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Kapoor I, Prabhakar H, Mahajan C, Zirpe KG, Tripathy S, Wanchoo J, Kakkar G, Sapra H, Gupta N, Singhal V, Chaturvedi A. A Nationwide Survey on the Practice of End-of-life Care Issues in Critical Care Units in India. Indian J Crit Care Med 2023; 27:305-314. [PMID: 37214124 PMCID: PMC10196640 DOI: 10.5005/jp-journals-10071-24446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 05/24/2023] Open
Abstract
Background End-of-life (EOL) care is the care of terminally ill patients who are nearing their end. It includes important components like palliative care, supportive care, hospice care, patient's right to choose, and choice of medical intervention, including continuation of routine medical interventions. The aim of this survey was to assess the practices of EOL care in various critical care units in India. Methods The participants included clinicians involved in EOL care of patients with advanced diseases in different hospital across India. We sent blast emails and posted links on social media for inviting participants to take the survey. Study data were collected and managed by using Google Forms. The collected information was automatically entered into a spread sheet and stored in a secure database. Results In total, 91 clinicians took the survey. The years of experience, practice area, and setting had significant effect on the palliative care, terminal strategy, and prognostication in terminally ill patients (p < 0.05). Statistical analysis was done using software STATA. Descriptive statistics were performed, and results were presented as number (percentage). Conclusion The years of work experience, the practice area, and the practice setting have a strong impact on EOL care management of terminally ill patients. There are a lot of gaps in providing EOL care for these patients. Many reforms are needed in the Indian health care system to make EOL care better. How to cite this article Kapoor I, Prabhakar H, Mahajan C, Zirpe KG, Tripathy S, Wanchoo J, et al. A Nationwide Survey on the Practice of End-of-life Care Issues in Critical Care Units in India. Indian J Crit Care Med 2023;27(5):305-314.
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Affiliation(s)
- Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | | | - Swagata Tripathy
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jaya Wanchoo
- Department of Neuroanaesthesia and Neurocritical Care, Medanta The Medicity, Gurgaon, Haryana, India
| | - Gaurav Kakkar
- Department of Neuroanaesthesia and Neurocritical Care, Amrita Hospital, Faridabad, India
| | - Harsh Sapra
- Department of Neuroanaesthesia and Neurocritical Care, Medanta The Medicity, Gurgaon, Haryana, India
| | - Nidhi Gupta
- Department of Neuroanaesthesia, Indraprastha Apollo Hospital, New Delhi, India
| | - Vasudha Singhal
- Department of Neuroanaesthesia and Neurocritical Care, Medanta The Medicity, Gurgaon, Haryana, India
| | - Arvind Chaturvedi
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Kapoor I, Mahajan C, Zirpe KG, Samavedam S, Sahoo TK, Sapra H, Mani RK, Divatia JV, Ramasubban S, Prabhakar H. The Curing Coma Campaign ®: Concerns in the Indian Subcontinent. Indian J Crit Care Med 2023; 27:89-92. [PMID: 36865517 PMCID: PMC9973058 DOI: 10.5005/jp-journals-10071-24397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Background The Curing Coma Campaign (CCC) was launched by the Neurocritical Care Society (NCS) in 2019, with the purpose to bring together a diverse group of coma scientists, neurointensivists, and neurorehabilitationists. Methods The aim of this campaign is to move beyond the limitations imposed by current definitions of coma and identify mechanisms to improve prognostication, identify test therapies, and impact outcomes. At the moment, whole approach of the CCC appears ambitiously challenging. Results This could be true only for the Western world, such as the North America, Europe, and few developed countries. However, the whole concept of CCC may face potential challenges in the lower-middle income countries. India has several stumbling blocks that need to and can be addressed in the future, for a meaningful outcome, as envisaged in the CCC. Conclusion India has several potential challenges, which we aim to discuss in this article. How to cite this article Kapoor I, Mahajan C, Zirpe KG, Samavedam S, Sahoo TK, Sapra H, et al. The Curing Coma Campaign®: Concerns in the Indian Subcontinent. Indian J Crit Care Med 2023;27(2):89-92.
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Affiliation(s)
- Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
| | - Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
| | | | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospitals, Hyderabad, Telangana, India
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India
| | - Harsh Sapra
- Department of Neurocritical Care, Medanta – The Medicity, Gurugram, Haryana, India
| | - Raj Kumar Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Suresh Ramasubban
- Department of Pulmonary and Critical Care, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India,Hemanshu Prabhakar, Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India, Phone: +91 011 26593474, e-mail:
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Vijayananthan A, Bhurani D, Sapra H, Yasuda H, Kim JY, Hoerauf K, Mifflin N, Hong SK, Sheng WH, Terasaka Y. Asia-Pacific guidelines for standardization of appropriate selection, placement, and management of vascular access devices. J Vasc Access 2023:11297298221150664. [PMID: 36688479 DOI: 10.1177/11297298221150664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Vascular access devices (VADs) are common and essential in the healthcare setting. However, several factors influence VAD selection and management. Wide variations in VAD practices and the degree of VAD awareness are noted across Asia-Pacific (APAC) countries. An international panel was convened that applied the ASA 2020 method to develop standard criteria for use of VADs in the APAC region. After a literature search, scenarios related to VAD use, care, and maintenance were developed according to the patient population, indication for insertion, and duration of use. These scenarios were rated on a scale of 1-5 (1 being strongly disagreed and 5 strongly agreed) by 11 expert members. A total of 48 clinical scenarios were developed: 23 in hospitalized patients, 3 in critical patients, 4 in cancer settings, 7 pertinent to VAD placement, and 11 for VAD maintenance. The multidisciplinary panel generated several recommendations for the use, care, and management of VADs across general hospitalized patients with or without difficult venous access, critically ill patients, patients with malignancy, patients with different stages of chronic kidney disease (CKD) with or without dialysis, and in other special populations through evidence-based standards. These recommendations may help in achieving uniformity in practice patterns and improving the quality of VAD care and quality of life of patients in APAC region.
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Affiliation(s)
| | - Dinesh Bhurani
- Rajiv Gandhi Cancer Institute & Research Centre Sector 5, West Delhi, New Delhi, DL, India
| | - Harsh Sapra
- The Medicity Hospital, Gurgaon, Haryana, India
| | - Hideto Yasuda
- Department of Emergency and Critical care Medicine, Jichi Medical University Saitama Medical Center, Kyoto, Japan
| | - Jang Yong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Klaus Hoerauf
- VP Global Medical Affairs, Becton, Dickinson and Company, New York City Metropolitan Area, USA
| | - Nicholas Mifflin
- Clinical Nurse Consultant Central Venous Access & Parenteral Nutrition Liverpool Hospital, Liverpool, NSW, Australia, Adjunct Fellow School of Nursing & Midwifery Western Sydney University, Blacktown, NSW, Australia
| | - Suk Kyung Hong
- University of Ulsan College of Medicine: Songpa-gu, Seoul, Korea
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City
| | - Yusuke Terasaka
- Director of Emergency Department, Kyoto Katsura Hospital, Kyoto City, Kyoto Prefecture, Japan
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Sapra H. "No Time to Die" - Saving the Neurons. Indian J Crit Care Med 2022; 26:539-540. [PMID: 35719449 PMCID: PMC9160637 DOI: 10.5005/jp-journals-10071-24221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
How to cite this article: Sapra H. "No Time to Die" - Saving the Neurons. Indian J Crit Care Med 2022;26(5):539-540.
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Affiliation(s)
- Harsh Sapra
- Department of Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India,Harsh Sapra, Department of Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India, Phone: +91 9650898677, e-mail:
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Abstract
How to cite this article: Sapra H. Intensive Care Unit-acquiredWeakness: A Frequent but Under-recognized Threat. Indian J Crit Care Med 2021;25(9):969-971.
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Affiliation(s)
- Harsh Sapra
- Neuroanaesthesia and Neurocritical Care, Medanta: The Medicity, Gurugram, Haryana, India
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Zirpe KG, Dixit S, Kulkarni AP, Sapra H, Kakkar G, Gupta R, Bansal AR, Garg A, Dash SK, Gurnani A, Khan A, Khatib KI, Mare PR. Pathophysiological Mechanisms and Neurological Manifestations in COVID-19. Indian J Crit Care Med 2020; 24:975-980. [PMID: 33281325 PMCID: PMC7689109 DOI: 10.5005/jp-journals-10071-23592] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
With increasing knowledge of the coronavirus disease-2019 (COVID-19), we now understand that COVID-19 presents with various extrapulmonary manifestations with multi-organ involvement. Involvement of the central nervous system (CNS) occurs probably via transsynaptic spread or transfer across the blood-brain barrier. Hypoxia, immune-mediated injury, and vascular damage are the potential mechanisms for the CNS manifestations. Headache, dizziness, chemosensory disturbances, such as loss of smell, taste, encephalopathy, stroke, etc., are among the commonly encountered neurological presentations. Headache is identified as one of the red flag symptoms for COVID-19. Sudden onset of loss of smell and/or taste in the absence of nasal congestion can help in COVID-19 case identification and testing prioritization. Both hemorrhagic and ischemic brain injury is common in patients developing stroke. Besides these, COVID-19-associated CNS involvement demands more careful attention toward patients with existing neurological disorders especially that are managed with immunosuppressant agents. In all, neurological involvement in COVID-19 is not uncommon and may precede, occur concomitantly or after the respiratory involvement. It may also be the sole presentation in some of the patients necessitating high vigilance for COVID-19. In this review, we briefly discussed the pathogenesis of CNS involvement and some important neurological manifestations in COVID-19. How to cite this article: Zirpe KG, Dixit S, Kulkarni AP, Sapra H, Kakkar G, Gupta R, et al. Pathophysiological Mechanisms and Neurological Manifestations in COVID-19. Indian J Crit Care Med 2020;24(10):975-980.
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Affiliation(s)
| | - Subhal Dixit
- Department of CCM, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anesthesia, Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Harsh Sapra
- Department of Neurocritical Care, Medanta: The Medicity, Gurugram, Haryana, India
| | - Gaurav Kakkar
- Department of Neuroanaesthesia and Neurocritical Care, Medanta: The Medicity, Gurugram, Haryana, India
| | - Rahul Gupta
- Department of Neuro and Spine Surgery, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Atma Ram Bansal
- Department of Neuro Sciences, Medanta: The Medicity, Gurugram, Haryana, India
| | - Arun Garg
- Department of Neuro Sciences, Medanta: The Medicity, Gurugram, Haryana, India
| | - Santosh Kumar Dash
- Department of Neurology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anil Gurnani
- Department of Critical Care, Kailash Hospital, Noida, Uttar Pradesh, India
| | - Azizullah Khan
- Department of Critical Care, Prince Ali Khan Hospital, Mumbai, Maharashtra, India
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Kakkar G, Zirpe KG, Sapra H, Dixit S, Chugh C, Nagaiyan S, Kumar P. Practice Implications for Acute Ischemic Stroke during the COVID-19 Pandemic for the Indian Scenario: Realistic and Achievable Recommendations by the Society of Neurocritical Care (SNCC), India. Indian J Crit Care Med 2020; 24:757-762. [PMID: 33132556 PMCID: PMC7584840 DOI: 10.5005/jp-journals-10071-23511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
COVID-19 disease caused by the SARS coronavirus has caused significant morbidity and mortality around the world ever since it was first declared as a pandemic by the World Health Organization (WHO) in March 2020. Acute neurological manifestations of this disease have also started emerging and being recognized around the world and acute ischemic stroke (AIS) or thrombotic stroke is becoming one of the major neurological illnesses related to COVID-19. The management of AIS is time-critical and major advances in its management over the recent years, such as bridging thrombolysis and mechanical thrombectomy (MT), are multidisciplinary activities requiring robust coordination and management in the acute setting. All these advances are severely challenged in the COVID-19 pandemic where severe pressures exist on the clinical resources and logistics required to deliver an effective stroke service. This is further compromised by legal and preventive measures during this pandemic like local lockdowns. Reporting of minor or initial symptoms has also been compromised due to the fear of approaching healthcare settings which are perceived as high-risk zones to catch the infection. The purpose of this document is to highlight these challenges and provide a guiding framework for the management of AIS under three principles: (a) Delivering an effective service, (b) Preventing infections within the healthcare setting, and (c) Optimizing resource utilization. How to cite this article: Kakkar G, Zirpe KG, Sapra H, Dixit S, Chugh C, Nagaiyan S, et al. Practice Implications for Acute Ischemic Stroke during the COVID-19 Pandemic for the Indian Scenario: Realistic and Achievable Recommendations by the Society of Neurocritical Care (SNCC), India. Indian J Crit Care Med 2020;24(9):757-762.
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Affiliation(s)
- Gaurav Kakkar
- Department of Neuroanaesthesia and Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India
| | - Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Harsh Sapra
- Department of Neuroanaesthesia and Neurocritical Care, Medanta–The Medicity, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of CCM, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Chandril Chugh
- Department of Interventional Neurology, Max Superspecialty Hospital, Delhi, India
| | - Sridhar Nagaiyan
- Department of Critical Care, Kauveri Hospital, Chennai, Tamil Nadu, India
| | - Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Sapra H. Dyselectrolytemia as a Predictor of Prognosis in Subarachnoid Hemorrhage: In the Clink or Still in the Dock? Indian J Crit Care Med 2019; 23:545-546. [PMID: 31988543 PMCID: PMC6970208 DOI: 10.5005/jp-journals-10071-23313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Harsh Sapra
- Department of Anesthesiology, Medanta: The Medicity Hospital, Gurugram, Haryana, India
- Harsh Sapra, Department of Anesthesiology, Medanta: The Medicity Hospital, Gurugram, Haryana, India, Phone: +91 9650898577, e-mail:
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Bindu B, Sapra H, Singhal V. Treating an International Patient: An Uncommon Experience. Journal of Neuroanaesthesiology and Critical Care 2019. [DOI: 10.1055/s-0039-1693077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Barkha Bindu
- Department of Neuroanaesthesia and Critical Care, Medanta—The Medicity, Gurugram, Haryana, India
| | - Harsh Sapra
- Department of Neuroanaesthesia and Critical Care, Medanta—The Medicity, Gurugram, Haryana, India
| | - Vasudha Singhal
- Department of Neuroanaesthesia and Critical Care, Medanta—The Medicity, Gurugram, Haryana, India
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Abstract
How to cite this article: Sapra H, Singhal V. Managing Meningo-encephalitis in Indian ICU. Indian J Crit Care Med 2019;23(Suppl 2):S124-S128.
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Affiliation(s)
- Harsh Sapra
- Department of Neuroanesthesiology and Critical Care, Medanta - The Medicity, Gurugram, Haryana, India
| | - Vasudha Singhal
- Department of Neuroanesthesiology and Critical Care, Medanta - The Medicity, Gurugram, Haryana, India
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Mahajan A, Das B, Narang KS, Jha AN, Singh VP, Sapra H, Goel G. Surpass Flow Diverter in the Treatment of Ruptured Intracranial Aneurysms-A Single-Center Experience. World Neurosurg 2018; 120:e1061-e1070. [PMID: 30213677 DOI: 10.1016/j.wneu.2018.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Use of a Surpass flow diverter (FD) device in the treatment of acutely ruptured aneurysm has not been well studied and reported in the literature. METHODS We retrospectively reviewed patients with subarachnoid hemorrhage who were treated by Surpass FD placement at our hospital between June 2016 and March 2018. Detailed analysis of medical records was performed to obtain patient age, gender, clinical history, Hunt and Hess grade, Fisher grade, results of radiographic and procedural details including technical success and complication, clinical outcome, and follow-up angiographic results. RESULTS Our search identified 16 patients with 16 aneurysms who were treated with Surpass FD, of which 13 aneurysms (81%) were in the anterior circulation and 3 (19%) were in the posterior circulation. Aneurysm size ranged from 1.1 to 16 mm, with a mean of 4 mm. The mean delay between subarachnoid hemorrhage and endovascular treatment was 5 days (range, 3-20 days). Only 1 Surpass FD was used in each patient, ranging in size from 3 × 25 mm to 4 × 50 mm. Fifteen patients (94%) achieved favorable clinical outcome (modified Rankin Scale score 0-1) at 3 months. One patient died of invasive fungal infection. Angiographic follow-up results were assessed by O'Kelly-Marotta grading scale in 15 surviving patients and showed a grade D result (no filling) in 13/15 aneurysms (87%) at 3 and 6 months. CONCLUSIONS A Surpass FD device is a feasible option for the treatment of ruptured intracranial aneurysms that are difficult to treat by conventional clipping and coiling; however, larger and comparative studies with long-term follow-up are needed to confirm its safety and efficacy.
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Affiliation(s)
- Anshu Mahajan
- Department of Neurointerventional surgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Biplab Das
- Department of Neurointerventional surgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Karanjit Singh Narang
- Department of Neurosurgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Ajaya Nand Jha
- Department of Neurosurgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Varindera Paul Singh
- Department of Neurosurgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Harsh Sapra
- Department of Neuroanaesthesia and Critical Care, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Gaurav Goel
- Department of Neurointerventional surgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
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Jain V, Sapra H, Bansal A. Refractory Seizures and Difficult Venous Cannulation: An Intensivist Nightmare! Journal of Neuroanaesthesiology and Critical Care 2018. [DOI: 10.1055/s-0038-1660960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Varun Jain
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Sapra
- Department of Neuroanaesthesia and Critical Care, Medanta-The Medicity, Gurugram, Haryana, India
| | - Atamaram Bansal
- Department of Neurology, Medanta-The Medicity, Gurugram, Haryana, India
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Jain V, Sapra H, Bhangale D. Systemic Intravenous Thrombolysis for Massive Pulmonary Embolism after Intracranial Surgery for Traumatic Head Injury: When Absolute Becomes Relative! Journal of Neuroanaesthesiology and Critical Care 2018. [DOI: 10.1055/s-0038-1654752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
AbstractIntravenous thrombolysis is the preferred treatment for massive pulmonary embolism with hemodynamic instability, when there are no contraindications to the therapy. However, when absolute contraindications to thrombolysis are present, clinicians are at a crux, especially when mechanical thrombectomy is also not possible. We present a case of a 40-year-old man with polytrauma with head injury who developed massive pulmonary embolism requiring intravenous thrombolysis on day 15 after decompressive craniotomy—possibly a first in the literature. The patient, however, successfully recovered from this near-fatal episode. With this report, we wish to highlight that at a near-dying situation, no contraindication is absolute, and all possible efforts must be made by the clinician to save the patient.
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Affiliation(s)
- Varun Jain
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Sapra
- Department of Neuroanaesthesiology and Critical Care, Medanta—The Medicity, Gurugram, Haryana, India
| | - Deepak Bhangale
- Department of Neurosurgery, Medanta—The Medicity, Gurugram, Haryana, India
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Mahajan A, Das B, Goel G, Garg A, Sapra H. Carotid stump syndrome treated with endovascular coiling: A rare cause of stroke in young patients. Neurol India 2018; 66:228-229. [PMID: 29322990 DOI: 10.4103/0028-3886.222861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anshu Mahajan
- Department of Neurointervention, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Biplab Das
- Department of Neurointervention, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Gaurav Goel
- Department of Neurointervention, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Arun Garg
- Department of Neurology, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Harsh Sapra
- Department of Neuroanaesthesia, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
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Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical radiographic diagnosis of heterogeneous etiologies. The pathogenesis of PRES remains unclear, but may be related to impaired cerebral autoregulation and endothelial dysfunction. We present a case of intravascular nonionic contrast-induced PRES observed after cerebral angiography. The index patient was a follow-up case of large vertebrobasilar artery-dissecting aneurysm for which endovascular coiling was done 6 months back. She improved completely within a week. Contrast-induced PRES is a reversible benign condition, knowledge of which is crucial for appropriate management.
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Affiliation(s)
- Biplab Das
- Department of Neurointervention, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Gaurav Goel
- Department of Neurointervention, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Anshu Mahajan
- Department of Neurointervention, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Atma Ram Bansal
- Department of Neurology, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Harsh Sapra
- Department of Neuroanesthesia, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
| | - Ajaya Nanda Jha
- Department of Neurosurgery, Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India
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Sapra H, Kakkar G. Report of the 3rd Annual Medanta Neuro Critical Care conference held at Medanta - The Medicity, Gurgaon from 31st March 2017 to 2nd April 2017. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.4103/jnacc-jnacc-36.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Harsh Sapra
- Department of Neuroanaesthesia and Neurocritical Care, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Gaurav Kakkar
- Department of Neuroanaesthesia and Neurocritical Care, Medanta - The Medicity, Gurgaon, Haryana, India
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Kakkar G, Sapra H. Report of the 3 rd Annual Medanta Neuro Critical Care conference held at Medanta - The Medicity, Gurgaon from 31 st March 2017 to 2 nd April 2017. J Neuroanaesthesiol Crit Care 2017. [DOI: 10.4103/jnacc.jnacc_36_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- Tumul Chowdhury
- Department of Neuroanesthesiology and Neurocritical Care, Medanta Institute of Critical Care and Anesthesiology, Gurgaon, Haryana, India
| | - Harsh Sapra
- Department of Neuroanesthesiology and Neurocritical Care, Medanta Institute of Critical Care and Anesthesiology, Gurgaon, Haryana, India
| | - Sudhir Dubey
- Department of Neuroanesthesiology and Neurocritical Care, Medanta Institute of Critical Care and Anesthesiology, Gurgaon, Haryana, India
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Gupta V, Goel G, Parthasarathy R, Gupta A, Anand S, Sapra H, Jha A. E-025 continuous intra arterial dilatation with combination of nimodipine and milrinone in severe and refractory vasospasm. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Anand S, Sapra H. Minutes of Medanta Neurocritical Care Conference 2014. Journal of Neuroanaesthesiology and Critical Care 2014. [DOI: 10.4103/2348-0548.139125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Saurabh Anand
- Consultant, Associate Director, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Harsh Sapra
- Associate Director, Medanta, The Medicity, Gurgaon, Haryana, India
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Abstract
Routine investigation of serum calcium is not recommended in ASA one and two patients unless abnormalities of calcium metabolism are clinically suspected. The clinical features of hypocalcaemia can often be subtle and may manifest in the presence of associated factors. Hypoparathyroidism, an important cause of hypocalcaemia, often presents as soft tissue calcification (ostosis). Ligamentum flavum ostosis can present with compressive myelopathy requiring laminectomy. We report a case of ligamentum flavum ostosis and subclinical hypocalcaemia due to hypoparathyroidism, who went undetected pre-operatively resulting in significant post-operative morbidity.
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Affiliation(s)
- Ashish Chakravarty
- Department of Neuroanaesthesiology and Critical Care, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Saurabh Anand
- Department of Neuroanaesthesiology and Critical Care, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Harsh Sapra
- Department of Neuroanaesthesiology and Critical Care, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Yatin Mehta
- Department of Neuroanaesthesiology and Critical Care, Medanta, The Medicity, Gurgaon, Haryana, India
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada
| | - Keshav Goyal
- Department of Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Sapra
- Department of Neuroanesthesiology and Neurocritical Care, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
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Sharma R, Mehta Y, Sapra H. Severe aortic stenosis and subarachnoid hemorrhage: Anesthetic management of lethal combination. J Anaesthesiol Clin Pharmacol 2013; 29:255-7. [PMID: 23878455 PMCID: PMC3713681 DOI: 10.4103/0970-9185.111662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.
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Affiliation(s)
- Rakesh Sharma
- Department of Anaesthesia and Critical Care, Medanta-The Medicity, Gurgaon, Haryana, India
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Affiliation(s)
- Sachidanand Jee Bharati
- Department of Anesthesiology, IRCH, All India Institute of Medical Sciences, New Delhi, India
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Anand S, Bhatia A, Rajkumar, Sapra H, Gupta V, Mehta Y. Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study. Saudi J Anaesth 2013; 6:358-62. [PMID: 23493652 PMCID: PMC3591554 DOI: 10.4103/1658-354x.105865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: It has been postulated that Multiple sclerosis (MS) stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as The “Liberation Procedure”. Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure. Aims: To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure. Settings and design: A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC) who will receive dexmedetomidine as an anesthetic agent. Methods: A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2–0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, “How would you rate your experience with the sedation you have received during surgery?” using a seven-point Likert-like verbal rating scale. Statistical analysis: Repeated measurements were analyzed by repeated measures ANOVA for HR and BP. Results: Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant. Conclusions: Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.
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Affiliation(s)
- Saurabh Anand
- Institute of Critical Care and Anaesthesia Medanta, The Medicity, Gurgaon, Haryana, India
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Affiliation(s)
- Tumul Chowdhury
- Department of Neuroanesthesiology and Neurocritical Care, Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity Hospital, Sector-38, Gurgaon, Haryana, India
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Bansal A, Das J, Kumar R, Khanna S, Sapra H, Mehta Y. Combined mucopolysaccharidosis type VI and congenital adrenal hyperplasia in a child: Anesthetic considerations. J Anaesthesiol Clin Pharmacol 2012; 28:364-7. [PMID: 22869947 PMCID: PMC3409950 DOI: 10.4103/0970-9185.98343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We present a child posted for magnetic resonance imaging of brain under general anesthesia with the rare combination of mucopolysachharidosis type VI and congenital adrenal hyperplasia. The presence of both these disorders has important anesthetic implications. The pathophysiology of this rare combination of disease is reviewed with emphasis on the anesthesia management.
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Affiliation(s)
- Abhishek Bansal
- Medanta Institute of Critical Care and Anaesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
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Sapra H, Farling P. A response to 'The Glidescope system: a clinical assessment of performance'. Anaesthesia 2005; 60:524. [PMID: 15819794 DOI: 10.1111/j.1365-2044.2005.04212.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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