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Hansda U, Mishra TS, Topno N, Sahoo S, Mohan S, Chakola S. Prehospital care and interfacility transfer of trauma patients before reaching the emergency of a level-1 trauma care center. J Family Med Prim Care 2024; 13:656-659. [PMID: 38605763 PMCID: PMC11006027 DOI: 10.4103/jfmpc.jfmpc_1271_23] [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: 08/03/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 04/13/2024] Open
Abstract
Background Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. Materials and Methods A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected. Results The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization. Conclusion The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care.
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Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Tushar S. Mishra
- Department of General Surgery, AIIMS, Bhubaneswar, Odisha, India
| | - Nitish Topno
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Sreshtaa Mohan
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Sebastian Chakola
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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Poddar KKD, Kumar P, Hansda U, Sethi MK, Mishra TS, Sasmal PK, Medhavi, Singh PK, Kumar R. On-demand (SOS) analgesia through Transversus Abdominis Plane (TAP) catheter route for post-operative pain relief in Emergency Laparotomies-a non-randomised interventional study (STAPLE trial). Langenbecks Arch Surg 2023; 408:325. [PMID: 37605091 DOI: 10.1007/s00423-023-03065-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION This study aimed to compare the efficacy and safety of on-demand bupivacaine infusion via transversus abdominis plane (TAP) catheter in emergency laparotomy patients. METHODS A non-randomised interventional study was conducted on patients undergoing emergency midline laparotomy. The intervention group received an on-demand infusion of 10 ml 0.5% bupivacaine through TAP catheters, whilst the control group received standard analgesic care. The primary outcome was the amount of rescue analgesic consumption. Secondary outcomes included the post-operative, measured by visual analogue scores (VAS), side effects, time to first flatus, post-operative nausea and vomiting, and pulmonary complications. RESULTS One-hundred-twenty patients (58 in the TAP-SOS group, 62 in the control group) were included in the final analysis. The TAP-SOS group showed significantly reduced rescue analgesic requirement by 91% (p < 0.001) and lower VAS scores at 3, 6, 12, and 24 h (adjusted p < 0.00). Time to out-of-bed mobilisation was significantly shorter in the TAP-SOS group by 12.47 h (p < 0.001), and post-operative pulmonary complications were lower by 75% (p < 0.05). There were no significant differences in bowel recovery, catheter-related complications, or post-operative morbidity. No incidences of catheter-site infection were reported on follow-up; however, the catheter tip-culture was positive in 3 (5.17%) patients. CONCLUSION On-demand bupivacaine infusion through a TAP catheter effectively reduced post-operative pain and opioid requirements in emergency laparotomy patients without complications. If an epidural is not an option, the TAP-SOS approach can be a helpful adjunct in implementing the ERAS protocol in an emergency since it allows for early ambulation and better pain management.
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Affiliation(s)
| | - Pankaj Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India.
| | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India
| | | | | | | | - Medhavi
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India
| | | | - Rahul Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India
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Sinha MK, Sahu S, Hansda U, Kumar A. End-to-Side Ileo-Sigmoid Anastomosis and Late Onset Gangrenous Diverticulitis: A Case Report. Cureus 2023; 15:e43441. [PMID: 37719581 PMCID: PMC10503664 DOI: 10.7759/cureus.43441] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
End-to-side ileo-sigmoid anastomosis converts the proximal colon into a blind intestinal segment which is excised during the surgery. If we do not resect the proximal colon, it is expected to behave like a colonic diverticulum, but direct evidence of this assumption is lacking. During an exploratory laparotomy, we detected an end-to-side ileo-sigmoid anastomosis and found that the proximal colon was gangrenous. The patient passed away during the postoperative period, yet their remarkably long period of symptom-free survival remained intriguing.
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Affiliation(s)
- Mithilesh K Sinha
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Shantanu Sahu
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Upendra Hansda
- Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Amarendra Kumar
- General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Shaji IM, Hansda U, Mohanty CR, Topno N, Varghese JJ, Sahoo S, Guru S. Efficacy of metoclopramide for prevention of gastric regurgitation during endotracheal intubation in the emergency department: A randomized controlled trial. Int J Crit Illn Inj Sci 2023; 13:92-96. [PMID: 38023576 PMCID: PMC10664037 DOI: 10.4103/ijciis.ijciis_80_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Gastric content regurgitation and aspiration are the dreaded complications of securing the airway. Cricoid pressure hinders intubation and causes lower esophageal sphincter (LES) relaxation. A recent study suggests no added benefit of cricoid pressure in preventing pulmonary aspiration of gastric contents. Metoclopramide increases LES tone, prevents gastroesophageal reflux, and increases antral contractions. Hence, we wanted to study the efficacy of metoclopramide for preventing gastric regurgitation during endotracheal intubation (ETI) in patients presenting to the emergency department (ED). Methods This study was a randomized controlled trial in patients requiring ETI in the ED. The study participants were randomized to receive either metoclopramide (intervention) 10 mg/2 ml intravenous (IV) bolus or a placebo of normal saline (placebo) 2 ml IV bolus 5 min before rapid sequence induction and intubation. The outcome of the study was the visualization of gastric regurgitation at the glottic opening during direct laryngoscopy at the time of intubation. Results Seventy-four study participants were randomized and allocated to the metoclopramide group (n = 37) or placebo group (n = 37). Gastric regurgitation at the glottis was noted in three study participants (8%) in the metoclopramide group, and six (16%) in the placebo group (odds ratio [OR] - 0.456; 95% confidence interval [CI] of 0.105-1.981; P = 0.295). The study participants who were intubated in the first attempt had less gastric regurgitation compared to ≥2 attempts (OR 0.031; 95% CI of 0.002-0.511; P = 0.015). Conclusion There was no decrease in regurgitation with metoclopramide as compared to placebo during ETI in study participants presenting to the ED.
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Affiliation(s)
- Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nitish Topno
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jithin Jacob Varghese
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satyabrata Guru
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Hansda U, Shaji IM, Uttanganakam S. Reply: Optic Nerve Sheath Diameter in Hyponatremia: A Closer Look. Indian J Crit Care Med 2023; 27:453. [PMID: 37378364 PMCID: PMC10291666 DOI: 10.5005/jp-journals-10071-24468] [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: 06/29/2023] Open
Abstract
How to cite this article: Hansda U, Shaji IM, Uttanganakam S. Reply: Optic Nerve Sheath Diameter in Hyponatremia: A Closer Look. Indian J Crit Care Med 2023;27(6):453.
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Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeed Uttanganakam
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Balmuchu G, Mohanty MK, Sahu MR, Hansda U, Naveen A, Lenka PK. Outcome prediction using sequential organ failure assessment (SOFA) score and serum lactate levels in organophosphate poisoning. J Family Med Prim Care 2023; 12:777-782. [PMID: 37312768 PMCID: PMC10259572 DOI: 10.4103/jfmpc.jfmpc_1713_22] [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] [Received: 08/27/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 06/15/2023] Open
Abstract
Background Organophosphorus compounds are widely used as pesticides in agriculture practicing countries like India. Since it is readily available and accessible, it is one of the most commonly used agents for suicidal poisoning. The current study was undertaken to evaluate the performance of the SOFA score (scoring system) and the serum lactate level (laboratory parameter) as a mortality predictor in organophosphorus poisoning. Material and Methods This prospective observational study was conducted at AIIMS, Bhubaneswar, for 17 months. The study population included all patients with an alleged history of ingestion of organophosphorus (OP) compounds reporting to the casualty. The receiver operating characteristic (ROC) curve and the logistic regression analysis were used for the analysis. Results In our study, 75 patients with OP poisoning were studied after satisfying the inclusion criteria. OP poisoning was commonly seen in married males aged 21-40 years. Twelve (16%) patients died during the process of treatment. There was a statistically significant difference in the mean SOFA score, serum lactate level, pH value, and mean duration of hospital stay between the discharged and the deceased patients. In the current study, the ROC curve analysis used to assess the predictor of the outcome of OP poisoning showed that the area under the curve for SOFA score and serum lactate level were 0.794 (95% CI 0.641-0.948) and 0.659 (95% CI 0.472-0.847), respectively. Conclusion Sequential Organ Failure Assessment (SOFA) score is significantly associated with the outcome of organophosphate poisoning and can be utilized to predict mortality.
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Affiliation(s)
- Govinda Balmuchu
- Department of Forensic Medicine and Toxicology, AIIMS, Bhubaneswar, Odisha, India
| | - Manoj K. Mohanty
- Department of Forensic Medicine and Toxicology, AIIMS, Bhubaneswar, Odisha, India
| | - Manas R. Sahu
- Department of Forensic Medicine and Toxicology, AIIMS, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Alagarasan Naveen
- Department of Forensic Medicine and Toxicology, SRM Medical College & Research Centre, Chengalpattu, Tamil Nadu, India
| | - Preetam K. Lenka
- Department of Forensic Medicine and Toxicology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
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Mitra JK, Hansda U, Bandyopadhyay D, Sarkar S, Sahoo J. The role of a combination of N-acetylcysteine and magnesium sulfate as adjuvants to standard therapy in acute organophosphate poisoning: A randomized controlled trial. Heliyon 2023; 9:e15376. [PMID: 37123961 PMCID: PMC10133766 DOI: 10.1016/j.heliyon.2023.e15376] [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] [Received: 06/26/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background Mortality in acute organophosphate (OP) poisoning remains high despite current standard therapy with atropine and oximes. Due to dose-limiting side effects of atropine, novel therapies are targeting other putative mechanisms of injury, including oxidative damage, to reduce atropine dosage. Objectives N-acetylcysteine (NAC) and magnesium sulfate (MgSO4) have different mechanisms of actions and should act synergistically in OP poisoning. In this study, we wanted to evaluate whether this novel combination, used as an adjuvant to standard care, could improve clinical outcomes. Methods The study was conducted in the Emergency Department and ICU of AIIMS Bhubaneswar (a tertiary care center and government teaching institute) between July 2019 and July 2021. Eighty-eight adult patients with history and clinical features of acute OP poisoning were randomly allocated (1:1) into two groups. The Study group received 600 mg NAC via nasogastric tube thrice daily for 3 days plus a single dose of 4 g Inj. MgSO4 IV on first day and the Control group received suitably matched placebo (double-blinding) - in addition to standard care in both the groups. The primary outcome measure was to compare the total dose of Inj. Atropine required (cumulative over the entire treatment duration) between the control group and the study group receiving NAC and MgSO4. The secondary outcome measures were lengths of ICU and hospital stays, need and duration of mechanical ventilation, the differences in BuChE activity, oxidative stress biomarkers - MDA and GSH levels, the incidences of adverse effects including delayed sequalae like intermediate syndrome and OPIDN, and comparison of mortality between the two groups. Results Data from 43 patients in Control and 42 patients in Study group was finally analyzed. The baseline parameters were comparable. Total atropine requirements were lower in the Study group [175.33 ± 81.25 mg (150.01-200.65)] compared to the Control [210.63 ± 102.29 mg (179.15-242.11)] [Mean ± SD (95% CI)], but was not statistically significant. No significant differences in any of the other clinical or biochemical parameters were noted. Conclusion The N-acetylcysteine and MgSO4 combination as adjuvants failed to significantly reduce atropine requirements, ICU/hospital stay, mechanical ventilatory requirements, mortality and did not offer protection against oxidative damage.
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Affiliation(s)
- Jayanta Kumar Mitra
- Department of Anesthesiology & Critical Care, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
- Corresponding author.
| | - Upendra Hansda
- Department of Trauma & Emergency, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Debapriya Bandyopadhyay
- Department of Biochemistry, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Satyaki Sarkar
- Department of Anesthesiology & Critical Care, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Joshna Sahoo
- Department of Anesthesiology & Critical Care, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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Hansda U, Uttanganakam S, Sahoo S, Shaji IM, Guru S, Topno N, Sahoo NK. Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study. Indian J Crit Care Med 2023. [DOI: 10.5005/jp-journals-10071-24438] [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: 04/03/2023] Open
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Patra S, Hansda U. Teaching Clinical Psychiatry in the Emergency Room: Is There a Room for Competency-Based Medical Education? Psychiatry 2023; 86:255-258. [PMID: 37549049 DOI: 10.1080/00332747.2023.2238572] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
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Mohanty CR, Varghese JJ, Panda R, Sahoo S, Mishra TS, Radhakrishnan RV, Topno N, Hansda U, Shaji IM, Behera SHP. Ultrasound-guided selective peripheral nerve block compared with the sub-dissociative dose of ketamine for analgesia in patients with extremity injuries. Am J Emerg Med 2023; 63:94-101. [PMID: 36332503 DOI: 10.1016/j.ajem.2022.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
STUDY OBJECTIVE To compare the analgesic efficacy of ultrasound-guided selective peripheral nerve block (PNB) and sub-dissociative dose ketamine (SDK) for management of acute pain in patients with extremity injuries presenting to the emergency department (ED). METHODS This prospective, open-label randomized clinical trial was conducted in the ED of a tertiary care Institute. The patients were provided with either ultrasound-guided selective PNB or SDK. The primary outcome was a reduction in pain in numerical rating scale (NRS) by at least 3 points without rescue analgesia. The secondary outcomes were the need for rescue analgesia, adverse events, and patient satisfaction on either arm. RESULTS A total of 111 patients with isolated traumatic extremity injuries were included in the final analysis. The NRS score was significantly lower in the PNB group compared to the SDK group at 30, 60,120, 180-, and 240-min post-intervention [group ∼ time interaction, F (5, 647) = 21.53, p ≤ 0.001]. All the patients in the PNB group exhibited primary outcome (NRS ≥3 reductions) at 30 min post-intervention compared with 36 (65%) in the SDK group [-1.02(-1.422,0.622)]. Rescue analgesia was required in 10 (18%) patients in the SDK group compared to none in the PNB group [0.663(0.277,1.050)]. The decrease in NRS score from baseline at 30 min was significantly higher in PNB groups compared to the SDK group [-2.166(-2.640, -1.692)]. The most common side effect reported in the SDK group was dizziness 35(64%), followed by nausea 15(27%). None of the patients in the PNB group reported any complications. Patient satisfaction was higher in the PNB group than SDK group. CONCLUSION The study provides evidence that ultrasound-guided PNB is superior to SDK in terms of its analgesic efficacy in the management of acute pain due to extremity injuries and is associated with higher patient satisfaction. The need for rescue analgesia was significantly less in the PNB group. SDK was associated with a high incidence of dizziness and nausea.
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Affiliation(s)
- Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Jithin Jacob Varghese
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ritesh Panda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | | | - Nitish Topno
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Shri Hari Priya Behera
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India; Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Guru S, Singh N, Sahoo S, Hansda U, Mohanty C. Comparison of endotracheal intubation with Macintosh versus King Vision video laryngoscope using coronavirus disease 2019 barrier box on manikins: A randomized crossover study. Turk J Emerg Med 2022; 22:149-155. [PMID: 35936952 PMCID: PMC9355073 DOI: 10.4103/2452-2473.348436] [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] [Received: 02/04/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied. OBJECTIVES: The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack–Lehane (CL) grade, and requirement of external laryngeal manipulation. METHODS: We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios. RESULTS: The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21–0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade. CONCLUSION: Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant.
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Affiliation(s)
- Satyabrata Guru
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Neha Singh
- Department of Anaesthesiology, AIIMS, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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Hansda U, Tripathy S, Sahoo AK, Panda I, Shetty AP, Mitra JK, Sanyal K, Venkateshan M, Paniyadi NK, Rao PB, Mahapatra S. Home Care of Tracheostomized Chronically Critically Ill Patients: A Study of Caregivers’ Burden and Comparison with the Burden of Palliative Care Patients in India. Indian J Crit Care Med 2022; 26:579-583. [PMID: 35719438 PMCID: PMC9160625 DOI: 10.5005/jp-journals-10071-24151] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronically critically ill (CCI) patients often have high costs of care and poor outcomes. Disease management programs offering home care may reduce costs but need buy-in from informal caregivers. An understanding of caregiver burden in this population is lacking. We aimed to study the caregiver burden, its change over time, and factors affecting it, in post-ICU tracheostomized patients. We compared the caregiver burden among CCI carers to that of palliative caregivers. Materials and methods Informal caregivers of thirty chronically critically ill tracheostomized patients (CGcci) were administered the Caregivers Burden Scale (CBS) tool at discharge, 2 and 4 weeks after discharge. A one-point assessment of burden was made in 30 caregivers of patients enrolled in Pain and Palliative care clinic (CGpc). Linear mixed models for repeated measures were used to analyze score of CGcci over time and compared to the burden in physical, psychologic, economic, time, and social domains between groups. Results All 60 caregivers were young (33–35 years), predominantly male, and children of the patients. Both CGcci and CGpc had moderate burden score of 60.5 (14.7) vs 61.5 (13), respectively. Physical burden (11.5 vs 8) was greater in CGcci (p = 0.001) compared to psychologic domain (10 vs 12.5) in CGpc (p = 0.01). Burden score over all domains in CGcci decreased rapidly from 67.5 (8) to 55 (16.5) (p = 0.001) in the first month after discharge. Conclusion Burden of care among caregivers of tracheostomized chronically critically ill patients is comparable to those of palliative caregivers and reduces significantly with time. CTRI 2020/11/029443 (registered on: 27/11/2020) How to cite this article Hansda U, Tripathy S, Sahoo AK, Panda I, Shetty AP, Mitra JK, et al. Home Care of Tracheostomized Chronically Critically Ill Patients: A Study of Caregivers’ Burden and Comparison with the Burden of Palliative Care Patients in India. Indian J Crit Care Med 2022;26(5):579–583.
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Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
- Upendra Hansda, Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, Phone: +91 6742476400, e-mail:
| | - Swagata Tripathy
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Alok Kumar Sahoo
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Itimayee Panda
- Department of Anaesthesiology, Bhubaneswar, Odisha, India
| | - Asha P Shetty
- Department of Child Health Nursing, College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jayanta Kumar Mitra
- Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kasturi Sanyal
- Department of Anaesthesiology, Bhubaneswar, Odisha, India
| | - Mahalingam Venkateshan
- Department of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nanda Kumar Paniyadi
- Department of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Parnandi Bhaskar Rao
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sujata Mahapatra
- Department of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Sahoo S, Sahoo J, Singh N, Hansda U, Guru S, Topno N. Point-of-care versus central laboratory measurements of electrolytes and hemoglobin: A prospective observational study in critically ill patients in a tertiary care hospital. Int J Crit Illn Inj Sci 2022; 12:160-164. [PMID: 36506927 PMCID: PMC9728077 DOI: 10.4103/ijciis.ijciis_2_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background A blood gas analyzer is a point-of-care (POC) testing device used in the Emergency Department (ED) to manage critically ill patients. However, there were differences in results found from blood gas analyzers for hemoglobin (Hgb) and electrolytes parameters. We conducted a comparative validity study in ED in patients who had requirements of venous gas analysis, complete blood count, and electrolytes. The objective was to find the correlation of Hgb, sodium (Na+), and potassium (K+) values between the blood gas analyzer and laboratory autoanalyzer. Methods A total of 206 paired samples were tested for Hgb, Na+, and K+. Total 4.6 ml of venous blood was collected from each participant, 0.6 ml was used for blood gas analysis as POC testing and 4 ml was sent to the central laboratory for electrolyte and Hgb estimation. Results The mean difference between POC and laboratory method was 0.608 ± 1.41 (95% confidence interval [CI], 0.41-0.80; P < 0.001) for Hgb, 0.92 ± 3.5 (95% CI, 0.44-1.40) for Na+, and 0.238 ± 0.62 (95% CI, -0.32-0.15; P < 0.001) for K+. POC testing and laboratory method showed a strong positive correlation with Pearson correlation coefficient (r) of 0.873, 0.928, and 0.793 for Hgb, Na+, and K+, respectively (P < 0.001). Conclusion Although there was a statistical difference found between the two methods, it was under the United States Clinical Laboratory Improvement Amendment range. Hence, starting the therapy according to the blood gas analyzer results may be beneficial to the patient and improve the outcome.
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Affiliation(s)
- Sangeeta Sahoo
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Jyotiranjan Sahoo
- Department of Community Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Neha Singh
- Department of Anesthesiology and Critical Care, AIIMS, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Upendra Hansda, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India. E-mail:
| | - Satyabrata Guru
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Nitish Topno
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India
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Sahoo S, Singh N, Mohanty CR, Hansda U, Sahoo J, Sahu A. Macintosh laryngoscope versus AMBU King Vision video laryngoscope for endotracheal intubation using a COVID-19 barrier box: A randomized controlled trial. Int J Crit Illn Inj Sci 2021; 11:151-155. [PMID: 34760661 PMCID: PMC8547677 DOI: 10.4103/ijciis.ijciis_34_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/22/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) barrier box is being used by health-care workers for protection against aerosol-transmitted infection. Usually, a Macintosh laryngoscope (MC) or a video laryngoscope (VL) is used for endotracheal intubation (ETI). We aimed to determine the most suitable laryngoscope blade in terms of time to ETI, ease of ETI, and the first-pass success rate. Methods American Society of Anesthesiologists Grade I and II patients undergoing surgery under general anesthesia were randomized into the MC and the King Vision VL groups in a 1:1 ratio. ETI was performed using either the MC (the MC group) or the King Vision VL (the VL group) with a COVID-19 barrier box. The first-pass intubation success rate, intubation time, and ease of ETI were analyzed. Results The first-pass success rate was higher in the MC group (P = 0.43). The mean duration of ETI was 33 s and 47 s in the MC group and VL group, respectively. The difference was statistically significant between the groups (P = 0.002). The ease of ETI was comparable between the groups (P = 0.57), and the Cormack-Lehane grade was significantly different between the groups (P = 0.0025). Conclusion ETI duration was shorter in the MC group than in the VL group. Hence, a MC can be used along with a COVID-19 barrier box by experienced operators for the prevention of aerosol spread.
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Affiliation(s)
- Sangeeta Sahoo
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Neha Singh
- Department of Anesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | | | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Jyotiranjan Sahoo
- Department of Community Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Ajitesh Sahu
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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Hansda U, Tripathy S, Paniyadi NK, Varghese JJ. Endotracheal tube as a conduit for difficult gastric feeding tube insertion in a tracheostomized patient. J Family Med Prim Care 2021; 10:3167-3168. [PMID: 34660467 PMCID: PMC8483118 DOI: 10.4103/jfmpc.jfmpc_255_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/20/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Swagata Tripathy
- Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | | | - Jithin J Varghese
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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16
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Mohanty CR, Radhakrishnan RV, Jain M, Sasmal PK, Hansda U, Vuppala SK, Doki SK. A Study of the Pattern of Injuries Sustained from Road Traffic Accidents Caused by Impact with Stray Animals. J Emerg Trauma Shock 2021; 14:23-27. [PMID: 33911432 PMCID: PMC8054802 DOI: 10.4103/jets.jets_29_20] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/07/2020] [Accepted: 07/07/2020] [Indexed: 11/04/2022] Open
Abstract
Background The incidence of road traffic accidents (RTA) is increasing every day, especially in developing nations. Amongst various attributable factors, the menace of the stray animals remains one of the most underrecognized factors leading to animal-vehicle collision (AVC). Objectives: Our prospective cross-sectional study aims to survey the incidence of RTA attributable to stray animals and record the pattern of injuries along with other epidemiological parameters. Methods The present study was conducted at a tertiary care trauma centre located in a major city of eastern India, between June 2019 and March 2020. Variables like demographic details, type of vehicle and injury with severity score, use of safety gear including types of stray animals were collected and analysed. Results A total of 185 patients had suffered RTA due to AVC during the study period. The median age of occurrence was 29.0 years. The evening was the most frequent time of accidents (4 PM to 8 PM) with two-wheelers affected in 92% of cases. Stray dogs account for 69% of cases followed by cattle 21% cases. 41% of all RTA victims had polytrauma. Patients with RTA due to impact with ox were found to have higher injury severity score (ISS). The ISS comparison between two-wheeler drivers with and without helmet and influence of alcohol were statistically significant (P<0.01). Conclusion The study highlights an alarming incidence of RTA due to stray animals roaming freely on roads, thus adding significant morbidity and costs to the society. There is a need of the hour for imposing stringent measures from the appropriate authority, including public awareness to make sustainable action plans to prevent animal homelessness and wander freely on streets and major roads.
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Affiliation(s)
- Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sunil Krishna Vuppala
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sunil Kumar Doki
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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17
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Hansda U, Sahoo S, Biswas S, Mohanty CR, Barik S, Giri PP. How much ambulance personnel know about basic life support (BLS)? A hospital-based study from Eastern India. J Family Med Prim Care 2020; 9:5601-5605. [PMID: 33532402 PMCID: PMC7842495 DOI: 10.4103/jfmpc.jfmpc_680_20] [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] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Basic life support (BLS) is an important component of emergency medical management. Ambulance personnel play a key role in resuscitation to save a life before reaching the hospital. We do not have any published data about the level of knowledge on BLS among the ambulance personnel. Objective: This study was done with the objective to assess the level of knowledge on BLS among the ambulance personnel. Materials and Methods: A cross-sectional study was done in the emergency department (ED) of a tertiary care hospital. Universal sampling was done taking all the personnel of ambulances over the period of one month. Data were collected about the type of vehicle used for ambulance, the number of personnel in an ambulance, educational qualifications, and equipment present in their ambulances. The questionnaire to capture the level of knowledge were based on American Heart Association 2015 guidelines. Result: The total number of ambulance arrivals was 729 times. But data analysis was done from 104 ambulances excluding the repeat arrivals and those who did not give consent. There were 62 type-C and D ambulances, and 42 were type-B ambulances. Total of 210 personnel were there in 104 ambulances. Seventy-nine team leaders did not have any paramedical degrees. Fifty-eight team leaders were trained in BLS before working in an ambulance. In spite of this, 66 (63%) team leaders had poor performance (score of 0 to 4). Conclusion: The level of knowledge on BLS was poor in more than half of the ambulance personnel. They should be trained regularly on providing BLS.
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Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sankalan Biswas
- Seventh Semester MBBS Student, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sadananda Barik
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prajna Paramita Giri
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Sahoo S, Hansda U, Mohanty CR, Mishra N. Modified aerosol box for endotracheal intubation: A safeguard for the frontline healthcare workers during COVID pandemic. J Family Med Prim Care 2020; 9:5802-5803. [PMID: 33532441 PMCID: PMC7842474 DOI: 10.4103/jfmpc.jfmpc_1235_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/08/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Sangeeta Sahoo
- Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, AIIMS Bhubaneswar, Odisha, India
| | | | - Nitasha Mishra
- Department of Anaesthesiology and Intensive Care, AIIMS Bhubaneswar, Odisha, India
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19
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Hansda U, Das PK, Sahoo S. Cesarean Section With Spinal Anesthesia in a Patient With Double Outlet Right Ventricle. J Cardiothorac Vasc Anesth 2019; 34:1394-1396. [PMID: 31784315 DOI: 10.1053/j.jvca.2019.10.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/21/2019] [Accepted: 10/26/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Kumar Das
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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20
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Agarwal J, Ganjoo P, Hansda U, Sharma MU, Tandon MS, Singh D. Perioperative concerns in neurosurgical patients with human immunodeficiency virus infection. Asian J Neurosurg 2016; 11:103-8. [PMID: 27057214 PMCID: PMC4802929 DOI: 10.4103/1793-5482.145050] [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: 12/03/2022] Open
Abstract
Background: The perioperative management of human immunodeficiency virus (HIV) infected patients undergoing neurosurgery is challenging due to the presence of HIV-related multi-system derangements, opportunistic infections and malignancies, history of substance abuse, and adverse effects of anti-retroviral therapy (ART), together with the inherent risks of neurosurgery. The possible adverse impact of HIV disease on the anesthetic outcome due to the associated co-morbidities, and conversely, the role of surgery and anesthesia in HIV disease progression due to their immunosuppressive effects, and also, the fear of HIV transmission among the attending medical personnel are the important perioperative concerns in such surgeries. Aim: To present our experience in the perioperative management of HIV-infected patients who underwent neurosurgery at our institute in the past 5 years and highlight the relevant perioperative issues. Materials and Methods: A retrospective analysis of the records of HIV-infected neurosurgical patients was undertaken to determine their HIV status and ART, anesthesia and surgery details, perioperative complications, and instances of postoperative worsening of HIV disease or its transmission, if any. Results: Seven HIV infected patients with variable severity of HIV infection and systemic disease underwent neurosurgery for different indications. Their perioperative management was modified in accordance with the co-morbidities and the type of neurosurgery. There was no obvious adverse impact of the HIV disease on the anesthetic outcome, no obvious clinical evidence of post-surgery worsening of the HIV disease, and no instance of HIV transmission in our patients. Conclusion: A goodunderstanding of the HIV disease and its perioperative implications during neurosurgery helps in better patient management and enables a safe outcome.
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Affiliation(s)
- Jyotsna Agarwal
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Pragati Ganjoo
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Upendra Hansda
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Megha U Sharma
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Monica S Tandon
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
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21
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Tripathy S, Hansda U, Seth N, Rath S, Rao PB, Mishra TS, Subba SH, Das R, Nayak S, Kar N. Validation of the EuroQol Five-dimensions - Three-Level Quality of Life Instrument in a Classical Indian Language (Odia) and Its Use to Assess Quality of Life and Health Status of Cancer Patients in Eastern India. Indian J Palliat Care 2015; 21:282-8. [PMID: 26600695 PMCID: PMC4617034 DOI: 10.4103/0973-1075.164896] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives: The EuroQol five-dimensions – 3-level (EQ5D) is a versatile quality of life (QOL) instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analog scale. It can be used to calculate quality-adjusted life years. We aimed to evaluate the validity, reliability, and responsiveness of an Odia version of EQ5D and to study the QOL of cancer patients in our part of the country as cancer treatment in India still focuses largely on longevity due to scarcity of resources. Materials and Methods: The EQ5D tool was translated into Odia language in collaboration with the EQ group. This tool and the World Health Organization-5 (WHO-5) questionnaires were administered to 155 surgical outpatients and 150 cancer patients in two hospitals of Eastern India. The convergent and discriminant validities (construct validity), concurrent validity, reliability (test-retest method of administering the tool to a part of the population after 7–14 days), and the internal consistency (Cronbach's alpha) were measured using preestablished hypotheses. The data from the cancer patients were analyzed separately. Results: The QOL worsened with age and was worse in cancer patients proved that the tool had good construct validity. The Anxiety Depression dimension had good correlation with all the dimensions WHO-5 (rho > 0.4) indicating a good concurrent validity. Internal consistency and reliability of the tool were good (Cronbach's alpha > 0.7). Cancer patients had a poor QOL (mean EQ5D index 0.37SD 0.4) with male patients, patients with Grade II cancer or referred for pain care services and those with living spouses reporting worse QOL. Conclusions: The Odia version of the EQ5D has good reliability and validity for the measurement of health status in cancer and outpatient department patients. Cancer patients in this part of the country have a poor QOL and may need a closer look at pain management and improved societal support systems.
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Affiliation(s)
| | - Upendra Hansda
- Department of Anaesthesia, Acharya Harihar Regional Cancer Centre AHRCC, Cuttack, India
| | - Newfight Seth
- Department of TEM Critical Care, Medical Student in 7th Semester, AIIMS, Bhubaneswar, India
| | - Satyajit Rath
- Department of General Surgery, AIIMS, Bhubaneswar, India
| | - P B Rao
- Department of Anaesthesia, AIIMS, Bhubaneswar, India
| | - T S Mishra
- Department of General Surgery, AIIMS, Bhubaneswar, India
| | - S H Subba
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, India
| | - Rekha Das
- Department of Anaesthesia, Acharya Harihar Regional Cancer Centre AHRCC, Cuttack, India
| | - Sukdev Nayak
- Department of Anaesthesia, AIIMS, Bhubaneswar, India
| | - Nilamadhab Kar
- Department of Psychiatry, Black County Partnership NHS Foundation Trust, Wolverhampton, UK ; Quality of Life Research and Development Foundation, Bhubaneswar, India
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Tempe D, Tomar AS, Agarwal S, Hansda U, Hasija S, Joshi CS, Malik I, Singh A. Use of Transthoracic Echocardiography Probe for Locating the Internal Jugular Vein to Assist Cannulation In Children and Its Comparison With the Standard Landmark Technique. MAMC J Med Sci 2015. [DOI: 10.4103/2394-7438.150055] [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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Abstract
Patients in the perioperative period and intensive care unit are commonly exposed to blood transfusion (BT). They are at increased risk of transfusion transmitted bacterial, viral and protozoal diseases. The risk of viral transmission has decreased steadily, but the risk of bacterial transmission remains same. Bacterial contamination is more in platelet concentrates than in red cells and least in plasma. The chances of sepsis, morbidity and mortality depend on the number of transfusions and underlying condition of the patient. Challenges to safe BT continue due to new emerging pathogens and various management problems. Strategies to restrict BT, optimal surgical and anaesthetic techniques to reduce blood loss and efforts to develop transfusion alternatives should be made. Literature search was performed using search words/phrases blood transfusion, transfusion, transfusion transmitted diseases, transfusion transmitted bacterial diseases, transfusion transmitted viral diseases, transfusion transmitted protozoal diseases or combinations, on PubMed and Google Scholar from 1990 to 2014.
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Affiliation(s)
- Rekha Das
- Department of Anaesthesiology, Acharya Harihar Regional Cancer Centre, Cuttack, Odisha, India
| | - Upendra Hansda
- Department of Anaesthesiology, Acharya Harihar Regional Cancer Centre, Cuttack, Odisha, India
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Abstract
Preoperative thrombocytosis, often detected incidentally in surgical patients and inadvertently overlooked, has important implications for the anesthesiologists. The primary form is a chronic clonal myeloproliferative disorder usually affecting adults while the secondary type is a benign reactive disease commonly found in children. Serious perioperative hemostatic complications are reported in primary thrombocytosis and hence, a detailed preoperative evaluation and initiation of therapy to lower the platelet count (PC) is required before undertaking surgery. Patients with reactive thrombocytosis however, usually have complication-free surgeries, and if there is no prior evidence of hemostatic complications and the reactive cause can be identified, no specific perioperative intervention may be required. A thorough preanesthetic checkup and implementation of basic thrombo-prophylaxis measures in all patients with a raised PC is advocated. We present here our experience with three infants diagnosed with high preoperative PC, presumably due to reactive causes, who underwent uneventful neurosurgeries at our institution.
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Affiliation(s)
- Kiranlata Kiro
- Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Pragati Ganjoo
- Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Deepti Saigal
- Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Upendra Hansda
- Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India
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Hansda U, Das R, Satapathy R, Mohanty S. Massive haemoptysis and endotracheal tube blockade during subclavian vein cannulation. Indian J Anaesth 2014; 58:353-4. [PMID: 25024491 PMCID: PMC4091014 DOI: 10.4103/0019-5049.135089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hansda U, Agarwal J, Patra C, Ganjoo P. Extradural hematoma surgery in a child with Hutchinson-Gilford progeria syndrome: Perioperative concerns. J Pediatr Neurosci 2013; 8:165-7. [PMID: 24082942 PMCID: PMC3783731 DOI: 10.4103/1817-1745.117860] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hutchinson–Gilford progeria syndrome (HGPS) is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult.
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Affiliation(s)
- Upendra Hansda
- Department of Anaesthesiology, SCB Medical College, Cuttack, India ; Department of Anaesthesiology Acharya Harihar Regional Cancer Centre, Cuttack, India
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