrine. Correction of hypotension after one minute was considered 'success'. The starting dose for the first patient and testing interval (the incremental or decremental dosing) were 100 μg and 10 μg in phenylephrine group, and 6 μg and 0.5 μg in norepinephrine group. Doses for subsequent patients were determined by the responses of previous patients according to the Narayana rule for up-down sequential allocation. ED95 and ED50 of phenylephrine and norepinephrine boluses and their potency ratio were calculated. Results: Using Probit analysis, ED95 and ED50 values were 43.1 µg (95% CI 39.5 to 65.0 µg) and 33.2 µg (95% CI 5.1 to 37.0 µg) for phenylephrine, and 3.7 µg (95% CI 3.5 to 4.7 µg) and 3.2 µg (95% CI 1.8 to 3.4 µg) for norepinephrine. The relative potency ratio of norepinephrine and phenylephrine was 11.3 (95% CI 8.1 to 16.9). 2 Conclusion: Based on the results of this study, norepinephrine is about 11 times more potent than phenylephrine; when used as bolus doses for treatment of hypotension, 100 μg phenylephrine should be approximately equivalent to 8.8 μg norepinephrine.
Journal of Anaesthesiology Clinical Pharmacology, 2016
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
In this issue of JETS,. Arora, et al. have highlighted various ventilatory strategies used in tra... more In this issue of JETS,. Arora, et al. have highlighted various ventilatory strategies used in trauma patients.[4] They have described common injuries to different organ systems and their management principles. Independent lung ventilation has an important role in cases of massive chest trauma where isolation of lungs is required. In most of the patients with traumatic injuries of chest, protective lung ventilatory strategy remains the basic principle. Some other ventilatory modes based on open lung concept, for example, airway pressure release ventilation (APRV), high frequency oscillatory ventilation (HFOV), and high frequency percussive ventilation (HFPV) also help in preventing and managing VALI. Extracorporeal membrane oxygenation (ECMO) provides rest to the lungs by facilitating gas exchange outside the body. Other newer techniques like closed loop ventilation seem to have potential for further improving ventilatory management of critically ill patients.
... Lecturer 4. MBBS, MD, Reader Department of Anaesthesiology and Critical Care University Colle... more ... Lecturer 4. MBBS, MD, Reader Department of Anaesthesiology and Critical Care University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi-95 Corresspond to : Dr Asha Tyagi 103 Siddhartha Enclave, New Delhi-14 E-mail : dr_ashatyagi@hotmail ...
... Depth of Femoral and Sciatic Nerves and its Correlation with Anthropometric Parameters Rohit ... more ... Depth of Femoral and Sciatic Nerves and its Correlation with Anthropometric Parameters Rohit Garkoti, Ashok Kumar Sethi, Asha Tyagi, Medha Mohta, Deepti Agarwal Drs. Rohit Garkoti, Ex-Senior Resident, Ashok Kumar Sethi ...
Journal of Evolution of Medical and Dental Sciences, 2021
BACKGROUND Paracetamol has been commonly used for perioperative pain management. The perceived be... more BACKGROUND Paracetamol has been commonly used for perioperative pain management. The perceived benefits of IV paracetamol (PCM) over oral are few if oral PCM is given sometime before surgery. We wanted to compare the effects of oral and intravenous paracetamol on perioperative pain management in patients undergoing total abdominal hysterectomy under general anaesthesia. METHODS Sixty-four female patients of American Society of Anesthesiologists (ASA) I / II, in the age group of 18 - 70 years, weighing 40 - 80 Kg, undergoing total abdominal hysterectomy (TAH) were randomised using computer-generated random number table, into two groups. They received oral dispersible 1 g PCM tablets (group PO) at least 45 minutes prior to surgery or intravenous (IV) PCM 1 g (group PI) after induction of anaesthesia. VAS pain scores were recorded and rescue analgesia with tramadol was provided postoperatively. RESULTS The primary outcome measure, time to first rescue analgesic, was statistically simil...
Background: The aim was to investigate the efficacy of prone positioning (PP) in the management o... more Background: The aim was to investigate the efficacy of prone positioning (PP) in the management of coronavirus disease-2019 (COVID-19) pneumonia in various setups, with various modes of oxygen therapy and its optimal duration. Materials and methods: A systematic literature search was conducted from inception until May 15, 2021. Patients with a validated diagnosis of COVID-19 and receiving PP were included. Various factors, including intensive care unit (ICU) or non-ICU setup, mode of oxygen therapy, outcome, duration of proning, and limitations, were noted. Results: We retrieved 36 articles with a total of 1,385 patients for qualitative analysis. Out of 36 articles, there were 17 original articles, 09 case series, and 10 case reports. Out of 1,385 participants, 78.9% (n = 1,093) and 21.0% (n = 292) of patients were managed in ICU and non-ICU setup, respectively. Awake PP with high flow nasal cannula (HFNC) was found to be a promising technique; however, the result was inconclusive with helmet continuous positive airway pressure (CPAP). No study has evaluated the optimal duration of awake PP and the associated long-term outcomes. Conclusion: We encourage the use of early awake self-proning in the management of COVID19 disease. However, the evidence in terms of its use in non-ICU setup, the optimal duration of PP, and various oxygenation devices are insufficient, thereby mandating further well-designed multicentric studies to evaluate its efficacy as an adjunct in the management of COVID-19 pneumonia in context to the aforementioned factor.
We report a case of severe hypokalemia presenting as Guillain Barre Syndrome (GBS). A 25 years ol... more We report a case of severe hypokalemia presenting as Guillain Barre Syndrome (GBS). A 25 years old male presented to hospital with history of acute onset ascending areflexic paralysis. A diagnosis of GBS was made by the physicians. The patient was shifted to Intensive Care Unit for mechanical ventilation and further management. Investigations revealed severe hypokalemia for which potassium replacement was started. With correction of serum potassium levels, the patient's muscle power recovered completely within 24 hours of Intensive Care Unit stay. Thus, if features suggestive of GBS are accompanied by low serum potassium levels, a possibility of hypokalemia induced paralysis should always be kept in mind. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h
Background and Objective: Various risk factors have been evaluated to predict the mortality assoc... more Background and Objective: Various risk factors have been evaluated to predict the mortality associated with COVID-19. We aim to explore and compare the clinical and laboratory risk factors with various outcomes of the disease between survivors and non-survivors amongst patients with moderate to severe COVID-19 disease. Methods: All COVID-19 adult (≥ 18 years old) ICU in-patients with a definite outcome i.e. either death or discharge were included. The demographic, clinical, laboratory, treatment, and outcome data were retrieved. To explore the association between factors, univariate and multivariate logistic regression were done. Results: A total of 163 patients were included out of which eight patients were shifted to other hospitals. Finally, a total of 145 patients were included in the study. Out of 145, 47 patients didn’t survive and 98 survived. A significant proportion (85%) of non-survivors were current smokers and were observed to have COPD, HT, and CAD as comorbidities when...
Journal of Anaesthesiology Clinical Pharmacology, 2018
Direct laryngoscopy and tracheal intubation is one of the basic and the most important skills in ... more Direct laryngoscopy and tracheal intubation is one of the basic and the most important skills in anesthetic practice. This requires proper positioning of head and neck to adequately visualize the glottis and easily negotiate the tracheal tube through the glottic opening. The position traditionally recommended and taught to all learners of airway management is the “sniffing position” (SP). This involves neck flexion (head elevation) by putting a pillow under the head and then extending the head at atlanto‐occipital joint. The SP is thought to help by allowing the line of vision to fall straight on the laryngeal inlet by aligning oral, pharyngeal, and laryngeal axes. This is the three‐axes alignment theory (TAAT) that describes alignment of pharyngeal and laryngeal axes by flexion of neck and alignment of oral axis with the other two axes by extension of the head.[1]
Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative peri... more Background: Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. Aim: The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. Settings and Design: This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. Patients and Methods: Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. Statistical Analysis: Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. Results: Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). Conclusion: Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS.
Objectives We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting orga... more Objectives We assessed whether repeat procalcitonin (PCT) estimation has a role in detecting organ dysfunctions and mortality in pregnancy associated sepsis (PAS). Methods The study included 85 pregnant, post-abortal, and postpartum women with PAS, diagnosed using the quick Sequential Organ Failure Assessment criteria. Median interquartile range PCT levels were documented at admission and 48 hours later. Statistical comparisons were performed between the groups with non-severe and severe (≥1 organ failure) PAS, and between the survivor and mortality groups. The relationship between PCT and the number of organ failures was also assessed. Results Most of the subjects with PAS were young and in the postpartum period (mean age 26 years; postpartum 55%). Sixteen (19%) patients died due to PAS. Sixty-two patients (74%) had severe PAS at presentation. Bacteria were isolated on culture in 64% of the subjects. PCT levels at admission were higher in patients with severe PAS than in those who did not have severe PAS. At 48 hours, this difference was significant (P=0.014; severe PAS 2.23 ng/mL vs. non-severe PAS 0.20 ng/mL). Furthermore, the number of organ failures increased at 48 hours. The PCT levels were significantly higher in the mortality group than in the survivors' group at admission (8.31 ng/mL vs. 1.72 ng/mL), and the difference increased further at 48 hours (9.54 ng/mL vs. 1.37 ng/mL). Conclusion Repeat PCT estimation at 48 hours could complement the clinical findings and enhance the prognostic value for PAS.
Background and Aims: Regional analgesic techniques are difficult to use in tubercular spine patie... more Background and Aims: Regional analgesic techniques are difficult to use in tubercular spine patients due to distorted spinal anatomy and presence of infection. This study was conducted with the aim to evaluate analgesic efficacy of local wound infiltration before wound closure in tubercular spine patients. Methods: This pilot randomised double-blind controlled study was conducted in 32 American Society of Anesthesiologists I-III patients, age ≥15 years, undergoing elective surgery for spinal tuberculosis. All the patients received general anaesthesia using standard technique and intravenous morphine for intraoperative analgesia. They received wound infiltration with either normal saline (group C) or local infiltration analgesia with 0.375% ropivacaine 3 mg/kg, adrenaline 5 μg/mL and dexmedetomidine 1 μg/kg in a total volume of 0.8 mL/kg (group LIA) before wound closure. Patient-controlled analgesia using intravenous morphine provided postoperative analgesia. The primary objective was to study 24-h morphine consumption, whereas the secondary objectives included pain scores, complications and patient satisfaction. Repeated measures analysis of variance, Chi-square test and Mann–Whitney U test were used for statistical analysis. Results: Morphine requirement was lower in group LIA (6.7 ± 2.7 mg) than in group C (27.7 ± 7.9 mg);P < 0.001. Group LIA also had lower pain scores (P < 0.001), longer time to rescue analgesic (P < 0.001), better patient satisfaction to pain relief (P = 0.001) and lower incidence of postoperative nausea and vomiting than group C. Conclusion: Wound infiltration with ropivacaine, adrenaline and dexmedetomidine before wound closure provided good postoperative analgesia with lower morphine requirement.
International Journal of Obstetric Anesthesia, 2018
Background: Phenylephrine, although considered the vasopressor of choice, can cause reflex bradyc... more Background: Phenylephrine, although considered the vasopressor of choice, can cause reflex bradycardia and a fall in cardiac output. Norepinephrine, due to its direct positive chronotropic and reflex negative chronotropic actions, is expected to overcome this problem. However, limited information about its effective dose for management of post-spinal hypotension, and its potency compared to phenylephrine, is available. Methods: One hundred consecutive patients who developed post-spinal hypotension were treated with a predetermined dose of either phenylephrine or norepinephrine. Correction of hypotension after one minute was considered 'success'. The starting dose for the first patient and testing interval (the incremental or decremental dosing) were 100 μg and 10 μg in phenylephrine group, and 6 μg and 0.5 μg in norepinephrine group. Doses for subsequent patients were determined by the responses of previous patients according to the Narayana rule for up-down sequential allocation. ED95 and ED50 of phenylephrine and norepinephrine boluses and their potency ratio were calculated. Results: Using Probit analysis, ED95 and ED50 values were 43.1 µg (95% CI 39.5 to 65.0 µg) and 33.2 µg (95% CI 5.1 to 37.0 µg) for phenylephrine, and 3.7 µg (95% CI 3.5 to 4.7 µg) and 3.2 µg (95% CI 1.8 to 3.4 µg) for norepinephrine. The relative potency ratio of norepinephrine and phenylephrine was 11.3 (95% CI 8.1 to 16.9). 2 Conclusion: Based on the results of this study, norepinephrine is about 11 times more potent than phenylephrine; when used as bolus doses for treatment of hypotension, 100 μg phenylephrine should be approximately equivalent to 8.8 μg norepinephrine.
Journal of Anaesthesiology Clinical Pharmacology, 2016
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
In this issue of JETS,. Arora, et al. have highlighted various ventilatory strategies used in tra... more In this issue of JETS,. Arora, et al. have highlighted various ventilatory strategies used in trauma patients.[4] They have described common injuries to different organ systems and their management principles. Independent lung ventilation has an important role in cases of massive chest trauma where isolation of lungs is required. In most of the patients with traumatic injuries of chest, protective lung ventilatory strategy remains the basic principle. Some other ventilatory modes based on open lung concept, for example, airway pressure release ventilation (APRV), high frequency oscillatory ventilation (HFOV), and high frequency percussive ventilation (HFPV) also help in preventing and managing VALI. Extracorporeal membrane oxygenation (ECMO) provides rest to the lungs by facilitating gas exchange outside the body. Other newer techniques like closed loop ventilation seem to have potential for further improving ventilatory management of critically ill patients.
... Lecturer 4. MBBS, MD, Reader Department of Anaesthesiology and Critical Care University Colle... more ... Lecturer 4. MBBS, MD, Reader Department of Anaesthesiology and Critical Care University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi-95 Corresspond to : Dr Asha Tyagi 103 Siddhartha Enclave, New Delhi-14 E-mail : dr_ashatyagi@hotmail ...
... Depth of Femoral and Sciatic Nerves and its Correlation with Anthropometric Parameters Rohit ... more ... Depth of Femoral and Sciatic Nerves and its Correlation with Anthropometric Parameters Rohit Garkoti, Ashok Kumar Sethi, Asha Tyagi, Medha Mohta, Deepti Agarwal Drs. Rohit Garkoti, Ex-Senior Resident, Ashok Kumar Sethi ...
Journal of Evolution of Medical and Dental Sciences, 2021
BACKGROUND Paracetamol has been commonly used for perioperative pain management. The perceived be... more BACKGROUND Paracetamol has been commonly used for perioperative pain management. The perceived benefits of IV paracetamol (PCM) over oral are few if oral PCM is given sometime before surgery. We wanted to compare the effects of oral and intravenous paracetamol on perioperative pain management in patients undergoing total abdominal hysterectomy under general anaesthesia. METHODS Sixty-four female patients of American Society of Anesthesiologists (ASA) I / II, in the age group of 18 - 70 years, weighing 40 - 80 Kg, undergoing total abdominal hysterectomy (TAH) were randomised using computer-generated random number table, into two groups. They received oral dispersible 1 g PCM tablets (group PO) at least 45 minutes prior to surgery or intravenous (IV) PCM 1 g (group PI) after induction of anaesthesia. VAS pain scores were recorded and rescue analgesia with tramadol was provided postoperatively. RESULTS The primary outcome measure, time to first rescue analgesic, was statistically simil...
Background: The aim was to investigate the efficacy of prone positioning (PP) in the management o... more Background: The aim was to investigate the efficacy of prone positioning (PP) in the management of coronavirus disease-2019 (COVID-19) pneumonia in various setups, with various modes of oxygen therapy and its optimal duration. Materials and methods: A systematic literature search was conducted from inception until May 15, 2021. Patients with a validated diagnosis of COVID-19 and receiving PP were included. Various factors, including intensive care unit (ICU) or non-ICU setup, mode of oxygen therapy, outcome, duration of proning, and limitations, were noted. Results: We retrieved 36 articles with a total of 1,385 patients for qualitative analysis. Out of 36 articles, there were 17 original articles, 09 case series, and 10 case reports. Out of 1,385 participants, 78.9% (n = 1,093) and 21.0% (n = 292) of patients were managed in ICU and non-ICU setup, respectively. Awake PP with high flow nasal cannula (HFNC) was found to be a promising technique; however, the result was inconclusive with helmet continuous positive airway pressure (CPAP). No study has evaluated the optimal duration of awake PP and the associated long-term outcomes. Conclusion: We encourage the use of early awake self-proning in the management of COVID19 disease. However, the evidence in terms of its use in non-ICU setup, the optimal duration of PP, and various oxygenation devices are insufficient, thereby mandating further well-designed multicentric studies to evaluate its efficacy as an adjunct in the management of COVID-19 pneumonia in context to the aforementioned factor.
We report a case of severe hypokalemia presenting as Guillain Barre Syndrome (GBS). A 25 years ol... more We report a case of severe hypokalemia presenting as Guillain Barre Syndrome (GBS). A 25 years old male presented to hospital with history of acute onset ascending areflexic paralysis. A diagnosis of GBS was made by the physicians. The patient was shifted to Intensive Care Unit for mechanical ventilation and further management. Investigations revealed severe hypokalemia for which potassium replacement was started. With correction of serum potassium levels, the patient's muscle power recovered completely within 24 hours of Intensive Care Unit stay. Thus, if features suggestive of GBS are accompanied by low serum potassium levels, a possibility of hypokalemia induced paralysis should always be kept in mind. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h
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