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Lazar MS, Ganesh V, Naik B N, Singh A, Puri GD, Kaur S. Efficacy of remote audio-visual system versus standard onsite buddy system to monitor the doffing of personal protective equipment during COVID-19 pandemic: An observational study. Int J Health Plann Manage 2024; 39:530-540. [PMID: 38163283 DOI: 10.1002/hpm.3754] [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: 10/22/2022] [Revised: 09/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Literature states a higher self-contamination rate among healthcare workers (HCWs) while doffing personal protective equipment (PPE). During the Covid-19 pandemic, onsite trained observers were not always available to monitor PPE compliance. The remote audio-visual doffing surveillance (RADS) system has the potential to overcome this limitation. We aimed to compare the efficacy of this real-time RADS system against the onsite buddy system for monitoring the doffing of PPE. METHODS This prospective, observational study was carried out at our tertiary care centre in northern India. 200 HCWs who cared for Covid-19 patients in the intensive care units/operation theatres were included. Group A included HCWs who performed doffing with the help of an onsite trained observer and group B included HCWs who performed doffing with the RADS system. An independent observer noted the error at any step using the CDC doffing checklist, in both groups. An online questionnaire to analyse the level of satisfaction post-doffing was also surveyed. RESULTS The proportion of errors committed during doffing was significantly lower in group B compared to group A with a low relative risk of 0.34 (95% CI 0.22-0.51) (p < 0.001) (Figure 1A,B). In both groups, there was no difference in HCWs feedback regarding the ease of the system and fear of committing an error. Though the perceived quality of monitoring was felt better with onsite buddy, the overall confidence rating of being safe after doffing was better with the RADS system. CONCLUSION Real-time RADS system may be more effective than the onsite buddy system for ensuring the safety of HCWs during doffing PPE. HCWs level of satisfaction related to the ease and anxiety with the monitoring systems were comparable. RADS system can reduce reliance on HCW resources and can integrate well into existing healthcare systems.
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Affiliation(s)
- Michelle Shirin Lazar
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkata Ganesh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Naik B
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sharma A, Puri GD, Chauhan R, Luthra A, Khurana G, Hazarika A, Meena SC. Nitrous oxide splurge in a tertiary health care center and its environmental impact: No more laughing stock. J Dent Anesth Pain Med 2024; 24:67-73. [PMID: 38362258 PMCID: PMC10864711 DOI: 10.17245/jdapm.2024.24.1.67] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Nitrous oxide has been an integral part of surgical anesthesia for many years in the developed world and is still used in developing countries such as India. The other main concerns in low-resource countries are the lack of an advanced anesthesia gas-scavenging system and modular surgical theatres. As a greenhouse gas that has been present in the atmosphere for more than 100 years and damages the ozone layer, nitrous oxide is three times worse than sevoflurane. Here, we conducted an observational study to quantify the annual nitrous oxide consumption and its environmental impact in terms of carbon dioxide equivalence in one of busiest tertiary health care and research centers in Northern India. Methods Data related to nitrous oxide expenditure' from the operation theatre and manifold complex of our tertiary care hospital and research center from 2018 to 2021 were collected monthly and analyzed. The outcomes were extracted from our observational study, which was approved by our institutional ethics board (INT/IEC/2017/1372 Dated 25.11.2017) and registered prospectively under the Central Registry (CTRI/2018/07/014745 Dated 05.07.2018). Results The annual nitrous oxide consumption in our tertiary care hospital was 22,081.00, 22,904.00, 17,456.00, and 18,392.00 m3 (cubic meters) in 2018, 2019, 2020, and 2021, respectively. This indicates that the environmental impact of nitrous oxide (in terms of CO2 equivalents) from our hospital in 2018, 2019, 2020, and 2021 was 13,016.64, 13,287.82, 10,289.94, and 10,841.24 tons, respectively. Conclusion This huge amount of nitrous oxide splurge is no longer a matter of laughter, and serious efforts should be made at every central and peripheral health center level to reduce it.
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Affiliation(s)
- Amit Sharma
- Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - GD Puri
- Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Rajeev Chauhan
- Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ankur Luthra
- Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Gauri Khurana
- Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Ghosh A, Goyal K, Singh R, Lakshmi PVM, Kaur R, Kumar V, Muralidharan J, Puri GD, Ram J, Singh MP. High prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among unvaccinated children of Chandigarh, Northwest India, in a household-based paediatric serosurvey post-second wave of pandemic (June to July 2021). Public Health 2023; 225:160-167. [PMID: 37931485 DOI: 10.1016/j.puhe.2023.10.010] [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: 06/13/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Current national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination policy covers children aged >12 years. Unvaccinated, uninfected children remain susceptible to SARS-CoV-2 and play a role in community transmission, as paediatric infection is mostly mild or asymptomatic. To estimate the proportion of susceptible children in a community for public health measures, there is a need to assess the extent of natural infection. STUDY DESIGN We performed a cross-sectional household serosurvey of SARS-CoV-2 antibodies in unvaccinated children aged between 6 and 18 years after the second COVID-19 wave. METHODS Anti-SARS-CoV-2 immunoglobin G (IgG) testing in serum was done using chemiluminescence immunoassay. We used a logistic regression model to investigate predicted factors of seropositivity. RESULTS We observed a high prevalence (weighted average: 68.3%) of anti-SARS-CoV-2 IgG in 2700 enrolled children. Logistic regression for predictors of IgG seropositivity showed lower odds in households with completely vaccinated adults (adjusted odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.26-0.71, P = 0.0011) compared with households with unvaccinated adults. Other factors for low seropositivity included frontline workers as family members (adjusted OR: 0.69, 95% CI: 0.52-0.91, P = 0.0091) and non-crowded households (adjusted OR: 0.74, 95% CI: 0.61-0.89, P = 0.0019). CONCLUSION A high SARS-CoV-2 IgG prevalence in unvaccinated children was indicative of previous exposure to potentially infected contacts. This implies in-person academic activities for children can be continued during future community transmission. Comparatively lower seropositivity in children of completely vaccinated households or frontline workers suggests decreased transmission due to vaccination-induced immunity of family members. Vaccination will still be required in these children to maintain protective IgG levels, particularly in low seroprevalence groups.
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Affiliation(s)
- A Ghosh
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - K Goyal
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - R Singh
- Department of Community Medicine & School of Public Health, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine & School of Public Health, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - R Kaur
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - V Kumar
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - J Muralidharan
- Advanced Pediatric Centre, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesiology & Critical Care, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - J Ram
- Department of Ophthalmology, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - M P Singh
- Department of Virology, Post-graduate Institute of Medical Education & Research, Chandigarh, India.
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Kaur S, Singh A, Saini S, Rohilla L, Kaur J, Chandi A, Kaur G, Singh M, Kumar P, Soni SL, Kajal K, Naik NB, Malhotra P, Verma S, Gupta M, Devnani M, Das K, Pandav SS, Puri GD. Authors' response. Indian J Med Res 2022; 0:356308. [PMID: 36124502 DOI: 10.4103/0971-5916.356308] [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)
- Sukhpal Kaur
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - Ajay Singh
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Sushma Saini
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - Latika Rohilla
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - Jasvir Kaur
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - Anadeep Chandi
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Gurpreet Kaur
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - Manjeet Singh
- Department of Medicine, Government Multispeciality Hospital, Chandigarh 160 012, India
| | - Pramod Kumar
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - Shiv Lal Soni
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Kamal Kajal
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Naveen B Naik
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Sanjay Verma
- Department of Paediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Madhu Gupta
- Department of Community Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Mahesh Devnani
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Karobi Das
- Department of Nursing, National Institute of Nursing Education, Chandigarh 160 012, India
| | - S S Pandav
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - G D Puri
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
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Gupta P, Biswal M, Kaur R, Kaur K, Kaur H, Kaur M, Mahajan V, Puri GD, Guru RR, Kaushal V. Quantification of diurnal variation in “glove hygiene” compliance in COVID ICUs: an exploratory study. Am J Infect Control 2022; 51:372-375. [PMID: 35908730 PMCID: PMC9334865 DOI: 10.1016/j.ajic.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 12/01/2022]
Abstract
Background Hand hygiene compliance (HHC) monitoring is almost always done in daytime. Documentation of HHC in health care workers (HCWs) is limited during odd hours and nighttime. The objective of the study was to determine diurnal variation in HHC in different categories of health care workers in tertiary care hospital in North India. Methods A prospective, observational study was conducted in 3 COVID-19 intensive care units (ICUs) with closed-circuit television (CCTV) cameras. Dedicated infection control nurses monitored HHC among various HCWs (doctors, nursing staff, technicians, hospital and sanitary attendants) during day and nighttime, in 20-minute durations. The difference in HHC by-professional category and for each WHO moment was assessed using χ² test and P value. Results A total of 705 opportunities were observed over a period of 7 days, with overall compliance of 53%. Day and nighttime compliance was recorded to be 60.7% and 42.1%, respectively (P < .001). HCC was highest amongst resident doctors with little diurnal variation. However, nurses and housekeeping staff exhibited significant diurnal variation. The compliance at “after” moments was much higher than “before” moments in all professional categories. Conclusion There was a significant decrease in compliance during nighttime, amongst all HCWs, with maximum variation exhibited by nursing staff. The present study underlines the importance of monitoring HHC at odd hours, to elicit a more accurate picture round the clock. Health care facilities monitoring compliance only during the daytime may substantially overestimate HHC.
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Affiliation(s)
- Parakriti Gupta
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
| | - Rupinder Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Kulbeer Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Harinder Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Manjinder Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Varun Mahajan
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - G D Puri
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Rashmi R Guru
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vipin Kaushal
- Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Singh A, Dhir A, Kajal K, Naik NB, Lazar MS, Puri GD, Soni SL, Neupane A, Ganesh V, Kaloria N, Saini K, Hazarika A, Mahajan V, Singla K, Bhalla A. Incidence & outcomes of clinically significant bleeding events in critically ill COVID-19 patients receiving Therapeutic dose AntiCoagulanTs: A retrospective cohort study (INTerACT study). Indian J Med Res 2022; 155:526-537. [PMID: 36124497 PMCID: PMC9807207 DOI: 10.4103/ijmr.ijmr_2292_21] [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: 02/04/2023] Open
Abstract
Background & objectives The high mortality associated with the thrombotic events in hospitalized COVID-19 patients resulted in the usage of anticoagulants in varying doses. Whether high-dose anticoagulants have led to better outcomes or higher incidence of clinically significant bleeding events is debatable. Thus, this study was conducted to find the incidence of clinically significant bleeding events in moderate-to-severe COVID-19 ARDS (acute respiratory distress syndrome) patients on therapeutic anticoagulation and their outcomes. Methods In this retrospective, single-centre study of 155 critically ill COVID-19 patients, the incidence of clinically significant bleeding was observed. Multivariate regression models were used to evaluate the association between anticoagulant regimen, coagulation and inflammatory markers with the incidence of bleeding and thrombotic events. Results The incidence of clinically relevant non-major bleeding was 33.54 per cent (26.17-41.46%) and major bleeding was 9.03 per cent (5.02-14.69%). The anticoagulation intensity at baseline had a high odds of major bleeding when enoxaparin and dual antiplatelet therapy were used together [adjusted odds ratio OR of 434.09 (3.81-49502.95), P<0.05]. At admission, bleeders had a poorer PaO2/FiO2 ratio with more patients on invasive ventilation. At the time of bleeding, the bleeders had a higher D-dimer, ferritin, C-reactive protein and procalcitonin compared to non-bleeders. The subhazard ratio for death in bleeders was 3.35 (95% confidence interval, 1.97-5.65; P<0.001). Interpretation & conclusions The incidence of bleeding in critically ill COVID-19 patients on therapeutic anticoagulation may increase with the severity of the disease as well as with concurrent use of dual antiplatelets. Major bleeding may also contribute to higher mortality.
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Affiliation(s)
- Ajay Singh
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankita Dhir
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Naveen B. Naik
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Michelle Shirin Lazar
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - G. D. Puri
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shiv Lal Soni
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Adhip Neupane
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Venkata Ganesh
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India,For correspondence: Dr Venkata Ganesh, Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160 012, India e-mail:
| | - Narender Kaloria
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kulbhushan Saini
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amarjyoti Hazarika
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Varun Mahajan
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Karan Singla
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Kaur S, Singh A, Saini S, Rohilla L, Kaur J, Chandi A, Kaur G, Singh M, Kumar P, Soni SL, Kajal K, Naik NB, Malhotra P, Verma S, Gupta M, Devnani M, Das K, Pandav SS, Puri GD. Reporting adverse events of ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) among the vaccinated healthcare professionals: A cross-sectional survey. Indian J Med Res 2022; 155:123-128. [PMID: 35859438 PMCID: PMC9552383 DOI: 10.4103/ijmr.ijmr_1221_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/05/2023] Open
Abstract
Background & objectives The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization.
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Affiliation(s)
- Sukhpal Kaur
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sushma Saini
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - Latika Rohilla
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - Jasvir Kaur
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - Anadeep Chandi
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gurpreet Kaur
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - Manjeet Singh
- Department of Medicine, Government Multispeciality Hospital, Chandigarh, India
| | - Pramod Kumar
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - Shiv Lal Soni
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Naveen B Naik
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sanjay Verma
- Department of Paediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mahesh Devnani
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Karobi Das
- Department of Nursing, National Institute of Nursing Education, Chandigarh, India
| | - S S Pandav
- Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Gupta R, Naik BN, Ganesh V, Singh A, Soni SL, Puri GD. Evaluation of utility and usefulness of webinars on COVID-19 management: a questionnaire-based survey. Ain-Shams J Anesthesiol 2021. [PMCID: PMC8527289 DOI: 10.1186/s42077-021-00187-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The COVID-19 pandemic and its consequent “social distancing” has fueled the use of social media platforms for educational purposes. Since the start of the pandemic, a plethora of experts and self-proclaimed experts have been keenly delivering webinars on COVID. This begs the question “Do webinars on COVID-19 really help in the improvement of knowledge base or management skills?”. The questionnaire was designed to assess information regarding COVID-webinars and their usefulness from the end-user standpoint. The response to the questions was measured using a 4- or 5-point Likert scale. The survey was open for a 4-week period with the extension of 1 week. Results The response rate was 54% as 270 out of 500 participants responded to the questionnaire. The majority of the respondents were anesthesiologists in-training, post-graduates, fellows, and seniors belonging to tertiary care settings with fewer percentages belonging to physicians and others. Most of the doctors had attended an average of 2 webinars per week. The tests of model effects showed a significant negative correlation of webinar quality ratings for district hospital healthcare setting of the attendees (of p value of 0.013) and for the number of COVID-related webinars attended per week (p value of 0.009). Conclusions Most respondents had favorable perceptions of webinars happening during the pandemic. However, there is a need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.
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Puri GD, Meena SC, Sinha V, Hazarika A, Hakkim H, Sharma A, Kajal K, Dogra N. Quantitative Assessment of Nitrous Oxide Levels in Room Air of Operation Theaters and Recovery Area: An Observational Study. Indian J Occup Environ Med 2021; 25:147-151. [PMID: 34759601 PMCID: PMC8559877 DOI: 10.4103/ijoem.ijoem_44_19] [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] [Received: 07/22/2019] [Revised: 03/09/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Nitrous oxide has been used during surgical anesthesia for many years. However, information about occupational exposure and related risks due to N2O exposure to the health care personnel in India are still poorly understood. Here, we measured the residual N2O levels during the working time of operation theatre room air in our tertiary care hospital. Material and Methods: The air samples were collected from different anesthesia exposure zones on different days for quantitative analysis of available N2O in the room air in respective areas. Nitrous oxide concentrations in the ambient air were also measured to compare outdoor and indoor levels. Observations and Results: Nitrous oxide mixing ratios were found to be 65.61 ± 0.05 ppm, 281.63 ± 0.43 ppm, and 165.42 ± 0.42 ppm in elective surgical theatres of the hospital on three different days whereas in emergency operation theatres of the same hospital levels of N2O were 166.75 ± 0.07 ppm, 510.19 ± 0.30 ppm and 2443.92 ± 0.64 ppm during same period. In elective pediatric surgical theatres levels of N2O were found to be 1132.55 ± 0.70 ppm and 362.21 ± 0.13 ppm on two days of reading respectively. Outdoor levels of N2O in contrast found 0.32 ± 0.01 ppm and was lower by a factor of 1000. Conclusion: We observed the very high ambient concentration of N2O in the surgical theatre's environment (up to 2443 ppm) and recovery areas (up to 50 ppm). It was 5 to 50 times higher ambient concentration of N2O than REL in OT area and 200-7000 times higher ambient concentration of N2O than outdoor ambient air in all surgical theaters other than CTVS OTs.
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Affiliation(s)
- G D Puri
- Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Shyam C Meena
- Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Vinayak Sinha
- Indian Institute of Science Education and Research, Mohali, Punjab, India
| | - Amarjyoti Hazarika
- Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Haseeb Hakkim
- Indian Institute of Science Education and Research, Mohali, Punjab, India
| | - Ashish Sharma
- Indian Institute of Science Education and Research, Mohali, Punjab, India
| | - Kamal Kajal
- Post Graduate Institute Medical Education and Research, Chandigarh, India
| | - Neeti Dogra
- Post Graduate Institute Medical Education and Research, Chandigarh, India
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10
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Guha Niyogi S, Kumar B, Puri GD, Negi S, Mishra AK, Thingnam SKS. Cardiac output monitoring using transthoracic echocardiography in children after cardiac surgery-an observational study of feasibility and concordance with transpulmonary thermodilution. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1516] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transthoracic echocardiography (TTE) is commonly used after pediatric cardiac surgery to monitor cardiac function and adequacy of surgery; however it depends on the availability of good echo window and operator skill [1]. Transpulmonary thermodilution (TPTD) is feasible along with calibrated continuous cardiac output measurement in children but seldom used due to cost and the need for a specialized catheter [2].
We hypothesized that TTE would be as good as TPTD, but limited in feasibility following pediatric cardiac surgery. Hence, the concordance, agreement as well as feasibility and trending of cardiac output monitoring by TTE was compared against a reference TPTD method in real-world usage in children after congenital heart surgery.
Methods
This was a secondary analysis of data from a previously registered and conducted study in our unit. TPTD monitoring was instituted in children undergoing congenital heart disease repair on cardiopulmonary bypass with a 3F femoral arterial cannula and a central venous injectate temperature sensor.
Cardiac output was also measured by transthoracic echocardiography by measurement of the left ventricular outflow tract (LVOT) diameter, LVOT velocity time integral (VTI) and the heart rate as previously described [3,4]. Measurements were taken after arrival in the ICU, and every 12 hours till after extubation. Correlation, Bland-Altman analysis and polar analysis was done for cardiac output measured by TPTD and TTE.
Results
TTE and TPTD measurements of cardiac output correlated well (Pearson's correlation coefficient 0.94; 95% CI 0.90–0.96) (Fig. 1A). Bland Altman analysis showed a mean bias of 0.15 l/min and upper and lower limits of agreement of 0.81 and −0.51 l/min respectively (Fig. 1B). Cardiac output measurement by TTE was possible in 72 instances while TPTD allowed measurement in all 113 instances. Hence, TTE was not feasible in 41 instances across 14 patients, including 19 instances in acyanotic and 22 instances in cyanotic patients. Polar analysis revealed acceptable trending.
Conclusions
TTE derived cardiac output demonstrated good correlation, minimal bias and narrow limits of agreement versus TPTD, and was feasible in most cases. This suggests TTE is an acceptable cardiac output measurement modality post pediatric cardiac surgery, as in adults [5]. TPTD-based continuous cardiac output monitoring might have a complementary role in pediatric cardiac critical care, particularly in high risk cases.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Institutional Special Research Grant from Postgraduate Institute of Medical Education and Research, Chandigarh, India. Figure 1
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Affiliation(s)
- S Guha Niyogi
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India
| | - B Kumar
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India
| | - G D Puri
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India
| | - S Negi
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care, Chandigarh, India
| | - A K Mishra
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
| | - S K S Thingnam
- Postgraduate Institute of Medical Education and Research (PGIMER), Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
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11
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Bansal R, Markan A, Gautam N, Guru RR, Lakshmi PVM, Katoch D, Agarwal A, Singh MP, Suri V, Mohindra R, Sahni N, Bhalla A, Malhotra P, Gupta V, Puri GD. Retinal Involvement in COVID-19: Results From a Prospective Retina Screening Program in the Acute and Convalescent Phase. Front Med (Lausanne) 2021; 8:681942. [PMID: 34249972 PMCID: PMC8264127 DOI: 10.3389/fmed.2021.681942] [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: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To detect retinal involvement in coronavirus disease 2019 (COVID-19) patients in acute and convalescent phase by their fundus screening. Methods: In a prospective, cross-sectional, observational study (July–November 2020), 235 patients (142 acute and 93 convalescent phase) underwent fundus screening in a tertiary care center in North India. For convalescent phase, “hospitalized” patients (73) were screened at least 2 weeks after hospital discharge, and “home-isolated” patients (20) were screened 17 days after symptom onset/COVID-19 testing. Results: None in acute phase showed any retinal lesion that could be attributed exclusively to COVID-19. Five patients (5.38%) in convalescent phase had cotton wool spots (CWSs) with/without retinal hemorrhage, with no other retinal finding, and no visual symptoms, seen at a median of 30 days from COVID-19 diagnosis. Conclusions: CWSs (and retinal hemorrhages) were an incidental finding in COVID-19, detected only in the convalescent phase. These patients were much older (median age = 69 years) than the average age of our sample and had systemic comorbidities (diabetes mellitus, hypertension, etc.). We propose the term “COVID-19 retinopathy” to denote the presence of CWSs at the posterior pole, occasionally associated with intraretinal hemorrhages, in the absence of ocular inflammation in patients with a history of COVID-19 disease.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Gautam
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Ranjan Guru
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Kajal K, Naik BN, Singh A, Soni SL, Hazarika A, Saini K, Jaswal S, Meena SC, Pandey N, Puri GD. Preparing Intensive Care Unit in Resource-Constraint Setting Amid COVID-19 Pandemic: Our Experience and Review. Anesth Essays Res 2021; 14:366-369. [PMID: 34092843 PMCID: PMC8159056 DOI: 10.4103/aer.aer_86_20] [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: 09/10/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022] Open
Abstract
COVID-19 pandemic is an emerging, rapidly evolving public health emergency where a nation's health-care system can face a marked surge in demand for intensive care unit (ICU) beds and organ support. In regions with insufficient medical resources, it may further aggravate the existing shortage, limiting an ICU's ability to provide the normal standard of care. It can present ethically or legally demanding questions about how to prioritize the allocation of life-saving medical resources. In developing countries like India, still many hospitals are challenged by competing priorities and remain underprepared. In the wake of COVID-19 pandemic, to guide the intensive care disaster planners in regions with low resources and to ensure ICU readiness, this review shares our experience and strategies for preparing ICU with existing and alternative resources, focusing on space, equipment, and health-care workers’ safety and training.
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Affiliation(s)
- Kamal Kajal
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Naveen Naik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Lal Soni
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amarjyoti Hazarika
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kulbhushan Saini
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jaswal
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Charan Meena
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Pandey
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Mehra A, Suri V, Sahoo S, Malhotra P, Yaddanapudi LN, Puri GD, Bhalla A, Grover S. Relationship of substance dependence and time to RT-PCR negative status in patients with COVID-19 infection. Asian J Psychiatr 2021; 57:102562. [PMID: 33571916 PMCID: PMC7825882 DOI: 10.1016/j.ajp.2021.102562] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND To date, no study has evaluated the association of alcohol dependence with the outcome of the COVID-19 infection. AIM The current study aimed to evaluate the association of substance dependence (alcohol and tobacco) with the outcome (i.e., time to have two consecutive negative test reports) of the COVID-19 infection. RESULTS The mean age of the study participants (n = 95) was 37.2 yrs (SD-13.2). More than half of the participants were males. About one-fourth (N = 25; 26.3 %) were consuming various substances in a dependent pattern. Alcohol dependence was present in 21 participants (22.1 %), and Tobacco dependence was present in 10.5 % of participants. Even after using gender, age, and physical illness as covariates, patients with any kind of substance dependence had a significantly lower chance of having a negative report on RT-PCR on 14th day, 18th 23rd day. CONCLUSION Persons with substance dependence takes a longer time to test negative on RT-PCR, once diagnosed with COVID-19 infection. Mental health professionals involved in the care of patients with COVID-19 should accordingly prepare these patients for a possible longer hospital stay to reduce the distress associated with prolongation of hospital stay.
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Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Lakshmi Narayana Yaddanapudi
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - G D Puri
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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14
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Ganesh V, Luthra A, Amburu V, Naik BN, Singh A, Puri GD. Low-Dose Dexmedetomidine Reduces Median Effective Concentration (EC 50) of Propofol More than Fentanyl in Unparalysed Anaesthetised Patients for I-gel Insertion: a Randomised Controlled Trial. Anaesth Crit Care Pain Med 2021; 40:100815. [PMID: 33640444 DOI: 10.1016/j.accpm.2021.100815] [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] [Received: 05/16/2020] [Revised: 09/25/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Literature shows fentanyl reduces the median effective concentration (EC50) of propofol when used for various noxious stimuli. However, fentanyl combined with propofol has a depressive effect on haemodynamics. We hypothesise that low dose dexmedetomidine will reduce the propofol requirement for induction with better haemodynamic profile compared with fentanyl. MATERIAL AND METHODS 120 ASA I/II adult patients, of age group 20 to 60 years, scheduled for elective day-care surgeries under general anaesthesia were randomised to three equally distributed groups as group D, group F and group S (control) of 40 patients each. They received infusions of dexmedetomidine 0.5 mcg/kg, fentanyl 1.5 mcg/kg and normal saline (control) respectively over 5 min prior to induction with propofol TCI (Marsh model). EC50 of propofol (primary objective) for I-gel insertion in each group was determined from the estimated effect site concentration (Ce), using Dixon's up-and-down method . Secondary objectives were propofol dose requirement and percentage change in haemodynamics during induction. RESULTS Our study demonstrates that low-dose dexmedetomidine premedication achieves more reduction in the EC50 (2.4 µg/ml, IQR 2.4 - 2.6 µg/ml, 95% CI 2.40 - 2.55 µg/ml) and dose of propofol (1.14 ± 0.28 mg/kg, 95% CI 1.05 - 1.23 mg/kg), for I-gel insertion, than that can be achieved by the use of fentanyl with propofol (EC50 of 3.0 µg/ml IQR 3.0 - 3.05 µg/ml, 95% CI 2.94 - 3.11 µg/ml; propofol dose 1.89 ± 0.55 mg/kg, 95% CI 1.72 - 2.07 mg/kg ) without any significant change in the haemodynamics. CONCLUSION Low-dose dexmedetomidine when compared with fentanyl significantly reduce the EC50 and dose of propofol required for I-gel insertion with propofol TCI, without much change in the haemodynamic profile. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2019/03/018003.
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Affiliation(s)
- Venkata Ganesh
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Luthra
- Department of Anaesthesia & Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vamsidhar Amburu
- Department of Anaesthesia & Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Naveen Naik
- Department of Anaesthesia & Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ajay Singh
- Department of Anaesthesia & Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia & Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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15
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Mehra A, Sahoo S, Suri V, Malhotra P, Yaddanapudi N, Puri GD, Grover S. Why involvement of mental health professionals and screening for past mental illness is important in persons with COVID-19 infection: A case report. Asian J Psychiatr 2020; 54:102294. [PMID: 32663797 PMCID: PMC7832217 DOI: 10.1016/j.ajp.2020.102294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 10/27/2022]
Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Narayana Yaddanapudi
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - G D Puri
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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16
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Sahoo S, Mehra A, Dua D, Suri V, Malhotra P, Yaddanapudi LN, Puri GD, Grover S. Psychological experience of patients admitted with SARS-CoV-2 infection. Asian J Psychiatr 2020; 54:102355. [PMID: 33271684 PMCID: PMC7434329 DOI: 10.1016/j.ajp.2020.102355] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Devakshi Dua
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Lakshmi Narayana Yaddanapudi
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - G D Puri
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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17
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Rastogi A, Bhansali A, Khare N, Suri V, Yaddanapudi N, Sachdeva N, Puri GD, Malhotra P. Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study). Postgrad Med J 2020; 98:87-90. [PMID: 33184146 DOI: 10.1136/postgradmedj-2020-139065] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vitamin D has an immunomodulatory role but the effect of therapeutic vitamin D supplementation in SARS-CoV-2 infection is not known. AIM Effect of high dose, oral cholecalciferol supplementation on SARS-CoV-2 viral clearance. DESIGN Randomised, placebo-controlled. PARTICIPANTS Asymptomatic or mildly symptomatic SARS-CoV-2 RNA positive vitamin D deficient (25(OH)D<20 ng/ml) individuals. INTERVENTION Participants were randomised to receive daily 60 000 IU of cholecalciferol (oral nano-liquid droplets) for 7 days with therapeutic target 25(OH)D>50 ng/ml (intervention group) or placebo (control group). Patients requiring invasive ventilation or with significant comorbidities were excluded. 25(OH)D levels were assessed at day 7, and cholecalciferol supplementation was continued for those with 25(OH)D <50 ng/ml in the intervention arm. SARS-CoV-2 RNA and inflammatory markers fibrinogen, D-dimer, procalcitonin and (CRP), ferritin were measured periodically. OUTCOME MEASURE Proportion of patients with SARS-CoV-2 RNA negative before day-21 and change in inflammatory markers. RESULTS Forty SARS-CoV-2 RNA positive individuals were randomised to intervention (n=16) or control (n=24) group. Baseline serum 25(OH)D was 8.6 (7.1 to 13.1) and 9.54 (8.1 to 12.5) ng/ml (p=0.730), in the intervention and control group, respectively. 10 out of 16 patients could achieve 25(OH)D>50 ng/ml by day-7 and another two by day-14 [day-14 25(OH)D levels 51.7 (48.9 to 59.5) ng/ml and 15.2 (12.7 to 19.5) ng/ml (p<0.001) in intervention and control group, respectively]. 10 (62.5%) participants in the intervention group and 5 (20.8%) participants in the control arm (p<0.018) became SARS-CoV-2 RNA negative. Fibrinogen levels significantly decreased with cholecalciferol supplementation (intergroup difference 0.70 ng/ml; P=0.007) unlike other inflammatory biomarkers. CONCLUSION Greater proportion of vitamin D-deficient individuals with SARS-CoV-2 infection turned SARS-CoV-2 RNA negative with a significant decrease in fibrinogen on high-dose cholecalciferol supplementation. TRIAL REGISTER NUMBER NCT04459247.
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Affiliation(s)
- Ashu Rastogi
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khare
- Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayana Yaddanapudi
- Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Sachdeva
- Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Affiliation(s)
- Ajay Singh
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India,
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19
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Sahoo S, Mehra A, Suri V, Malhotra P, Yaddanapudi N, Puri GD, Grover S. Handling children in COVID wards: A narrative experience and suggestions for providing psychological support. Asian J Psychiatr 2020; 53:102207. [PMID: 32599438 PMCID: PMC7293452 DOI: 10.1016/j.ajp.2020.102207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Narayana Yaddanapudi
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - G D Puri
- Department of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Affiliation(s)
- Swapnajeet Sahoo
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Dept. of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Dept. of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshmi Narayana Yaddanapudi
- Dept. of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Dept. of Anaesthesia and Intensive Care Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Dept. of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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21
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Naik BN, Gupta R, Singh A, Soni SL, Puri GD. Real-Time Smart Patient Monitoring and Assessment Amid COVID-19 Pandemic - an Alternative Approach to Remote Monitoring. J Med Syst 2020; 44:131. [PMID: 32533379 PMCID: PMC7292797 DOI: 10.1007/s10916-020-01599-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022]
Affiliation(s)
- B Naveen Naik
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Rekha Gupta
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Ajay Singh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Shiv Lal Soni
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - G D Puri
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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Mahajan V, Singla K, Kajal K, Soni S, Hazarika A, Agrawal P, Puri GD. Effects of personal protective equipment on the physiological parameters of health care workers. J Emerg Manag 2020; 18:37-39. [PMID: 33368140 DOI: 10.5055/jem.2020.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We would like to add to the study, Understanding the physiological effects of wearing enhanced personal protective equipment while providing patient care by Bulson and Shawl from the November/December 2019 issue of Journal of Emergency Management.
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Affiliation(s)
- Varun Mahajan
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. ORCID: https://orcid.org/0000-0001-5915-3608
| | - Karan Singla
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. ORCID: https://orcid.org/0000-0002-5877-678X
| | - Kamal Kajal
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. ORCID: https://orcid.org/0000-0003-3271-0122
| | - Shiv Soni
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. ORCID: https://orcid.org/0000-0002-8334-1868
| | - Amarjyoti Hazarika
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. ORCID: https://orcid.org/0000-0001-6563-1477
| | - Prachi Agrawal
- Department of Anaesthesia and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India. ORCID: https://orcid.org/0000-0001-5486-6510
| | - G D Puri
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. ORCID: https://orcid.org/0000-0002-9763-4055
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23
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Puri GD, Bagchi A, Anandamurthy B, Dhaliwal RS. The Bispectral Index and Induced Hypothermia— Electrocerebral Silence at an Unusually High Temperature. Anaesth Intensive Care 2019; 31:578-80. [PMID: 14601285 DOI: 10.1177/0310057x0303100515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The optimal temperature for deep hypothermic circulatory arrest remains undefined. We present a case in which Bispectral Index monitoring during hypothermic cardiopulmonary bypass showed electrocerebral silence at a higher temperature than previously reported. Bispectral Index monitoring may be a potentially useful tool in surgery employing deep hypothermic circulatory arrest.
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Affiliation(s)
- G D Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh-160012, India
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24
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Devi R, Ghai S, Singh NV, Puri GD. A Methodological Study to Develop a Standard Operational Protocol for Nurses on Central Line Catheter Care of Patients in Selected Intensive Care Units. Indian J Crit Care Med 2017; 21:483-487. [PMID: 28904476 PMCID: PMC5588481 DOI: 10.4103/ijccm.ijccm_261_16] [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: 12/15/2022] Open
Abstract
AIM This study aims to develop a standard operational protocol (SOP) for central line catheter care for nurses. MATERIALS AND METHODS A preliminary draft of protocol based on extensive review of the literature was developed. The current practices of the nurses regarding central line catheter care were observed. Focus group discussions (FGD) were conducted with the nurses to identify the problems encountered by them during care of central line. Four rounds of Delphi were conducted to validate the protocol. The protocol was found to be feasible in terms of understanding, clarity and easy implementation after conducting a pilot study. An observation checklist was developed from the final draft of the protocol. The nurses were taught regarding the central line catheter care as per the protocol. 30 nurses were observed during central line catheter care by the researcher. After implementation of the protocol, feedback of the nurses was taken by conducting FGDs. RESULTS Content validity index of each item in the protocol was acceptable. The overall Cronbach's alpha value of the checklist was 0.75. It was concluded that the checklist is reliable and each item has a contribution in the checklist. CONCLUSION This protocol addresses interventions to enable staff to provide proper care of the central line catheter to prevent CLABSI.
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Affiliation(s)
- Rashmita Devi
- Department of Nursing, National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Sandhya Ghai
- Department of Nursing, National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Neena Vir Singh
- Department of Nursing, National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - G. D. Puri
- Department of Anaesthesia, PGIMER, Chandigarh, India
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Abstract
Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair.
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Affiliation(s)
- Alok Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Dutta
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunder Negi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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26
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Gupta MD, Kaur H, Ray P, Gautam V, Puri GD. Ribosomal RNA-based panbacterial polymerase chain reaction for rapid diagnosis of septicaemia in Intensive Care Unit patients. Indian J Med Microbiol 2016; 34:219-21. [PMID: 27080778 DOI: 10.4103/0255-0857.180351] [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: 11/04/2022]
Abstract
Early diagnosis and treatment of sepsis by appropriate antibiotics is of utmost importance. Therefore, we evaluated 16S rRNA panbacterial polymerase chain reaction (PCR) for rapid diagnosis of sepsis in 49 adult patients in Intensive Care Units (ICUs) and compared it with an automated blood culture. 8 ml of 10 ml blood collected was inoculated into BACTEC® aerobic bottle and the remaining 2 ml was used for DNA extraction and PCR. 109 of 115 (93%) episodes of suspected sepsis showed concordant results between automated culture and PCR. Six episodes were positive by PCR only. Panbacterial PCR reduces turnaround time with rapid differentiation between systemic inflammatory response syndrome and sepsis.
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Affiliation(s)
| | | | | | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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27
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Del Cerro MJ, Moledina S, Haworth SG, Ivy D, Al Dabbagh M, Banjar H, Diaz G, Heath-Freudenthal A, Galal AN, Humpl T, Kulkarni S, Lopes A, Mocumbi AO, Puri GD, Rossouw B, Harikrishnan S, Saxena A, Udo P, Caicedo L, Tamimi O, Adatia I. Cardiac catheterization in children with pulmonary hypertensive vascular disease: consensus statement from the Pulmonary Vascular Research Institute, Pediatric and Congenital Heart Disease Task Forces. Pulm Circ 2016; 6:118-25. [PMID: 27076908 PMCID: PMC4809667 DOI: 10.1086/685102] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Cardiac catheterization is important in the diagnosis and risk stratification of pulmonary hypertensive vascular disease (PHVD) in children. Acute vasoreactivity testing provides key information about management, prognosis, therapeutic strategies, and efficacy. Data obtained at cardiac catheterization continue to play an important role in determining the surgical options for children with congenital heart disease and clinical evidence of increased pulmonary vascular resistance. The Pediatric and Congenital Heart Disease Task Forces of the Pulmonary Vascular Research Institute met to develop a consensus statement regarding indications for, conduct of, acute vasoreactivity testing with, and pitfalls and risks of cardiac catheterization in children with PHVD. This document contains the essentials of those discussions to provide a rationale for the hemodynamic assessment by cardiac catheterization of children with PHVD.
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Affiliation(s)
| | | | | | - Dunbar Ivy
- Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Hanaa Banjar
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gabriel Diaz
- Universidad Nacional de Colombia, Bogota, Colombia
| | | | | | - Tilman Humpl
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Snehal Kulkarni
- Kokilaben Dhirubai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | - G D Puri
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - S Harikrishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anita Saxena
- All-India Institute of Medical Sciences, New Delhi, India
| | | | | | - Omar Tamimi
- King Saud bin Abdulaziz University, Riyadh, Saudi Arabia
| | - Ian Adatia
- Stollery Children's Hospital, Edmonton, Alberta, Canada; on behalf of the PVRI Pediatric Task Force members Steven Abman, Vera Aiello, Rolf Berger, Patricia Cortez, Jeffrey Fineman, Marilyne Lévy, Marlene Rabinovitch, J. Usha Raj, Irwin Reiss, Julio Sandoval, Kurt Stenmark, and Rao Sureshi
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28
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Mathew PJ, Sailam S, Sivasailam R, Thingnum SKS, Puri GD. Performance of target-controlled infusion of propofol using two different pharmacokinetic models in open heart surgery - a randomised controlled study. Perfusion 2015; 31:45-53. [DOI: 10.1177/0267659115578001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared the performance of a propofol target-controlled infusion (TCI) using Marsh versus PGIMER models in patients undergoing open heart surgery, in terms of measured plasma levels of propofol and objective pharmacodynamic effect. Methods: Twenty-three, ASA II/III adult patients aged 18-65 years and scheduled for elective open heart surgery received Marsh or PGIMER (Postgraduate Institute of Medical Education and Research) pharmacokinetic models of TCI for the induction and maintenance of anaesthesia with propofol in a randomized, active-controlled, non-inferiority trial. The plasma levels of propofol were measured at specified time points before, during and after bypass. Results: The performances of both the models were similar, as determined by the error (%) in maintaining the target plasma concentrations: MDPE of -5.0 (-12.0, 5.0) in the PGIMER group vs -6.4 (-7.7 to 0.5) in the Marsh group and MDAPE of 9.1 (5, 15) in the PGIMER group vs 8 (6.7, 10.1) in the Marsh group. These values indicate that both models over-predicted the plasma propofol concentration. Conclusions: The new pharmacokinetic model based on data from Indian patients is comparable in performance to the commercially available Marsh pharmacokinetic model.
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Affiliation(s)
- PJ Mathew
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Sailam
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - R Sivasailam
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - SKS Thingnum
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - GD Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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29
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Kumar B, Puri GD, Singh A, Rana SS. Critical pulmonary stenosis: challenges following surgical correction. World J Pediatr Congenit Heart Surg 2013; 2:136-8. [PMID: 23804946 DOI: 10.1177/2150135110387166] [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: 11/16/2022]
Abstract
A 20-day-old girl was diagnosed with critical pulmonary valvular stenosis with patent ductus arteriosus (PDA). She underwent surgical pulmonary valvotomy and infundibular resection. A trial snaring of the PDA resulted in significant systemic desaturation, and the PDA was left undivided. A continuous infusion of prostaglandin was used to keep the PDA open for the next 8 days. The PDA acted as a "natural systemic-to-pulmonary shunt" to provide pulmonary blood flow until right ventricular compliance and function improved. The various causes of persistent desaturation following pulmonary valvotomy are discussed.
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Affiliation(s)
- Bhupesh Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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30
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Puri GD, Shyam KST, Mishra AK, Madhavan JS. Complete neurological recovery after delayed onset resuscitation in a normothermic witnessed arrest. Perfusion 2013; 28:253-5. [PMID: 23381347 DOI: 10.1177/0267659112469550] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest following aortic dissection carries high morbidity and mortality, primarily due to poor neurological outcomes. Most efforts are directed towards perfusing vital organs and replenishing oxygen and adenosine triphosphate (ATP) stores during and immediately after arrest. Methods of reperfusion (including external cardiopulmonary resuscitation (CPR), open CPR, extracorporeal life support and ventricular assist devices) and other ATP preservation methods, such as pharmaceutical agents and hypothermia, are maximally beneficial only if started early during cardiac arrest. We describe a case of aortic rupture with arrest on the table which was re-perfused after 20 minutes, using cardiopulmonary bypass (CPB), but still managed to recover without neurological sequelae.
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Affiliation(s)
- G D Puri
- Cardiac Anesthesia, Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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31
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Puri A, Medhi B, Panda NB, Puri GD, Dhawan S. Propofol pharmacokinetics in young healthy Indian subjects. Indian J Pharmacol 2012; 44:402-6. [PMID: 22701256 PMCID: PMC3371469 DOI: 10.4103/0253-7613.96348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/05/2011] [Accepted: 02/28/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To analyze population pharmacokinetics of Propofol in Indian patients after single bolus dose of Propofol using WINNONLIN program. MATERIALS AND METHODS Population pharmacokinetics of Propofol was investigated in Indian subjects in 26 elective surgical patients (14 males and 12 females) following single bolus dose of 2 mg/kg propofol. A total of 364 samples were estimated by High Performance Liquid Chromatography and pharmacokinetic parameters were derived using WINNONLIN (5.2). The effect of demographic characters of the study population on pharmacokinetic parameters was investigated. RESULTS Three-compartment model was used to describe the pharmacokinetic data of Propofol in Indian subjects. Initial volume of distribution (V1) clearance (Cl) and steady state volume of distribution (Vd(ss)) was 13.5 ± 3.3 l, 1.08 ± 0.42 l/min, and 77.69 ± 48.0 l, respectively. Body weight best described the volume of central compartment (V1) as well as elimination clearance (P<0.01). CONCLUSION Pharmacokinetics of Propofol in young healthy Indian subjects show lower volume of distribution and clearance as compared with most of the western data. Body weight best describes the V1, Vd(ss), and Clearance in this group.
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Affiliation(s)
- Avinash Puri
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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32
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Mohite PN, Rana SS, Singh J, Kotkar KD, Puri GD, Sodhi SK. Acute superior vena cava obstruction due to tight pericardial closure following congenital defect repair. J Cardiovasc Dis Res 2012; 3:135-7. [PMID: 22629033 PMCID: PMC3354458 DOI: 10.4103/0975-3583.95369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/30/2022] Open
Abstract
The obstruction of the superior vena cava (SVC) of acute onset nature following surgery is a rare and serious condition. The tight closure of the pericardium over the heart during surgical procedures may cause external compression on the SVC. Echocardiography and Computed tomography (CT) scan aids in the diagnosis. Cutting open the pericardial stitches relieves the condition.
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Affiliation(s)
- Prashant N Mohite
- Department of Cardiothoracic and Vascular surgery, Post Graduation Institute of Medical Education and Research, Sector - 12, Chandigarh - 160 012, India
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33
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Khan A, Agarwal R, Aggarwal AN, Bal A, Sen I, Yaddanapuddi LN, Puri GD. Experience with treatment of pulmonary alveolar proteinosis from a tertiary care centre in north India. Indian J Chest Dis Allied Sci 2012; 54:91-97. [PMID: 22973777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pulmonary alveolar proteinosis (PAP) is a disorder characterised by accumulation of lipids and proteins in the alveoli, with the resultant symptoms ranging from indolent subclinical disease to progressive respiratory failure. METHODS We retrospectively studied five patients with PAP managed at our center between January 2007 and April 2010, with whole lung lavage (WLL) and/or subcutaneous granulocyte macrophage-colony stimulating factor (GM-CSF) therapy. Patients undergoing WLL under general anaesthesia were supplemented with three months of GM-CSF therapy. Pre- and post-lavage symptom assessment was performed with a 10-point, symptom-based visual analogue scale. RESULTS Their mean age was 37.6-7.0 years; there were four males. Diagnosis of PAP [idiopathic (n=3); secondary to Nocardia (n=1)] was established by surgical lung biopsy in four patients who presented with respiratory failure. Three patients with idiopathic PAP (n=3) were treated with a combination of GM-CSF and WLL; one patient with secondary PAP was treated with antibiotics alone. In another patient transbronchial lung biopsy was used to diagnose PAP and GM-CSF alone was administered. All patients were followed up for a median period of two years (range 0.5-3 years). Significant improvement was achieved in all the patients with therapeutic WLL and/or GM-CSF. CONCLUSIONS Whole lung lavage appeared to be an effective and safe therapy in patients with PAP. Efficacy of simultaneous administration of GM-CSF and WLL in the treatment of PAP merits further study.
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Affiliation(s)
- A Khan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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34
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Abstract
Cardiac surgery involving cardiopulmonary bypass (CPB) in its conventional form involves many processes leading to free radical production, such as perioperative ischemia, reperfusion, circulation of whole body blood through the CPB circuit, hypothermia and acidosis. The red blood cells of a glucose-6-phosphate dehydrogenase (G6PD)-deficient person are unable to scavenge these free radicals, resulting in haemolysis. Here, we describe the successful anaesthetic management of two G6PD-deficient children who underwent cardiac surgery, on and off CPB, without any obvious haemolytic reaction, followed by a discussion of the disorder, with specific consideration of perioperative management of such cases.
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Affiliation(s)
- N Dogra
- Advanced Cardiac Centre, Department of Anaesthesiology and Critical Care, PGIMER, Chandigarh, India.
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35
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Hegde HV, Puri GD, Fiehn A. An unusual phenomenon with entropy during induction of general anaesthesia. Anaesth Intensive Care 2010; 38:215-216. [PMID: 20191808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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36
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Gautam V, Ray P, Puri GD, Sharma K, Vandamme P, Madhup SK, Das A, Malhotra P, Trehan A, Garg RK, Rana S, Koushal V, Kumar A. Investigation of Burkholderia cepacia complex in septicaemic patients in a tertiary care hospital, India. Nepal Med Coll J 2009; 11:222-224. [PMID: 20635597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Burkholderia cepacia complex (BCC) is being increasingly recognized as an important pathogen of humans. During the year 2007-8, 39 putative BCC isolates were obtained from 21 cases and subjected to recA PCR RFLP. Twenty-four isolates were confirmed as Burkholderia cenocepacia IIIA (nineteen isolates, recA PCR RFLP type G and five isolates, recA PCR RFLP type I), six were confirmed as B. cepacia (recA PCR RFLP type E). BCC were isolated from inpatients of different wards of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh with increased isolation from children admitted to different wards of Advanced Pediatric Centre (11/21 cases). BCC isolates are often resistant to most commonly used antibiotics and an early use of effective antimicrobial therapy can decrease morbidity and mortality.
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Affiliation(s)
- V Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012 India
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37
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Mathew PJ, Puri GD, Dhaliwal RS. Propofol requirement titrated to bispectral index: a comparison between hypothermic and normothermic cardiopulmonary bypass. Perfusion 2009; 24:27-32. [DOI: 10.1177/0267659109106071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Though propofol requirement is expected to decrease during cardiopulmonary bypass (CPB), a few studies have failed to demonstrate this. The factors affecting pharmacokinetics of propofol and, therefore, the requirement, are different during hypothermic and normothermic CPB. We evaluated and compared the requirement of propofol during hypothermic and normothermic CPB. Fifty adult patients scheduled for elective cardiac surgery on CPB were recruited and randomly allocated into hypothermic CPB (28–300 C) (Group H) and normothermic CPB (35–370 C) (Group N) groups. Patients were induced and maintained with propofol titrated to maintain a target bispectral index (BIS) of 50 ± 10. Propofol requirement (mean ± SD) was similar in normothermic and hypothermic groups, both before CPB (4.9 ± 1.5 mg.kg−1hr−1 in Group N, 4.6 ± 1.5 mg.kg−1hr−1 in Group H) and after cessation of bypass (p > 0.05) (4.6 ± 1.8 mg.kg−1hr−1 in Group N and 4.3 ± 1.7 mg.kg−1hr−1 in Group H). CPB significantly reduced (p < 0.001) propofol requirements in both arms of the study (Group N: 2.9 ± 1.4 mg.kg−1hr−1and Group H: 1.3 ± 0.7 mg.kg−1hr−1). This reduction was more pronounced in the hypothermic group (p < 0.001). The BIS (median ± inter quartile range) remained constant during normothermic CPB (50 ± 8.8), but declined significantly during hypothermic CPB (41 ± 5.6) despite decreased usage of propofol during hypothermia. No patient had recall of intra-operative events. CPB decreases the magnitude of propofol requirements and the effect of hypothermic CPB is significantly more than that of normothermic CPB.
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Affiliation(s)
- PJ Mathew
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - GD Puri
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - RS Dhaliwal
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Behera BK, Puri GD, Ghai B. Patient-controlled epidural analgesia with fentanyl and bupivacaine provides better analgesia than intravenous morphine patient-controlled analgesia for early thoracotomy pain. J Postgrad Med 2009; 54:86-90. [PMID: 18480522 DOI: 10.4103/0022-3859.40772] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) were studied in terms of analgesic efficacy, respiratory function and side effects after thoracic surgery for 24h. PCEA using fentanyl and bupivacaine as compared to IVPCA using morphine provides better pain relief both at rest and during coughing and is associated with fewer side effects. AIMS To compare IVPCA and PCEA in terms of analgesic efficacy, respiratory function and side effects after thoracic surgery. SETTINGS AND DESIGN Tertiary care teaching hospital. Prospective, randomized and open study. MATERIALS AND METHODS Thirty ASA-I or II patients undergoing thoracotomy were assigned randomly to receive either IVPCA using morphine or PCEA using fentanyl and bupivacaine combination postoperatively. No background infusion was administered in either group. Postoperative evaluation included pain intensity both at rest and during coughing, degree of sedation, arterial blood gas, forced vital capacity (FVC), peak expiratory flow rate (PEFR), presence of side effects such as nausea/vomiting and pruritus at 0, 2, 8, 12 and 24h. The primary outcome of the study was the percentage of patients with analgesia failure defined as VAS>30 despite three consecutive PCA boluses requiring rescue analgesia with intravenous fentanyl. STATISTICAL ANALYSIS Data were analyzed using t -test, chi2 test and Mann-Whitney test. RESULTS Significantly less number of patients required rescue analgesia in PCEA group ( P< 0.05). Pain relief was better both at rest and during coughing ( P< 0.05) in PCEA group as compared to IVPCA. Patients in the PCEA group were less sedated and had fewer incidences of side effects, i.e. nausea/vomiting and pruritus. Postoperative FVC and PEFR were reduced significantly compared to baseline only in IVPCA group ( P< 0.05). CONCLUSION After thoracic surgery, PCEA using fentanyl and bupivacaine as compared to IVPCA using morphine provides better pain relief both at rest and during coughing and associated with fewer side effects.
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Affiliation(s)
- B K Behera
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India
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Abstract
BACKGROUND In recent years, electroencephalographic indices of anaesthetic depth have facilitated automated anaesthesia delivery systems. Such closed-loop control of anaesthesia has been described in various surgical settings in ASA I-II patients (1-4), but not in open heart surgery characterized by haemodynamic instability and higher risk of intra-operative awareness. Therefore, a newly developed closed-loop anaesthesia delivery system (CLADS) to regulate propofol infusion by the Bispectral index (BIS) was compared with manual control during open heart surgery. METHODS Forty-four adult ASA II-III patients undergoing elective cardiac surgery under cardiopulmonary bypass were enrolled. The study participants were randomized to two groups: the CLADS group received propofol delivered by the CLADS, while in the manual group, propofol delivery was adjusted manually. The depth of anaesthesia was titrated to a target BIS of 50 in both the groups. RESULTS During induction, the CLADS group required lower doses of propofol (P<0.001), resulting in lesser overshoots of BIS (P<0.001) and mean arterial blood pressure (P=0.004). Subsequently, BIS was maintained within +/- 10 of the target for a significantly longer time in the CLADS group (P=0.01). The parameters of performance assessment, median absolute performance error (P=0.01), wobble (P=0.04) and divergence (P<0.001), were all significantly better in the CLADS group. Haemodynamic stability was better in the CLADS group and the requirement of phenylephrine in the pre-cardiopulmonary bypass period as well as the cumulative dose of phenylephrine used were significantly higher in the manual group. CONCLUSION The automated delivery of propofol using CLADS was safe, efficient and performed better than manual administration in open heart surgery.
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Affiliation(s)
- J Agarwal
- Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India
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Bangaari A, Puri GD. Murphy's eye: go for the eye: learning fibreoptic intubation. Anaesth Intensive Care 2009; 37:136-137. [PMID: 19160553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
Mediastinal pheochromocytomas account for only a small fraction of mediastinal tumors. Most commonly, these tumors are located in posterior mediastinum. Increasing number of cases of pheochromocytomas is being reported from middle mediastinum. Excision of mediastinal paraganglioma is often hazardous because of its rich blood supply and tendency to involve surrounding structures. It can be a big challenge to manage asymptomatic cases of pheochromocytoma intraoperatively. It is imperative that these patients receive adequate alpha adrenergic and if necessary beta adrenergic blockade. Adequate preoperative preparation with alpha and beta blockers may not prevent serious intraoperative hypertension. We report a case of posterior mediastinal pheochromocytoma which was biochemically active preoperatively. We review the presentation, diagnosis and management of intrathoracic pheochromocytomas including cardiac pheochromocytomas.
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Affiliation(s)
- Jaswinder Singh
- Department of Cardiovascular and Thoracic Surgery, Military Hospital (Cardiothoracic Centre), Golibar Maidan, Pune, India.
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Puri GD, Hegde HV, Jayant A, Bhukal I. Haemodynamic and Bispectral Index Response to Insertion of the Streamlined Liner of the Pharynx Airway (SLIPA™): Comparison with the Laryngeal Mask Airway. Anaesth Intensive Care 2008; 36:404-10. [DOI: 10.1177/0310057x0803600312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The newly developed supralaryngeal airway Streamlined Liner of the Pharynx Airway (SLIPA™) has been compared successfully to the LMA™, but the haemodynamic response to its insertion has not been evaluated in a randomised study. We compared haemodynamic and Bispectral index(BIS) responses to insertion of the SLIPA™ with classic LMA™ after standardising the anaesthetic technique using BIS to monitor and control the anaesthetic depth. One hundred patients were randomised to receive either a classic LMA™ or SLIPA™ following induction with fentanyl and propofol titrated to a target BIS of 40 and compared heart rate, mean arterial pressure and BIS responses to insertion. There was a significant rise in mean arterial pressure from the pre-stimulus value (73.8 [10.6] mmHg, mean ± SD) at two and three minutes (P <0.05) following insertion of the LMA™ with maximum rise (80.8 [11.5] mmHg) seen at two minutes. There was a significant rise in mean arterial pressure from the pre-stimulus value (73.2 [12.6] mmHg) atone, two, three, four and five minutes (P <0.05) following insertion of the SLIPA™ with maximum rise (86.9 [15.1] mmHg) observed at three minutes. Mean arterial pressure was significantly higher (P <0.05) with SLIPA™ at two, three, four and five minutes. BIS increased significantly (P <0.05) at one, two, three, four and five minutes following insertion of both the devices, but there was no significant difference between the groups. There was a significantly higher (P=0.001) incidence of blood on the device with the SLIPA™ (20/50 vs. 6/50 with LMA™). Thus, insertion of SLIPA™ causes significantly higher blood-pressure response but similar BIS response compared to the LMA™.
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Affiliation(s)
- G. D. Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - H. V. Hegde
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A. Jayant
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - I. Bhukal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Puri GD, Jayant A, Dorje M, Tashi M. Propofol-fentanyl anaesthesia at high altitude: anaesthetic requirements and haemodynamic variations when compared with anaesthesia at low altitude. Acta Anaesthesiol Scand 2008; 52:427-31. [PMID: 18269393 DOI: 10.1111/j.1399-6576.2007.01561.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are few published accounts of anaesthesia delivery at high altitude. Natives at high altitude are known to have altered cardiorespiratory reserve. This study seeks to demonstrate the safety of propofol-fentanyl anaesthesia at high altitude titrated to the bispectral index (BIS) (3505 metres above sea level) in native highlanders. It also shows the differential effects of anaesthesia and surgery on the haemodynamics of such individuals as compared with individuals living at low altitude. METHODS Fifteen consenting adults scheduled to undergo general surgical/orthopaedic procedures under general anaesthesia using fentanyl, and propofol infusions titrated to the BIS along with nitrous oxide in oxygen after intubation, were recruited in the high-altitude arm. Their anaesthesia record was compared with retrospective data from low altitude with respect to anaesthetic requirements, recovery after anaesthesia and the haemodynamic responses to surgical stress. RESULTS The high-altitude dwellers required significantly larger doses of propofol at anaesthetic induction (2.31+/-0.64 vs. 1.41+/-0.24 mg/kg, P<0.0001) and thereafter to maintain designated BIS than their low-altitude counterparts (6.22+/-1.14 vs. 4.61+/-1.29 mg/kg/h, P<0.01). They, however, had uneventful and short recovery times. The high-altitude population also had significantly lower baseline heart rates (72+/-9.83 vs. 88+/-12.1, P<0.04) as also the heart rate responses to noxious stimulation such as direct laryngoscopy or skin incision (P<0.04, P<0.005, respectively). CONCLUSIONS High-altitude dwellers require significantly larger amounts of intravenous anaesthetic propofol. Heart rate at rest as also the heart rate responses to surgical stress were significantly attenuated at high altitude.
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Affiliation(s)
- G D Puri
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
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Abstract
The development of electroencephalographic indices of anaesthetic depth has in turn generated interest in automated anaesthesia delivery systems using these as the input variable. In this paper, one patented closed loop anaesthesia delivery system (CLADS) (502/DEL/2003) is compared to manual control of propofol delivery titrated to the bispectral index (BIS). Forty ASA I-II patients undergoing elective surgery under general anaesthesia were enrolled in the study. The study participants were randomised using computer generated random numbers to two equal groups. One group received propofol titrated by the CLADS while in the other group (control), anaesthetic delivery was manually titrated to BIS. Closed loop anaesthetic delivery using our patented system led to lower induction doses of propofol (P < 0.05) and less overshoot of the target BIS (P < 0.05). The closed loop system maintained BIS to within +/-10 of target for a significantly longer time during the maintenance phase of anaesthesia (P < 0.01). Smaller amounts of anaesthetic agent were required (P < 0.01) and there was faster postoperative recovery (P < 0.05). Manual delivery of propofol required the infusion rate to be changed a median of 30 times (IQR 12-45), which required considerable time and attention by the anaesthetist. In conclusion, automated delivery of propofol adjusted to the bispectral index using our CLADS was both effective and efficient as compared to manual control.
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Affiliation(s)
- G D Puri
- Department of Anaesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The authors studied the factors affecting drug use pattern, cost of therapy, and the association between the pattern of drug use and survival as well as the duration of stay in a prospective, observational study in an intensive care unit between February and May 2005. Data were collected regarding drugs used, severity of the disease, and their outcome. The mean +/- SD of the Acute Physiology and Chronic Health Evaluation (APACHE III) and Glasgow Coma Scale (GCS) scores of 84 patients were 52.2 +/- 19.4 and 7.5 +/- 2.4, respectively. Although the mean number of drugs at the time of admission to the intensive care unit was 5.3, it increased to 12.9 on the first day and 22.2 during the entire stay. More than 50% of the average expenditure on drugs and nutrition was accounted by antibiotics. Requirement of insulin or inotropes signified an adverse outcome on mortality (odds ratios of 3.43 and 8.44, respectively). In conclusion, there is a tremendous impact of antibiotic use on the cost of therapy in the intensive care unit. The requirement of certain drugs such as insulin and inotropes is of prognostic significance.
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Affiliation(s)
- S Biswal
- Department of Pharmacology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Saluja K, Marwaha N, Thakral B, Goni V, Sharma RR, Puri GD. Feasibility of pre-operative autologous blood donation in Indian patients with elective orthopaedic surgery. Indian J Med Res 2006; 124:505-12. [PMID: 17213518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND & OBJECTIVES Pre-operative autologous blood donation (PABD) in elective orthopaedic surgeries is a well known procedure in the West. We initiated this programme at a tertiary care hospital in north India to study its feasibility in Indian patients. METHODS In a prospective case-control study, 144 patients undergoing primary total hip or knee replacement, inter-vertebral discectomy, mal-union and non-union reconstruction were educated and motivated to pre-donate. Patients fulfilling the inclusion criteria and making autologous donation formed the PABD group (n=22). Patients eligible for PABD, but unwilling to participate; age, sex, pre-operative haemoglobin and operative procedure matched acted as controls (n=27). Unit(s) collected was processed like an allogeneic unit. Unit(s) found reactive for infectious markers or not utilized was discarded. Mean blood losses, transfusion trigger, allogeneic exposure and wastage between the two groups were compared. RESULTS Of the 144 patients motivated, 40 per cent of the eligible subjects pre-deposited. The main motivational factor was fear of getting infection from someone's blood. Cardiac events and anaemia prevented 61.8 per cent patients to participate. Of the 50 units ordered, autologous units with a mean of 1.4 units/patient contributed 62 per cent. For total hip and total knee replacement (THR and TKR), autologous units met 76.2 and 80 per cent respectively of the total blood requirement. A significant decrease in the allogeneic exposure was observed between PABD and control group (18.2 vs 66.7%); 32.3 per cent of the autologous units were discarded. INTERPRETATION & CONCLUSION Comprehensive PABD programme may be an effective method for reducing the need for allogeneic transfusion in patients undergoing joint replacement surgeries in our country, where transfusion transmitted infections due to high percentage of replacement donations and lack of sensitive assays for testing are still a cause for concern.
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Affiliation(s)
- Karan Saluja
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
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Chinnan NK, Puri GD, Thingnam SKS. Myocardial protection by nicorandil during open-heart surgery under cardiopulmonary bypass. Eur J Anaesthesiol 2006; 24:26-32. [PMID: 16723058 DOI: 10.1017/s0265021506000676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the myocardial protective effect of nicorandil when used as an adjuvant to cold hyperkalaemic cardioplegia in open-heart surgery. METHODS Patients who underwent surgery under cardiopulmonary bypass (CPB) for mitral valve replacement (MVR, 23 patients) or coronary artery bypass grafting (CABG, 24 patients) were entered in a double-blind study. The patients were randomized to a nicorandil Group (N) or placebo Group (P). Nicorandil 0.1 mg kg-1 (Group N), or normal saline (Group P), were administered at three time points: (1) after aortic cannulation, but prior to going on CPB, (2) 5 min before aortic cross-clamping and (3) 5 min before reperfusion. The following variables were studied: (a) time until electromechanical arrest after cardioplegia administration (Tarrest), (b) time until return of electromechanical activity after aortic cross-clamp removal (Trecovery), (c) incidence of postoperative myocardial infarction or low output syndromes (d) dysrhythmias requiring intervention after aortic cross-clamp removal and (e) haemodynamic changes after nicorandil administration. RESULTS The Tarrest after cardioplegia administration was significantly faster in nicorandil group in both MVR and CABG patients (P 75 IU L-1 in MVR patients was significantly lower in the Group N than in placebo patients (P < 0.05). However, in CABG patients there was no such significant difference. The incidence of dysrhythmias requiring intervention after aortic cross-clamp removal was also less in Group N. Administration of 0.1 mg kg-1 boluses of nicorandil did not cause significant haemodynamic changes or precipitate dysrhythmias in any patient. CONCLUSION Nicorandil enhances the myocardial protective effect of cold hyperkalaemic cardioplegia in cardiac surgery patients.
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Affiliation(s)
- N K Chinnan
- Post Graduate Institute of Medical Education and Research, Department of Anaesthesia and Intensive Care, Chandigarh, India.
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Affiliation(s)
- G D Puri
- Department of Anaesthesia and Intensive Care; Post Graduate Institute of Medical and Research; Chandigarh, India;
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Puri GD, Dutta A, Chinnan NK, Thingnam SKS, Sharma SK, Chari P. Arterial oxygenation changes in valvular heart disease patients with cardiomegaly in different recumbent positions. Eur J Anaesthesiol 2005; 22:834-8. [PMID: 16225717 DOI: 10.1017/s0265021505001407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio > or = 0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. METHODS Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. RESULTS Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 +/- 29.5 mmHg, SaO2 = 98.1 +/- 1.4%) than in supine (PaO2 = 111.0 +/- 30.6 mmHg, SaO2 = 97.6 +/- 2.2%) and left lateral positions (PaO2 = 109.7 +/- 32.0 mmHg, SaO2 = 97.6 +/- 1.7%; mean +/- SD; P 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). CONCLUSION Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.
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Affiliation(s)
- G D Puri
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India.
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Sen I, Puri GD, Bapuraj JR. Early detection of cerebral vasospasm during a neurointerventional procedure using the BIS. Anaesth Intensive Care 2005; 33:691-2. [PMID: 16235500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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