Sudhir Venkataramaiah

Effect of Atropine Premedication on Cardiac Autonomic Function During Electroconvulsive Therapy: A Randomized Crossover Study

Objectives Electroconvulsive therapy (ECT) results in significant cardiovascular changes. The acute cardiac autonomic changes during ECT remain unexplored. The primary objective of this study was to compare autonomic dysfunction with and without atropine premedication during ECT and secondarily to evaluate dysautonomia across psychiatric diagnoses before and after ECT. Methods In this crossover study, 41 psychiatric patients were monitored during 82 ECT sessions. Patients were randomized either to receive atropine or not to receive atropine during their second ECT session and were crossed over during their third session. Heart rate, blood pressure, and oxygen saturation were continuously monitored from stimulus application until 300 seconds after ECT. Demographic characteristics and ANSiscope indices derived pre- and post-ECT were collected. Results Autonomic dysfunction (%) before ECT was similar between atropine and no-atropine sessions (32.4 ± 15.7 vs 32.8 ± 16.7; 95% confidence interval, −7.6 to 6.7; P = 0.90) but increased significantly after ECT to 60.9 ± 16.3 and to 47.0 ± 17.3, respectively, and this difference was significant (95% confidence interval, 6.5–21.3; P < 0.001). There was no difference in the autonomic function across psychiatric diagnoses both before (P = 0.07) and after ECT (P = 0.12). Conclusions Cardiac autonomic dysfunction worsens after ECT in patients with psychiatric illnesses and to a significantly greater extent with atropine premedication. The degree of dysautonomia is similar across various psychiatric diagnoses both before and after ECT. Atropine premedication during ECT should be restricted to select patients susceptible to bradyarrhythmia and could be avoided in others.

Carotid Cavernous Fistula

A 26-year-old man who had had blunt trauma to the head 2 months earlier presented with rapidly progressive swelling, pain, and diminishing vision in the left eye. The physical examination of the left eye revealed chemosis, pulsating proptosis, and an ulcerated cornea.

Acute Pulmonary Edema Following Plasma Exchange in a Patient With Guillian Barre Syndrome.

To JNA Readers: Occurrence of acute pulmonary edema in patients with Guillian Barre Syndrome (GBS) is a rare entity. We describe the occurrence of acute pulmonary edema following plasmapheresis in a patient with GBS and discuss the role of hypoproteinemia and autonomic dysfunction in its occurrence. A 23-year-old lady with a diagnosis of GBS was undergoing third session of high-volume plasmapheresis during which she developed uneasiness, dyspnea, and hypertension (220/130mm Hg). Plasmapheresis was immediately discontinued. She was managed with propped-up position, supplemental oxygen, and diuretics. She also received 2U of fresh frozen plasma to replace lost plasma volume. Twenty-four hours later, she developed tachypnea (respiratory rate of 40/min), decrease in oxygen saturation (SpO2) to 82%, and persistent hypertension. She was intubated and shifted to intensive care unit for acute care management and mechanical ventilation. Chest radiograph showed evidence of significant pulmonary edema (Fig. 1A). Large quantities of pink frothy secretions were continuously cleared from the trachea by frequent suctioning. She was ventilated in prone position with fraction of inspired oxygen (FiO2) of 1 and positive end-expiratory pressure (PEEP) was increased from 6 to 15mm Hg to achieve and maintain SpO2>94%. She was initiated on furosemide 20mg thrice daily, mor-

Internet use among anaesthesiologists: A cross-sectional survey

Anaesthesiologists access the internet for both personal and professional reasons, and the global network has helped to bridge the information gap between developed and developing countries.[1] There are limited data regarding how anaesthesiologists professionally use the internet. The objectives of this study were to assess time spent by anaesthesiologists on the internet, as well as purposes and patterns of use.

Concerns and challenges during anesthetic management of aneurysmal subarachnoid hemorrhage.

Anesthetic management of patients with aneurysmal subarachnoid hemorrhage is challenging because of the emergency nature of the presentation, complex pathology, varied intracranial and systemic manifestations and need for special requirements during the course of management. Successful perioperative outcome depends on overcoming these challenges by thorough understanding of pathophysiology of Subarachnoid hemorrhage, knowledge about associated complications, preoperative optimization, choice of definitive therapy, a good anesthetic and surgical technique, vigilant monitoring and optimal postoperative care. Guidelines based on randomized studies and provided by various societies are helpful in the routine management of these patients and wherever there is a lack of high quality evidence, the available data is provided for practical management.

Anesthetic management during electroconvulsive therapy in a patient with burn injury

We could diagnose tumor migration only in the postanesthesia care unit; but this migration may have occurred earlier, possibly at the end of surgery or during patient repositioning. We should have performed fiberoptic bronchscopy after changing the Double Lumen Tube to single lumen tube and should have checked the tracheobronchial tree before shifting patient from OT, to avoid this life-threatening complication. We strongly recommend performance of flexible fibreoptic bronchoscopy routinely before and after ET tube change or extubation especially with excessive handling of tumor tissue.

Misinterpretation of minimum alveolar concentration: Importance of entering demographic variables

Indian Journal of Anaesthesia | Vol. 58 | Issue 4 | Jul-Aug 2014 504 arising from visceral organs upon the heart. Acta Neuroveg 1966;28:224-33. 7. Yamaguchi Y, Tsuchiya M, Akiba T, Yasuda M, Kiryu Y, Hagiwara T, et al. Nervous influences upon the heart due to overdistension of the urinary bladder: The relation of its mechanism to vago-vagal reflex. Keio J Med 1964;13:87-99. 8. Fagius J, Karhuvaara S. Sympathetic activity and blood pressure increases with bladder distension in humans. Hypertension 1989;14:511-7.