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Nandita Mehta

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Papers by Nandita Mehta

Comparison of dose–response to two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia

Ain-Shams Journal of Anesthesiology

Background Various studies have demonstrated the analgesic benefit of systemic lidocaine in the p... more Background Various studies have demonstrated the analgesic benefit of systemic lidocaine in the perioperative setting, especially during laparoscopic abdominal surgery. However, the best appropriate dose for an administered bolus and continuous infusion of lignocaine is unclear. Our aim is to compare the effect of two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Fifty-four patients of ASA PS I or II, aged between 18 and 65 years undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups of 26 patients each. Patients in group A received an intravenous bolus injection of lidocaine 1.5 mg/kg slowly over 10 min, prior to induction and then followed by a continuous infusion at the rate of 1.5 mg/kg/h via infusion pump whereas group B patients received intravenous lidocaine bolus of 1.5 mg/kg slowly over 10 min followed by infusion at the ra...

Adjuvant Drugs to Local Anesthetics

IntechOpen eBooks, Sep 30, 2020

Local anesthetics have a potential to be used in a wide variety of situations including central n... more Local anesthetics have a potential to be used in a wide variety of situations including central neuraxial blocks, peripheral nerve blocks, intravenous, and local infiltration both for surgeries and acute and chronic pain management. Their use can be limited by their duration of action and the dose-dependent adverse effects on the cardiac and central nervous system. Adjuvants are drugs which, when coadministered along with local anesthetic agents, improve the latency of onset and duration of analgesia and counteract disadvantageous effects of local anesthetics. There is a wide armamentarium of adjuvant drugs to choose to be added in neuraxial and peripheral nerve blocks. They can be broadly divided into non-opioids and opioids, with non-opioids being vasoconstrictors, α2-adrenoceptor agonists, anti-inflammatory agents, acetylcholine esterase inhibitors (neostigmine), adenosine, ketorolac, midazolam, magnesium, and sodium bicarbonate and opioids being lipophilic (fentanyl and sufentanil) and hydrophilic (morphine).

Levobupivacaine, Bupivacaine, Isobaric

Evaluation of Hemodynamic Changes Using Different Intra-Abdominal Pressures for Laparoscopic Cholecystectomy

Indian Journal of Surgery, May 1, 2012

with more fluctuations in hemodynamic parameters and increased peritoneal absorption of CO2 as co... more

Attenuation of the Pressor Response to Laryngoscopy and Endotracheal Intubation with Different Intravenous Doses of Esmolol

International journal of medical research profesionals, Sep 1, 2016

Aim: To find out the most effective dose of beta adrenoreceptor blocker esmolol for attenuation o... more Aim: To find out the most effective dose of beta adrenoreceptor blocker esmolol for attenuation of pressor response. Settings and Design: Prospective, hospital-based. Subjects and Methods: A total of 100 patients randomly divided into four groups of 25 each were included who were ASA-I i.e.18 years old and above, of both sexes. Group I, II, III and IV received 0, 1, 2 and 3 mg/kg of esmolol hydrochloride diluted in 10 ml of dextrose 5% slowly injected over a period of 15-20 seconds. Baseline parameters i.e. heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) mean arterial pressure (MAP), oxygen saturation (SpO2) and electrocardiography (ECG) were recorded. These parameters were again recorded at 30 seconds after administration of propofol, at 1 and 2 minutes after esmolol administration and at 1, 3, 5 and 10 minutes after intubation. Results: Values of baseline parameters and at 30 seconds after giving propofol were comparable. Oxygen saturation (SpO2) in all the four groups did not show any variation at all intervals i.e. baseline, 30 seconds after propofol, 1 and 2 minutes after administration of the study drug, 1, 3, 5 and 10 minutes after intubation. A decrease in HR, SBP, DBP and MAP was observed in Groups II, III and IV when compared to their individual baseline values which started at 1 minute after the administration of the study drug. However, there was an increase in mean HR, SBP, DBP and MAP seen immediately 1 minute after intubation in Groups I and II when compared with their individual baseline values. Whereas, in Group III and IV the mean values for the various parameters were comparable to the baseline. No rhythm disturbance was seen in the ECG in any of the groups. Conclusion: Intravenous esmolol in a dose of 1 mg/kg body weight is ineffective in blunting the haemodynamic responses to laryngoscopy and intubation, but esmolol in a dose of 2 mg/kg body weight given 3 minutes before laryngoscopy and endotracheal intubation is effective in attenuating the haemodynamic responses, without any deleterious effects.

Comparative evaluation of supraglottic airway devices I-Gel versus LMA-supreme in patients undergoing surgery under general Anaesthesia

Indian Journal of Clinical Anaesthesia, 2015

Background and Aim: Supraglottic airway devices are increasingly being used as an excellent alter... more Background and Aim: Supraglottic airway devices are increasingly being used as an excellent alternative to mask ventilation and tracheal intubation with least complications. The present randomized, prospective study was conducted to compare the I-Gel with LMA-Supreme with respect to time taken for insertion, insertion success rate, ease of insertion of gastric tube, hemodynamic changes before and after insertion and post-operative airway morbidity. Materials and Methods: Sixty American Society of Anaesthesiologist (ASA) grade-I and II patients between 18-60 years age, of either sex, were randomly assigned to two groups of 30 patients each. Group A: I-gel was inserted and Group B: LMA-supreme was inserted by grasping firmly along the integral bite block (Digital Technique). Hemodynamic responses were recorded before induction and at the intervals after insertion of LMA Supreme/I-Gel. Time taken for insertion, insertion success rate and ease of insertion of gastric tube was noted. Patients were inspected for any trauma to mouth, lip and tongue in the immediate postoperative period and asked about sore throat, hoarseness and dysphonia 24 hours after the surgery. Statistical analysis was carried out with student's t-test and chi-square test and value of P0.05 was considered statistically significant. Results: Insertion time of I-Gel (11.07±1.93 seconds) was faster than the LMA-Supreme (12.50±2.35 seconds) and the results were statistically significant (P=0.01). Ease of insertion of gastric tube was more in LMA Supreme (28/30) as compared to I Gel (26/30) but statistically this difference came out to be non-significant (P=0.157).The two groups were comparable as far as the insertion success rate , hemodynamics and post-operative airway morbidity were concerned. Conclusion: I-Gel is better than LMA-Supreme in terms of faster insertion time. Insertion success rate, ease of insertion of gastric tube, hemodynamics and post-operative airway morbidity is comparable in both the groups.

Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy: A feasibility study

Journal of Anaesthesiology Clinical Pharmacology, 2016

Drug allergies, asthma, and obesity are more common in modern societies, and patients with these ... more Drug allergies, asthma, and obesity are more common in modern societies, and patients with these problems are often a challenge for anesthetists. Different techniques of regional anesthesia can be beneficial particularly for this group of patients. We present a patient who suffered from all of the above-mentioned conditions and successfully underwent laparoscopic cholecystectomy under thoracic combined spinal-epidural anesthesia. It is still not a popular practice, and we would like to show another indication for using it.

Intraoperative Nociception Monitoring by qNOX Score Using Three Different Doses of Fentanyl

Per Cutaneous Nephrolithotomy Under Spinal Anesthesia And The Efficacy Of Adding Adjuvant Clonidine To Intrathecal Hyperbaric Bupivacaine : A Comparative Study

The Internet Journal of Anesthesiology, May 23, 2014

Context: Percutaneous nephrolithotomy (PCNL) is an established procedure of choice for renal ston... more Context: Percutaneous nephrolithotomy (PCNL) is an established procedure of choice for renal stones > 2cm. However, there are few studies regarding the efficacy of spinal anesthesia for PCNL. Aim: The purpose of present study was to evaluate the feasibility of doing PCNL under spinal anesthesia and whether addition of clonidine improves the quality of spinal block needed for PCNL. Setting and Design : A prospective randomized double blind trial Methods and Material: Sixty patients scheduled for PCNL were randomly divided into two groups of which group B received spinal anesthesia with hyperbaric bupivacaine (15 mg) and group BC received 45 microgram clonidine in addition to hyperbaric bupivacaine. Parameters recorded were onset of sensory and motor block, intraoperative analgesia, 2 segment regression of sensory block, sedation score, surgeon satisfaction score and postoperative analgesia. Hemodynamic parameters were recorded both intraoperative and postoperatively. Statistical analysis: Student's t-test for parametric data and Chi-Square test for non-parametric data using SPSS 17.0. Results: Although the onset of sensory and motor blockade was same in both the groups, but the two segment regression of sensory block was significantly prolonged in clonidine group (p=0.003). The clonidine group also had good intraoperative analgesia. Time to first rescue analgesia post operatively was significantly more for BC group (p=0.003). Both systolic and diastolic blood pressure was significantly lowered in the clonidine group and patients in this group had longer duration of postoperative analgesia. Conclusion: Spinal Anesthesia using bupivacaine and clonidine offers a reliable bock, excellent patient and surgeon acceptance and prolonged intraoperative and postoperative analgesia in patients undergoing PCNL.

Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

Local and regional anesthesia, Dec 1, 2015

Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting... more Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.

Coblation-Assisted Turbinoplasty: A Comparative Analysis of Reflex Ultra and Turbinator Wand

Ear, nose, & throat journal, Apr 11, 2019

Coblation is a novel technology and has a wide application in the field of otorhinolaryngology. W... more Coblation is a novel technology and has a wide application in the field of otorhinolaryngology. We conducted a randomized, noncontrolled study to compare the effectiveness of 2 types of wands used for turbinoplasty for nasal obstruction due to inferior turbinate hypertrophy. Reflex Ultra and Turbinator wands were compared on a total of 150 patients. These patients were divided into a group of 75 patients each in a randomized manner. Results were compared based on the visual analog scale, and objective assessment was done on the basis of endoscopic assessment, that is, Nasal Endoscopic Score (NES). Assessment was done on postoperative day 7, first month, third month, and first year. Both groups demonstrated significant and similar results in long term, but an immediate improvement at 1 week was seen in the Turbinator group. Hence, we conclude that coblation turbinoplasty is an effective technique for turbinate reduction and both wands are equally effective in long term. However, Reflex Ultra has the advantage of mucosal preservation and minimal morbidity, and Turbinator has the advantage of immediate relief in nasal symptoms.

First-pass success rate and number of attempts required for intubation in anticipated difficult airway: Comparison between Macintosh and channeled King Vision video laryngoscopes

Anesthesia: Essays and Researches

Intraoperative Nociception Monitoring by qNOX Score Using Three Different Doses of Fentanyl

JK Science: Journal of Medical Education & Research, Oct 10, 2021

Granisetron, Palonosetron, Ramosetron, Postoperative Nausea and Vomiting, Complete Response

A Rare Case of Primary Extra-Nodal Mixed Cell Non-Hodgkin’s Lymphoma of the Testis; Case Report

Journal of Surgical Arts, 2014

ABSTRACT Primary testicular non-Hodgkin’s lymphoma is an uncommon extra nodal presentation, const... more ABSTRACT Primary testicular non-Hodgkin’s lymphoma is an uncommon extra nodal presentation, constituting less than 1% of all non-Hodgkin’s lymphoma. The disease is typically present in patient’s aged sixth and seventh decade of life. Both testes involvement is equal in frequency and in approximately 6% of testicular lymphomas will have bilateral involvement. In our case, there was non-Hodgkin’s lymphoma of right testes without any central node system involvement. Primary testicular non-Hodgkin’s lymphoma is an uncommon entity and with combined modalities with high inguinal orchiectomy and chemotherapy has good outcome. OZET Ekstranodal ve primer non-Hodgkin lenfoma’nin testiste oldukca nadirdir ve %1’den daha az gorulen bir durumdur. Hastalik daha cok 60 ve 70’li yaslarda gorulur. Her ijki testista e gorulebilecegi gibi %6 vakada her iki testiste de birlikte gorulebilir. Vakamizda, baska nodal sistemi tutmayan ve primer olarak sag testisten kaynaklanan non-Hodgkin lenfoma vardi. Cok nadir gorulen bu vakamiza once sag orsiektomi ve daha sonra kemoterapi yapildi ve sifa ile taburcu edildi.

Local and Regional Anesthesia Dovepress submit your manuscript | www.dovepress.com

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Comparative Evaluation of a Mixture of Atracurium and Tramadol or Ketorolac as an Adjunct to Low Dose Lignocaine in Intravenous Regional Anesthesia

BACKGROUND: Purpose of the study was to evaluate the efficacy of Atracurium as adjuvant with tram... more BACKGROUND: Purpose of the study was to evaluate the efficacy of Atracurium as adjuvant with tramadol or Ketorolac in reducing the dose of lignocaine used for intravenous regional anesthesia thereby decreasing the chances of systemic toxicity of lignocaine. PATIENTS AND METHODS: Sixty adult patients of ASA grade I and II were divided into three equal groups of twenty each in randomized double blind manner. Group I patients received 40ml of 0.5% lignocaine. Group II and III received 40 ml of 0.25% lignocaine with addition of 2 mg Atracurium and 50 mg tramadol while in Group III, tramadol was replaced with 30 mg of Ketorolac. Onset of sensory and motor block, intraoperative degree of analgesia, intraoperative and postoperative complications were recorded in all the three groups. RESULTS: There was no significant difference between the groups with respect to age, weight and sex distribution. Mean time of onset of motor block in group I, II and III was 4.15+0.81, 11.7+0.86 and 14.2+0.69 minutes respectively which was statistically significant (p < 0.001). Mean time of onset of sensory block in groups I, II and III was 2.95+0.82, 8.75+1.20 and 11.05+1.04 minutes respectively which was also statistically significant. Intraoperative degree of analgesia in group II and III was comparable to group I. CONCLUSIONS: The use of 0.25% lignocaine and Atracurium with tramadol or Ketorolac provides comparable analgesia to 0.5% lignocaine used alone. This decreases the concentration and total dose of lignocaine required but delays the onset of both sensory and motor block.

Design and Development of In Vivo Robot for Biopsy

Mechanics Based Design of Structures and Machines, 2014

ABSTRACT In vivo robot is an emerging medical technology that could greatly help biopsy and surge... more ABSTRACT In vivo robot is an emerging medical technology that could greatly help biopsy and surgery. This paper proposes to design and develop a miniature in vivo robot for biopsy as an add-on to the current endoscope. To allow more dexterity and flexibility, a four degree of freedom (DOF) robot manipulator is proposed. Accordingly, a wire actuated robot with articulated links like in a snake robot has been conceptualized. The robot was mathematically modeled and designed. To test the design, a 4-scaled aluminum model was manufactured. The kinematics of the model is verified experimentally. The four degree of freedom of the miniature robot are: a linear motion of the flexible shaft (first DOF); an axial rotation of the flexible shaft (second DOF); planar through differential wire movement (third DOF); and a combined wire motion for clipper action to take biopsy (fourth DOF). The proposed robot manipulator was modeled in SolidWorks and the kinematic and dynamic analysis was performed using the Robotics Toolbox in MATLAB.

Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous verapamil

Acta Anaesthesiologica Scandinavica, 1989

This study was undertaken in surgical patients in order to evaluate the effects of intravenous ve... more This study was undertaken in surgical patients in order to evaluate the effects of intravenous verapamil on the circulatory responses to laryngoscopy and tracheal intubation. Laryngoscopy for tracheal intubation was initiated 1 min after thiamylal 5 mg. kg-I and succinylcholine 1.5 m g. kg-I in the control group (n=21). The verapamil group (n = 23) received intravenous verapamil 0.1 mg. kg-' immediately after thiamylalsuccinylcholine administration. The resulting changes in mean arterial pressure (MAP) and heart rate (HR) were continuously measured. Compared with the control group, MAP increased less in response to laryngoscopy and tracheal intubation (56+ 13% versus 25 15% above baselines, P<O.OI) and returned toward baseline sooner in patients receiving verapamil. For hypertensive patients, MAP increases from baseline after intubation were 18 5 9% in the verapamil group, and 53 ~t 14% in the control group, respectively (P<O.OOl). Increases in H R response to laryngoscopy for intubation were comparable in both groups. We conclude that intravenous verapamil is effective in reducing pressor responses during endotracheal intubation, especially in hypertensive patients.

Comparative Evaluation of Fastrach Silicone Wire-Reinforced Tube, Polyvinyl Chloride Tube and PVC Armoured Tube for Blind Tracheal Intubation through the Intubating Laryngeal Mask Airway

Background and Aims : The reusable Fastrach silicone wire reinforced tube (FTST) was designed for... more Background and Aims : The reusable Fastrach silicone wire reinforced tube (FTST) was designed for tracheal intubation through the intubating laryngeal mask airway (ILMA). The polyvinyl chloride (PVC) tube and the PVC armoured tube (PAT) are disposable, cheaper and readily available as compared to the FTST. Hence, we decided to compare the clinical performance of these 3 types of tubes for tracheal intubation through the ILMA. Methods : Ninety patients between 18-65 years with ASA class I and II and Mallampati Grading I and II undergoing elective surgery under general anaesthesia were enrolled for this prospective, randomised study. Patients were divided randomly into three groups consisting of 30 patients each, to undergo intubation by FTST, PVC, PAT tubes through an ILMA. Overall success rate, ease of insertion, the number of attempts for successful intubation, critical incidence during intubation and post-operative sore throat were compared. Data was compiled and analysed using ap...

Comparison of dose–response to two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia

Ain-Shams Journal of Anesthesiology

Background Various studies have demonstrated the analgesic benefit of systemic lidocaine in the p... more Background Various studies have demonstrated the analgesic benefit of systemic lidocaine in the perioperative setting, especially during laparoscopic abdominal surgery. However, the best appropriate dose for an administered bolus and continuous infusion of lignocaine is unclear. Our aim is to compare the effect of two different doses of intravenous lidocaine for analgesia in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Fifty-four patients of ASA PS I or II, aged between 18 and 65 years undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups of 26 patients each. Patients in group A received an intravenous bolus injection of lidocaine 1.5 mg/kg slowly over 10 min, prior to induction and then followed by a continuous infusion at the rate of 1.5 mg/kg/h via infusion pump whereas group B patients received intravenous lidocaine bolus of 1.5 mg/kg slowly over 10 min followed by infusion at the ra...

Adjuvant Drugs to Local Anesthetics

IntechOpen eBooks, Sep 30, 2020

Local anesthetics have a potential to be used in a wide variety of situations including central n... more Local anesthetics have a potential to be used in a wide variety of situations including central neuraxial blocks, peripheral nerve blocks, intravenous, and local infiltration both for surgeries and acute and chronic pain management. Their use can be limited by their duration of action and the dose-dependent adverse effects on the cardiac and central nervous system. Adjuvants are drugs which, when coadministered along with local anesthetic agents, improve the latency of onset and duration of analgesia and counteract disadvantageous effects of local anesthetics. There is a wide armamentarium of adjuvant drugs to choose to be added in neuraxial and peripheral nerve blocks. They can be broadly divided into non-opioids and opioids, with non-opioids being vasoconstrictors, α2-adrenoceptor agonists, anti-inflammatory agents, acetylcholine esterase inhibitors (neostigmine), adenosine, ketorolac, midazolam, magnesium, and sodium bicarbonate and opioids being lipophilic (fentanyl and sufentanil) and hydrophilic (morphine).

Levobupivacaine, Bupivacaine, Isobaric

Evaluation of Hemodynamic Changes Using Different Intra-Abdominal Pressures for Laparoscopic Cholecystectomy

Indian Journal of Surgery, May 1, 2012

with more fluctuations in hemodynamic parameters and increased peritoneal absorption of CO2 as co... more

Attenuation of the Pressor Response to Laryngoscopy and Endotracheal Intubation with Different Intravenous Doses of Esmolol

International journal of medical research profesionals, Sep 1, 2016

Aim: To find out the most effective dose of beta adrenoreceptor blocker esmolol for attenuation o... more Aim: To find out the most effective dose of beta adrenoreceptor blocker esmolol for attenuation of pressor response. Settings and Design: Prospective, hospital-based. Subjects and Methods: A total of 100 patients randomly divided into four groups of 25 each were included who were ASA-I i.e.18 years old and above, of both sexes. Group I, II, III and IV received 0, 1, 2 and 3 mg/kg of esmolol hydrochloride diluted in 10 ml of dextrose 5% slowly injected over a period of 15-20 seconds. Baseline parameters i.e. heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) mean arterial pressure (MAP), oxygen saturation (SpO2) and electrocardiography (ECG) were recorded. These parameters were again recorded at 30 seconds after administration of propofol, at 1 and 2 minutes after esmolol administration and at 1, 3, 5 and 10 minutes after intubation. Results: Values of baseline parameters and at 30 seconds after giving propofol were comparable. Oxygen saturation (SpO2) in all the four groups did not show any variation at all intervals i.e. baseline, 30 seconds after propofol, 1 and 2 minutes after administration of the study drug, 1, 3, 5 and 10 minutes after intubation. A decrease in HR, SBP, DBP and MAP was observed in Groups II, III and IV when compared to their individual baseline values which started at 1 minute after the administration of the study drug. However, there was an increase in mean HR, SBP, DBP and MAP seen immediately 1 minute after intubation in Groups I and II when compared with their individual baseline values. Whereas, in Group III and IV the mean values for the various parameters were comparable to the baseline. No rhythm disturbance was seen in the ECG in any of the groups. Conclusion: Intravenous esmolol in a dose of 1 mg/kg body weight is ineffective in blunting the haemodynamic responses to laryngoscopy and intubation, but esmolol in a dose of 2 mg/kg body weight given 3 minutes before laryngoscopy and endotracheal intubation is effective in attenuating the haemodynamic responses, without any deleterious effects.

Comparative evaluation of supraglottic airway devices I-Gel versus LMA-supreme in patients undergoing surgery under general Anaesthesia

Indian Journal of Clinical Anaesthesia, 2015

Background and Aim: Supraglottic airway devices are increasingly being used as an excellent alter... more Background and Aim: Supraglottic airway devices are increasingly being used as an excellent alternative to mask ventilation and tracheal intubation with least complications. The present randomized, prospective study was conducted to compare the I-Gel with LMA-Supreme with respect to time taken for insertion, insertion success rate, ease of insertion of gastric tube, hemodynamic changes before and after insertion and post-operative airway morbidity. Materials and Methods: Sixty American Society of Anaesthesiologist (ASA) grade-I and II patients between 18-60 years age, of either sex, were randomly assigned to two groups of 30 patients each. Group A: I-gel was inserted and Group B: LMA-supreme was inserted by grasping firmly along the integral bite block (Digital Technique). Hemodynamic responses were recorded before induction and at the intervals after insertion of LMA Supreme/I-Gel. Time taken for insertion, insertion success rate and ease of insertion of gastric tube was noted. Patients were inspected for any trauma to mouth, lip and tongue in the immediate postoperative period and asked about sore throat, hoarseness and dysphonia 24 hours after the surgery. Statistical analysis was carried out with student's t-test and chi-square test and value of P0.05 was considered statistically significant. Results: Insertion time of I-Gel (11.07±1.93 seconds) was faster than the LMA-Supreme (12.50±2.35 seconds) and the results were statistically significant (P=0.01). Ease of insertion of gastric tube was more in LMA Supreme (28/30) as compared to I Gel (26/30) but statistically this difference came out to be non-significant (P=0.157).The two groups were comparable as far as the insertion success rate , hemodynamics and post-operative airway morbidity were concerned. Conclusion: I-Gel is better than LMA-Supreme in terms of faster insertion time. Insertion success rate, ease of insertion of gastric tube, hemodynamics and post-operative airway morbidity is comparable in both the groups.

Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy: A feasibility study

Journal of Anaesthesiology Clinical Pharmacology, 2016

Drug allergies, asthma, and obesity are more common in modern societies, and patients with these ... more Drug allergies, asthma, and obesity are more common in modern societies, and patients with these problems are often a challenge for anesthetists. Different techniques of regional anesthesia can be beneficial particularly for this group of patients. We present a patient who suffered from all of the above-mentioned conditions and successfully underwent laparoscopic cholecystectomy under thoracic combined spinal-epidural anesthesia. It is still not a popular practice, and we would like to show another indication for using it.

Intraoperative Nociception Monitoring by qNOX Score Using Three Different Doses of Fentanyl

Per Cutaneous Nephrolithotomy Under Spinal Anesthesia And The Efficacy Of Adding Adjuvant Clonidine To Intrathecal Hyperbaric Bupivacaine : A Comparative Study

The Internet Journal of Anesthesiology, May 23, 2014

Context: Percutaneous nephrolithotomy (PCNL) is an established procedure of choice for renal ston... more Context: Percutaneous nephrolithotomy (PCNL) is an established procedure of choice for renal stones > 2cm. However, there are few studies regarding the efficacy of spinal anesthesia for PCNL. Aim: The purpose of present study was to evaluate the feasibility of doing PCNL under spinal anesthesia and whether addition of clonidine improves the quality of spinal block needed for PCNL. Setting and Design : A prospective randomized double blind trial Methods and Material: Sixty patients scheduled for PCNL were randomly divided into two groups of which group B received spinal anesthesia with hyperbaric bupivacaine (15 mg) and group BC received 45 microgram clonidine in addition to hyperbaric bupivacaine. Parameters recorded were onset of sensory and motor block, intraoperative analgesia, 2 segment regression of sensory block, sedation score, surgeon satisfaction score and postoperative analgesia. Hemodynamic parameters were recorded both intraoperative and postoperatively. Statistical analysis: Student's t-test for parametric data and Chi-Square test for non-parametric data using SPSS 17.0. Results: Although the onset of sensory and motor blockade was same in both the groups, but the two segment regression of sensory block was significantly prolonged in clonidine group (p=0.003). The clonidine group also had good intraoperative analgesia. Time to first rescue analgesia post operatively was significantly more for BC group (p=0.003). Both systolic and diastolic blood pressure was significantly lowered in the clonidine group and patients in this group had longer duration of postoperative analgesia. Conclusion: Spinal Anesthesia using bupivacaine and clonidine offers a reliable bock, excellent patient and surgeon acceptance and prolonged intraoperative and postoperative analgesia in patients undergoing PCNL.

Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

Local and regional anesthesia, Dec 1, 2015

Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting... more Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.

Coblation-Assisted Turbinoplasty: A Comparative Analysis of Reflex Ultra and Turbinator Wand

Ear, nose, & throat journal, Apr 11, 2019

Coblation is a novel technology and has a wide application in the field of otorhinolaryngology. W... more Coblation is a novel technology and has a wide application in the field of otorhinolaryngology. We conducted a randomized, noncontrolled study to compare the effectiveness of 2 types of wands used for turbinoplasty for nasal obstruction due to inferior turbinate hypertrophy. Reflex Ultra and Turbinator wands were compared on a total of 150 patients. These patients were divided into a group of 75 patients each in a randomized manner. Results were compared based on the visual analog scale, and objective assessment was done on the basis of endoscopic assessment, that is, Nasal Endoscopic Score (NES). Assessment was done on postoperative day 7, first month, third month, and first year. Both groups demonstrated significant and similar results in long term, but an immediate improvement at 1 week was seen in the Turbinator group. Hence, we conclude that coblation turbinoplasty is an effective technique for turbinate reduction and both wands are equally effective in long term. However, Reflex Ultra has the advantage of mucosal preservation and minimal morbidity, and Turbinator has the advantage of immediate relief in nasal symptoms.

First-pass success rate and number of attempts required for intubation in anticipated difficult airway: Comparison between Macintosh and channeled King Vision video laryngoscopes

Anesthesia: Essays and Researches

Intraoperative Nociception Monitoring by qNOX Score Using Three Different Doses of Fentanyl

JK Science: Journal of Medical Education & Research, Oct 10, 2021

Granisetron, Palonosetron, Ramosetron, Postoperative Nausea and Vomiting, Complete Response

A Rare Case of Primary Extra-Nodal Mixed Cell Non-Hodgkin’s Lymphoma of the Testis; Case Report

Journal of Surgical Arts, 2014

ABSTRACT Primary testicular non-Hodgkin’s lymphoma is an uncommon extra nodal presentation, const... more ABSTRACT Primary testicular non-Hodgkin’s lymphoma is an uncommon extra nodal presentation, constituting less than 1% of all non-Hodgkin’s lymphoma. The disease is typically present in patient’s aged sixth and seventh decade of life. Both testes involvement is equal in frequency and in approximately 6% of testicular lymphomas will have bilateral involvement. In our case, there was non-Hodgkin’s lymphoma of right testes without any central node system involvement. Primary testicular non-Hodgkin’s lymphoma is an uncommon entity and with combined modalities with high inguinal orchiectomy and chemotherapy has good outcome. OZET Ekstranodal ve primer non-Hodgkin lenfoma’nin testiste oldukca nadirdir ve %1’den daha az gorulen bir durumdur. Hastalik daha cok 60 ve 70’li yaslarda gorulur. Her ijki testista e gorulebilecegi gibi %6 vakada her iki testiste de birlikte gorulebilir. Vakamizda, baska nodal sistemi tutmayan ve primer olarak sag testisten kaynaklanan non-Hodgkin lenfoma vardi. Cok nadir gorulen bu vakamiza once sag orsiektomi ve daha sonra kemoterapi yapildi ve sifa ile taburcu edildi.

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Comparative Evaluation of a Mixture of Atracurium and Tramadol or Ketorolac as an Adjunct to Low Dose Lignocaine in Intravenous Regional Anesthesia

BACKGROUND: Purpose of the study was to evaluate the efficacy of Atracurium as adjuvant with tram... more BACKGROUND: Purpose of the study was to evaluate the efficacy of Atracurium as adjuvant with tramadol or Ketorolac in reducing the dose of lignocaine used for intravenous regional anesthesia thereby decreasing the chances of systemic toxicity of lignocaine. PATIENTS AND METHODS: Sixty adult patients of ASA grade I and II were divided into three equal groups of twenty each in randomized double blind manner. Group I patients received 40ml of 0.5% lignocaine. Group II and III received 40 ml of 0.25% lignocaine with addition of 2 mg Atracurium and 50 mg tramadol while in Group III, tramadol was replaced with 30 mg of Ketorolac. Onset of sensory and motor block, intraoperative degree of analgesia, intraoperative and postoperative complications were recorded in all the three groups. RESULTS: There was no significant difference between the groups with respect to age, weight and sex distribution. Mean time of onset of motor block in group I, II and III was 4.15+0.81, 11.7+0.86 and 14.2+0.69 minutes respectively which was statistically significant (p < 0.001). Mean time of onset of sensory block in groups I, II and III was 2.95+0.82, 8.75+1.20 and 11.05+1.04 minutes respectively which was also statistically significant. Intraoperative degree of analgesia in group II and III was comparable to group I. CONCLUSIONS: The use of 0.25% lignocaine and Atracurium with tramadol or Ketorolac provides comparable analgesia to 0.5% lignocaine used alone. This decreases the concentration and total dose of lignocaine required but delays the onset of both sensory and motor block.

Design and Development of In Vivo Robot for Biopsy

Mechanics Based Design of Structures and Machines, 2014

ABSTRACT In vivo robot is an emerging medical technology that could greatly help biopsy and surge... more ABSTRACT In vivo robot is an emerging medical technology that could greatly help biopsy and surgery. This paper proposes to design and develop a miniature in vivo robot for biopsy as an add-on to the current endoscope. To allow more dexterity and flexibility, a four degree of freedom (DOF) robot manipulator is proposed. Accordingly, a wire actuated robot with articulated links like in a snake robot has been conceptualized. The robot was mathematically modeled and designed. To test the design, a 4-scaled aluminum model was manufactured. The kinematics of the model is verified experimentally. The four degree of freedom of the miniature robot are: a linear motion of the flexible shaft (first DOF); an axial rotation of the flexible shaft (second DOF); planar through differential wire movement (third DOF); and a combined wire motion for clipper action to take biopsy (fourth DOF). The proposed robot manipulator was modeled in SolidWorks and the kinematic and dynamic analysis was performed using the Robotics Toolbox in MATLAB.

Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous verapamil

Acta Anaesthesiologica Scandinavica, 1989

This study was undertaken in surgical patients in order to evaluate the effects of intravenous ve... more This study was undertaken in surgical patients in order to evaluate the effects of intravenous verapamil on the circulatory responses to laryngoscopy and tracheal intubation. Laryngoscopy for tracheal intubation was initiated 1 min after thiamylal 5 mg. kg-I and succinylcholine 1.5 m g. kg-I in the control group (n=21). The verapamil group (n = 23) received intravenous verapamil 0.1 mg. kg-' immediately after thiamylalsuccinylcholine administration. The resulting changes in mean arterial pressure (MAP) and heart rate (HR) were continuously measured. Compared with the control group, MAP increased less in response to laryngoscopy and tracheal intubation (56+ 13% versus 25 15% above baselines, P<O.OI) and returned toward baseline sooner in patients receiving verapamil. For hypertensive patients, MAP increases from baseline after intubation were 18 5 9% in the verapamil group, and 53 ~t 14% in the control group, respectively (P<O.OOl). Increases in H R response to laryngoscopy for intubation were comparable in both groups. We conclude that intravenous verapamil is effective in reducing pressor responses during endotracheal intubation, especially in hypertensive patients.

Comparative Evaluation of Fastrach Silicone Wire-Reinforced Tube, Polyvinyl Chloride Tube and PVC Armoured Tube for Blind Tracheal Intubation through the Intubating Laryngeal Mask Airway

Background and Aims : The reusable Fastrach silicone wire reinforced tube (FTST) was designed for... more Background and Aims : The reusable Fastrach silicone wire reinforced tube (FTST) was designed for tracheal intubation through the intubating laryngeal mask airway (ILMA). The polyvinyl chloride (PVC) tube and the PVC armoured tube (PAT) are disposable, cheaper and readily available as compared to the FTST. Hence, we decided to compare the clinical performance of these 3 types of tubes for tracheal intubation through the ILMA. Methods : Ninety patients between 18-65 years with ASA class I and II and Mallampati Grading I and II undergoing elective surgery under general anaesthesia were enrolled for this prospective, randomised study. Patients were divided randomly into three groups consisting of 30 patients each, to undergo intubation by FTST, PVC, PAT tubes through an ILMA. Overall success rate, ease of insertion, the number of attempts for successful intubation, critical incidence during intubation and post-operative sore throat were compared. Data was compiled and analysed using ap...