Harsh Sapra

Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study.

Background: It has been postulated that Multiple sclerosis (MS) stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as The “Liberation Procedure”. Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure. Aims: To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure. Settings and design: A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC) who will receive dexmedetomidine as an anesthetic agent. Methods: A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2–0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, “How would you rate your experience with the sedation you have received during surgery?” using a seven-point Likert-like verbal rating scale. Statistical analysis: Repeated measurements were analyzed by repeated measures ANOVA for HR and BP. Results: Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant. Conclusions: Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.

Chronic haemodynamic disturbances in neurointensive care: First description

Page | 361 incite trigeminal cardiac reflex (TCR) and may produce similar symptoms such as hypotension and bradycardia but manifestation of wide array of arrhythmias point towards reverse herniation.5 In addition, dural stretch can produce TCR; however, very late haemodynamic changes in this patient rule out TCR as a probable diagnosis. The reversal of haemodynamic disturbances after removal of negative suction also suggests our hypothesis.

Combined mucopolysaccharidosis type VI and congenital adrenal hyperplasia in a child: Anesthetic considerations.

We present a child posted for magnetic resonance imaging of brain under general anesthesia with the rare combination of mucopolysachharidosis type VI and congenital adrenal hyperplasia. The presence of both these disorders has important anesthetic implications. The pathophysiology of this rare combination of disease is reviewed with emphasis on the anesthesia management.

Severe hypotension in transforaminal lumbar interbody fusion surgery: Is it vasovagal or?

In this case, we ruled out the other possible causes of hemodynamic disturbances such as prone positioning, anesthetic‐induced blood loss, electrolyte and acid base disturbances, and diabetic autonomic neuropathy. In other case reports, the vasovagal reflex and Bezold–Jarisch reflex were postulated as the probable mechanisms of bradycardia. Its mechanism has been described as resulting from stimulation of afferent parasympathetic nerve endings due to traction on the dura, causing a reflex celiac (vasovagal) reaction. In our patient, the possibility of this dural traction cannot be ignored. In a recent case report, the author highlighted that autonomic dysreflexia and some central cord connections of the nerve fibers persist through which these kinds of hemodynamic perturbances occurred. The severe hemodynamic alteration in our case was associated with changes in respiration too and all events occurred only during the dilatation phase of TLIF. This means the surgical stimulus might be associated with some kind of central stimulation and warrants further research. It is noteworthy here that the heart rate became normal within a few seconds, but hypotension remained for a few minutes. In this regard, invasive arterial line could detect the sudden hypotensive changes which could be easily missed by noninvasive blood pressure monitoring (usually set as 3‐5 min interval).

Minutes of medanta neurocritical care conference 2014

Journal of Neuroanaesthesiology and Critical Care | Vol. 1 • Issue 3 • Sep-Dec 2014 | ‘relation between surgeon and critical care team’. The third session was on ‘Homeostasis’ which began with the talk on ‘Hypothermia: When and how to cool’ by Dr. Umamaheswara Rao (Banglore). In the same session, Dr. Hemant Bhagat (Chandigarh) spoke about ‘Hyponatremia’ and Dr. Girija P Rath (Delhi) spoke on ‘Management of potential organ donor in ICU’. This session was followed by lunch. Post lunch, first session was on ‘Neurological Emergency’ which started with lecture on ‘Emergency management of stroke’ by Dr. Kapil Zirpe (Pune). The other two topics covered in this session were on ‘Critical care management of ICH’ and ‘Critical care management of status epilepticus guidelines and beyond’ taken by Dr. Pravin Amin (Mumbai) and Dr. Shashi Srivastava (Lucknow), respectively. We didn’t ignore the importance of infection in intensive care unit (ICU) as the evening session addressed this issue with two lectures. The first one was on ‘Biochemical marker of sepsis’ by Dr. Jaya Wanchoo (Gurgaon) and the other one was on ‘Aseptic meningitis and role of intrathecal antibiotics’ taken by Dr. Neha Gupta (Gurgaon). Every session was followed with a 15‐minute discussion. This was followed by a short tea break.

Undetected hypoparathyroidism: An unusual cause of perioperative morbidity.

Routine investigation of serum calcium is not recommended in ASA one and two patients unless abnormalities of calcium metabolism are clinically suspected. The clinical features of hypocalcaemia can often be subtle and may manifest in the presence of associated factors. Hypoparathyroidism, an important cause of hypocalcaemia, often presents as soft tissue calcification (ostosis). Ligamentum flavum ostosis can present with compressive myelopathy requiring laminectomy. We report a case of ligamentum flavum ostosis and subclinical hypocalcaemia due to hypoparathyroidism, who went undetected pre-operatively resulting in significant post-operative morbidity.

Severe aortic stenosis and subarachnoid hemorrhage: Anesthetic management of lethal combination.

Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.