Research Interests:
Pain is an unpleasant experience which can produce changes in all the systems of the body. Pain in children is not different from that in adults and can lead to similar detrimental effects on the body. The anticipation and effective... more
Pain is an unpleasant experience which can produce changes in all the systems of the body. Pain in children is not different from that in adults and can lead to similar detrimental effects on the body. The anticipation and effective treatment of pain in pediatric patients is thus, an essential component of care. A careful assessment of pediatric pain using age-specific pain scoring systems allows for exact quantification of pain. The use of various analgesics should be done early and in adequate doses for them to be effective. The use of multimodal approach with weaker analgesics along with regional blocks is an effective modality to control pain and prevent severe adverse effects associated with higher doses of potent analgesics. The advancement in the pharmacology of analgesics allows for their more widespread use with minimal side-effects. The use of patient or nurse controlled analgesia and continuous regional nerve blocks with the use of indwelling catheters can augment the pediatric pain management. Keywords: Pediatrics; Postoperative pain management; Neuraxial Citation: Kulshrestha A, Bajwa SJS. Management of acute postoperative pain in pediatric patients. Anaesth Pain & Intensive Care 2014;18(1):101-107
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Pre-eclampsia is an important cause of mortality and morbidity in parturients with varied presentations and controversial pathophysiology. The central pathology is a profound vasoconstriction in the vasculature leading to volume... more
Pre-eclampsia is an important cause of mortality and morbidity in parturients with varied presentations and controversial pathophysiology. The central pathology is a profound vasoconstriction in the vasculature leading to volume contraction and placental hypoperfusion. The management mainly involves a multi-disciplinary approach with the anesthesiologist playing a significant role for a positive outcome. Anesthesia for such parturients remains a challenge and starts with provision of labor analgesia which should be offered to all preeclamptic parturients. The neuraxial techniques of analgesia are most favourable for adequate pain relief and if contraindicated, intravenous PCA technique with the use of opioids should be used. Recent studies show favourable maternal and fetal outcomes with the use of patient controlled epidural analgesia technique with the combination of lower concentrations of local anesthetics with opioids. Regional anesthesia should be preferred in these parturient...
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Research Interests: Neurosurgery and Medicine
Pre-eclampsia is a disease of pregnancy involving various systems with associated high blood pressure and other changes. The pathophysiology of this disease is not well known but the main pathological change is vasoconstriction in the... more
Pre-eclampsia is a disease of pregnancy involving various systems with associated high blood pressure and other changes. The pathophysiology of this disease is not well known but the main pathological change is vasoconstriction in the vascular bed of the parturient with abnormalities in the uteroplacental circulation. A multi-disciplinary approach is essential for proper management of this disease. The provision of analgesia during labor significantly reduces the stress response and thus is helpful in reducing the elevated blood pressure and also exerts beneficial effects on uteroplacental perfusion. The neuraxial analgesia technique is considered to be the gold standard and has been found to be effective and safe in pre-eclamptic parturients. The use of lower concentrations of local anesthetic drugs in combination with opioids results in less motor blockade, lesser dose of drugs and lesser incidence of significant side-effects. The patient-controlled epidural analgesia technique is...
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Auxiliary lanes are generally used to reduce the traffic turbulence created by merging and diverging movements and are primarily used by vehicles either entering or exiting the freeway. The Highway Capacity Manual (HCM) does not offer... more
Auxiliary lanes are generally used to reduce the traffic turbulence created by merging and diverging movements and are primarily used by vehicles either entering or exiting the freeway. The Highway Capacity Manual (HCM) does not offer explicit guidance on the benefit of adding an auxiliary lane between an on- and off-ramp. The objective of this part of the project was to quantify the additional traffic volume that can be accommodated on a freeway segment by connecting an on-ramp to an off-ramp with an auxiliary lane. The approach used was to identify the traffic volume level at which each level of service density threshold was met for the conditions of with and without an auxiliary lane. The CORSIM simulation program was used to generate the data upon which to establish the quantitative effect of an auxiliary lane. Two versions of an adjustment equation that gives the percentage increase in volume throughput due to adding an auxiliary lane were developed. The developed equations are simply a function of the number of mainline lanes, as other factors were not found to significantly affect the percentage increase in volume throughput. The capacity of a freeway segment is a critical factor for the assessment of the traffic flow operations on freeway facilities. The HCM (2000) is considered to be one of the authoritative sources on capacity values for a variety of roadway types in the U.S. It provides a single set of capacity values for basic freeway segments as a function of free-flow speed. These values are considered to be reasonably representative values for freeways located throughout the U.S., but it is recognized that lower or higher values may be more appropriate in any given location. However, the HCM does not provide any guidance on how its recommended values can be adjusted to reflect significant differences in capacity due to local conditions, nor how to directly measure or estimate capacity values. The objective of this part of the project was to investigate various methods that can be used to arrive at an estimate of freeway capacity values, and to recommend one of these methods to the Florida Department of Transportation for use in developing its own estimates of capacity for Florida freeways. Three methods were investigated: one that fits a mathematical function to speed-flow data points, from which the apex of the function is taken as capacity; one that estimates a breakdown probability distribution based on flow rates preceding breakdown events, from which capacity can be taken to correspond to a certain percentile value of the breakdown probability distribution; and one that uses a flow rate corresponding to a specified percentile within a specified range of maximum flow rates observed at a site. It is recommended that this latter method is most suitable for planning and preliminary engineering applications.
Research Interests:
Auxiliary lanes are generally used to reduce the traffic turbulence created by merging and diverging movements and are primarily used by vehicles either entering or exiting the freeway. The Highway Capacity Manual (HCM) does not offer... more
Auxiliary lanes are generally used to reduce the traffic turbulence created by merging and diverging movements and are primarily used by vehicles either entering or exiting the freeway. The Highway Capacity Manual (HCM) does not offer explicit guidance on the benefit of adding an auxiliary lane between an on- and off-ramp. The objective of this part of the project was to quantify the additional traffic volume that can be accommodated on a freeway segment by connecting an on-ramp to an off-ramp with an auxiliary lane. The approach used was to identify the traffic volume level at which each level of service density threshold was met for the conditions of with and without an auxiliary lane. The CORSIM simulation program was used to generate the data upon which to establish the quantitative effect of an auxiliary lane. Two versions of an adjustment equation that gives the percentage increase in volume throughput due to adding an auxiliary lane were developed. The developed equations are simply a function of the number of mainline lanes, as other factors were not found to significantly affect the percentage increase in volume throughput. The capacity of a freeway segment is a critical factor for the assessment of the traffic flow operations on freeway facilities. The HCM (2000) is considered to be one of the authoritative sources on capacity values for a variety of roadway types in the U.S. It provides a single set of capacity values for basic freeway segments as a function of free-flow speed. These values are considered to be reasonably representative values for freeways located throughout the U.S., but it is recognized that lower or higher values may be more appropriate in any given location. However, the HCM does not provide any guidance on how its recommended values can be adjusted to reflect significant differences in capacity due to local conditions, nor how to directly measure or estimate capacity values. The objective of this part of the project was to investigate various methods that can be used to arrive at an estimate of freeway capacity values, and to recommend one of these methods to the Florida Department of Transportation for use in developing its own estimates of capacity for Florida freeways. Three methods were investigated: one that fits a mathematical function to speed-flow data points, from which the apex of the function is taken as capacity; one that estimates a breakdown probability distribution based on flow rates preceding breakdown events, from which capacity can be taken to correspond to a certain percentile value of the breakdown probability distribution; and one that uses a flow rate corresponding to a specified percentile within a specified range of maximum flow rates observed at a site. It is recommended that this latter method is most suitable for planning and preliminary engineering applications.
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Research Interests:
Research Interests:
The Florida Department of Transportation recently implemented high occupancy/toll (HOT) lanes (known as 95 Express) in the Miami regional area on Interstate 95. This report investigates three aspects relevant to the operations and... more
The Florida Department of Transportation recently implemented high occupancy/toll (HOT) lanes (known as 95 Express) in the Miami regional area on Interstate 95. This report investigates three aspects relevant to the operations and management of HOT lanes such as 95 Express. First, two questions concerning the impact and effectiveness of dynamic tolling are investigated. One is whether a managed-lane system exhibits hysteresis-like behavior that motorists periodically shift their departure times to cope with the volatility of the toll being charged. The other is whether dynamic pricing necessarily performs better than static or time-of-day pricing. Second, this report examines whether and how the reduced lane, shoulder widths, delineators, and designs of ingress/egress points have affected the capacity and operations of the toll lanes and the general-purpose lanes of 95 Express. Lastly, the report focuses on enhancement and evaluation of the tolling algorithms for the current and future 95 Express.
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The Florida Department of Transportation recently implemented high occupancy/toll (HOT) lanes (known as 95 Express) in the Miami regional area on Interstate 95. This report investigates three aspects relevant to the operations and... more
The Florida Department of Transportation recently implemented high occupancy/toll (HOT) lanes (known as 95 Express) in the Miami regional area on Interstate 95. This report investigates three aspects relevant to the operations and management of HOT lanes such as 95 Express. First, two questions concerning the impact and effectiveness of dynamic tolling are investigated. One is whether a managed-lane system exhibits hysteresis-like behavior that motorists periodically shift their departure times to cope with the volatility of the toll being charged. The other is whether dynamic pricing necessarily performs better than static or time-of-day pricing. Second, this report examines whether and how the reduced lane, shoulder widths, delineators, and designs of ingress/egress points have affected the capacity and operations of the toll lanes and the general-purpose lanes of 95 Express. Lastly, the report focuses on enhancement and evaluation of the tolling algorithms for the current and future 95 Express.
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Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS). We aimed at comparing... more
Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS). We aimed at comparing nitroglycerine, esmolol and dexmedetomidine for inducing controlled hypotension in patients undergoing FESS. One hundred and fifty American Society of Anesthesiologists physical status I or II adult patients undergoing FESS under general anesthesia were randomly allocated to three groups of 50 patients each. Group E received esmolol in a loading and maintenance dose of 1 mg/kg over 1 min and 0.5-1.0 mg/kg/h, respectively. Group D received a loading dose of dexmedetomidine 1 μg/kg over 10 min followed by an infusion 0.5-1.0 μg/kg/h, and group N received nitroglycerine infusion at a dose of 0.5-2 μg/kg/min so as to maintain mean arterial pressure (MAP) between 60 and 70 mmHg in all the groups. The visibility of the surgical field was assessed by surgeon using...
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Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS). We aimed at comparing... more
Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS). We aimed at comparing nitroglycerine, esmolol and dexmedetomidine for inducing controlled hypotension in patients undergoing FESS. One hundred and fifty American Society of Anesthesiologists physical status I or II adult patients undergoing FESS under general anesthesia were randomly allocated to three groups of 50 patients each. Group E received esmolol in a loading and maintenance dose of 1 mg/kg over 1 min and 0.5-1.0 mg/kg/h, respectively. Group D received a loading dose of dexmedetomidine 1 μg/kg over 10 min followed by an infusion 0.5-1.0 μg/kg/h, and group N received nitroglycerine infusion at a dose of 0.5-2 μg/kg/min so as to maintain mean arterial pressure (MAP) between 60 and 70 mmHg in all the groups. The visibility of the surgical field was assessed by surgeon using...
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Research Interests: Engineering, Civil Engineering, Computer Science, Transport Engineering, Urban And Regional Planning, and 13 moreComparative Study, Simulation, Microsimulation, Regression Analysis, Traffic Flow, Application, Highway Capacity Manual, Record, Intersection, Level of Service, Spillover Effect, Queue, and Probabilistic Model
Research Interests: Engineering, Civil Engineering, Computer Science, Transport Engineering, Urban And Regional Planning, and 13 moreComparative Study, Simulation, Microsimulation, Regression Analysis, Traffic Flow, Application, Highway Capacity Manual, Record, Intersection, Level of Service, Spillover Effect, Queue, and Probabilistic Model
The use of laparoscopy has revolutionised the surgical field with its advantages of reduced morbidity with early recovery. Laparoscopic procedures have been traditionally performed under general anaesthesia (GA) due to the respiratory... more
The use of laparoscopy has revolutionised the surgical field with its advantages of reduced morbidity with early recovery. Laparoscopic procedures have been traditionally performed under general anaesthesia (GA) due to the respiratory changes caused by pneumoperitoneum, which is an integral part of laparoscopy. The precise control of ventilation under controlled conditions in GA has proven it to be ideal for such procedures. However, recently the use of regional anaesthesia (RA) has emerged as an alternative choice for laparoscopy. Various reports in the literature suggest the safety of the use of spinal, epidural and combined spinal-epidural anaesthesia in laparoscopic procedures. The advantages of RA can include: Prevention of airway manipulation, an awake and spontaneously breathing patient intraoperatively, minimal nausea and vomiting, effective post-operative analgesia, and early ambulation and recovery. However, RA may be associated with a few side effects such as the requirement of a higher sensory level, more severe hypotension, shoulder discomfort due to diaphragmatic irritation, and respiratory embarrassment caused by pneumoperitoneum. Further studies may be required to establish the advantage of RA over GA for its eventual global use in different patient populations.
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The use of laparoscopy has revolutionised the surgical field with its advantages of reduced morbidity with early recovery. Laparoscopic procedures have been traditionally performed under general anaesthesia (GA) due to the respiratory... more
The use of laparoscopy has revolutionised the surgical field with its advantages of reduced morbidity with early recovery. Laparoscopic procedures have been traditionally performed under general anaesthesia (GA) due to the respiratory changes caused by pneumoperitoneum, which is an integral part of laparoscopy. The precise control of ventilation under controlled conditions in GA has proven it to be ideal for such procedures. However, recently the use of regional anaesthesia (RA) has emerged as an alternative choice for laparoscopy. Various reports in the literature suggest the safety of the use of spinal, epidural and combined spinal-epidural anaesthesia in laparoscopic procedures. The advantages of RA can include: Prevention of airway manipulation, an awake and spontaneously breathing patient intraoperatively, minimal nausea and vomiting, effective post-operative analgesia, and early ambulation and recovery. However, RA may be associated with a few side effects such as the requirement of a higher sensory level, more severe hypotension, shoulder discomfort due to diaphragmatic irritation, and respiratory embarrassment caused by pneumoperitoneum. Further studies may be required to establish the advantage of RA over GA for its eventual global use in different patient populations.
Research Interests:
An increasing proportion of patients coming for anesthesia and surgery have some form of nutritional deficiency disorder which can have extremely variable presentation ranging from anorexia nervosa to obesity. All these nutritional... more
An increasing proportion of patients coming for anesthesia and surgery have some form of nutritional deficiency disorder which can have extremely variable presentation ranging from anorexia nervosa to obesity. All these nutritional disorders produce various pathophysiological changes in cardiovascular, respiratory, renal, endocrine, and immune systems, which make these patients highly susceptible to various anesthetic complications. The serious biochemical alterations and interaction of anesthetic drugs with various psychiatric drugs used for treatment of psychiatric nutritional disorders should also be kept in mind while anesthetizing such patients. A careful preoperative planning and optimization of general condition of these patients is mandatory to prevent any catastrophe. The importance of intense perioperative and postoperative monitoring cannot be underestimated in preventing any untoward incident during this period.
Research Interests:
An increasing proportion of patients coming for anesthesia and surgery have some form of nutritional deficiency disorder which can have extremely variable presentation ranging from anorexia nervosa to obesity. All these nutritional... more
An increasing proportion of patients coming for anesthesia and surgery have some form of nutritional deficiency disorder which can have extremely variable presentation ranging from anorexia nervosa to obesity. All these nutritional disorders produce various pathophysiological changes in cardiovascular, respiratory, renal, endocrine, and immune systems, which make these patients highly susceptible to various anesthetic complications. The serious biochemical alterations and interaction of anesthetic drugs with various psychiatric drugs used for treatment of psychiatric nutritional disorders should also be kept in mind while anesthetizing such patients. A careful preoperative planning and optimization of general condition of these patients is mandatory to prevent any catastrophe. The importance of intense perioperative and postoperative monitoring cannot be underestimated in preventing any untoward incident during this period.
Research Interests:
Acute and chronic neurological diseases are associated with a high incidence of malnutrition due to the stress response created by them. Early recognition of nutritional deficiency by careful assessment of nutritional status by various... more
Acute and chronic neurological diseases are associated with a high incidence of malnutrition due to the stress response created by them. Early recognition of nutritional deficiency by careful assessment of nutritional status by various means is essential. These patients may have decreased intake, disease related changes in resting energy expenditure, and effect of drug therapy on food intake, all of which predisposes for undernutrition. Enteral route of nutrition is the preferred route for supplementation of nutrition in these patients however, parenteral route also can be utilised if the enteral route is contraindicated. A close monitoring of the patient on nutrition supplementation is required to prevent complications of nutrition. A reassessment of nutritional status is required in the chronic phase of these neurological diseases as diseases related reduction in resting energy expenditure and requirements may lead to overnutrition and obesity.
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Acute and chronic neurological diseases are associated with a high incidence of malnutrition due to the stress response created by them. Early recognition of nutritional deficiency by careful assessment of nutritional status by various... more
Acute and chronic neurological diseases are associated with a high incidence of malnutrition due to the stress response created by them. Early recognition of nutritional deficiency by careful assessment of nutritional status by various means is essential. These patients may have decreased intake, disease related changes in resting energy expenditure, and effect of drug therapy on food intake, all of which predisposes for undernutrition. Enteral route of nutrition is the preferred route for supplementation of nutrition in these patients however, parenteral route also can be utilised if the enteral route is contraindicated. A close monitoring of the patient on nutrition supplementation is required to prevent complications of nutrition. A reassessment of nutritional status is required in the chronic phase of these neurological diseases as diseases related reduction in resting energy expenditure and requirements may lead to overnutrition and obesity.
Research Interests:
Infections have almost become an inseparable part of the intensive care units throughout the globe in spite of numerous advancements in diagnostic and therapeutic interventions. With advances in critical care medicine and introduction of... more
Infections have almost become an inseparable part of the intensive care units throughout the globe in spite of numerous advancements in diagnostic and therapeutic interventions. With advances in critical care medicine and introduction of broad-spectrum antibiotics, the incidence of invasive fungal infections in intensive care is on the rise, especially in patients with immunosuppression. The aim of this review is to collect recent information about various types of invasive fungal infections prevalent in the intensive care unit, the problems in their diagnosis and recent trends in their management. A thorough literature search was made in PubMed and Google using the following keywords for our search: Invasive fungal infection, antifungal therapy in intensive care unit, candidiasis. The major fungi implicated worldwide are Candida and Aspergillus spp., followed by Cryptococcus, Histoplasma, etc., in endemic areas. These produce a wide variety of infections that are difficult to diagn...
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Infections have almost become an inseparable part of the intensive care units throughout the globe in spite of numerous advancements in diagnostic and therapeutic interventions. With advances in critical care medicine and introduction of... more
Infections have almost become an inseparable part of the intensive care units throughout the globe in spite of numerous advancements in diagnostic and therapeutic interventions. With advances in critical care medicine and introduction of broad-spectrum antibiotics, the incidence of invasive fungal infections in intensive care is on the rise, especially in patients with immunosuppression. The aim of this review is to collect recent information about various types of invasive fungal infections prevalent in the intensive care unit, the problems in their diagnosis and recent trends in their management. A thorough literature search was made in PubMed and Google using the following keywords for our search: Invasive fungal infection, antifungal therapy in intensive care unit, candidiasis. The major fungi implicated worldwide are Candida and Aspergillus spp., followed by Cryptococcus, Histoplasma, etc., in endemic areas. These produce a wide variety of infections that are difficult to diagn...
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Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no... more
Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were al...
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Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no... more
Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were al...
Research Interests:
With an increasing demand for newer anti-epileptic agents having a better pharmacological profile, many newer agents are being investigated. Lacosamide is a newer functional amino acid being developed as an adjunctive therapy for... more
With an increasing demand for newer anti-epileptic agents having a better pharmacological profile, many newer agents are being investigated. Lacosamide is a newer functional amino acid being developed as an adjunctive therapy for resistant partial-onset seizures owing to its activity of enhancing the slow inactivation of voltage-gated sodium channels thereby reducing pathologic hyperactivity in neurons. It has also being investigated for its role as anti-nociceptive in variety of pain scenarios specifically in diabetic neuropathic pain. It is well-absorbed orally, metabolized in liver and excreted by the kidneys. It has a favorable pharmacologic profile in having minimal drug interactions. The adverse effects include mild dizziness, behavioral changes and dose dependent prolongation of PR interval. This review is directed toward the development of lacosamide and its potential usefulness as an anti-epileptic and an anti-nociceptive drug.
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With an increasing demand for newer anti-epileptic agents having a better pharmacological profile, many newer agents are being investigated. Lacosamide is a newer functional amino acid being developed as an adjunctive therapy for... more
With an increasing demand for newer anti-epileptic agents having a better pharmacological profile, many newer agents are being investigated. Lacosamide is a newer functional amino acid being developed as an adjunctive therapy for resistant partial-onset seizures owing to its activity of enhancing the slow inactivation of voltage-gated sodium channels thereby reducing pathologic hyperactivity in neurons. It has also being investigated for its role as anti-nociceptive in variety of pain scenarios specifically in diabetic neuropathic pain. It is well-absorbed orally, metabolized in liver and excreted by the kidneys. It has a favorable pharmacologic profile in having minimal drug interactions. The adverse effects include mild dizziness, behavioral changes and dose dependent prolongation of PR interval. This review is directed toward the development of lacosamide and its potential usefulness as an anti-epileptic and an anti-nociceptive drug.
Research Interests:
Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very... more
Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very economical as blood donated from a single donor can be utilized for many recipients at the same time. However, the transfusion of blood and its components do carry the inherent risk of various transfusion reactions as well as transmission of infections. The indications for transfusion should be strictly adhered to for preventing nonjudicious use. The health care persons involved in transfusion should be well aware of implications of the mismatched transfusion and should be able to provide treatment if such mishaps do occur. A health care professional should carefully weigh the benefits of blood transfusion against the risks involved before subjecting the patients to the transfusion. This manuscript aims to comprehensively review the current evidence based approaches in blood and component transfusion which are being followed in anesthesiology and intensive care practice.
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Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very... more
Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very economical as blood donated from a single donor can be utilized for many recipients at the same time. However, the transfusion of blood and its components do carry the inherent risk of various transfusion reactions as well as transmission of infections. The indications for transfusion should be strictly adhered to for preventing nonjudicious use. The health care persons involved in transfusion should be well aware of implications of the mismatched transfusion and should be able to provide treatment if such mishaps do occur. A health care professional should carefully weigh the benefits of blood transfusion against the risks involved before subjecting the patients to the transfusion. This manuscript aims to comprehensively review the current evidence based approaches in blood and component transfusion which are being followed in anesthesiology and intensive care practice.
Research Interests:
Advancements in medicine, better diagnostics and zeal for a high quality of life have enabled many geriatric patients seeking medical attention for any type of illness. The elderly population is increasing globally and so does the number... more
Advancements in medicine, better diagnostics and zeal for a high quality of life have enabled many geriatric patients seeking medical attention for any type of illness. The elderly population is increasing globally and so does the number of such patients in hospital and critical care units. However, increased incidence of debilitating diseases in elderly makes them more prone to develop malnutrition and thus supplementation of nutrition plays an important role in care of these patients. The parenteral nutrition is usually given if enteral nutrition is inadequate or cannot be given. The causes of malnutrition in elderly can be manifold and may be due to weight loss, loss of fat free mass and due to muscle wasting. The special considerations when formulating parenteral nutrition in elderly population is increased content of lipids, early supplementation of trace elements, minerals and vitamins. The outcomes of parenteral nutrition in elderly population have been found to be similar to that in young patients, however overall prognosis in these patients remain guarded due to more severity and guarded prognosis of the diseases found in these patients. The complications due to parenteral nutrition in elderly patients are similar to that of the young patients and are mainly mechanical (catheter related), infectious and metabolic. It has been recommended that the parenteral nutrition should be started early, if indicated, in geriatric patients and should follow the same guidelines as in younger patients with some modifications.
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Advancements in medicine, better diagnostics and zeal for a high quality of life have enabled many geriatric patients seeking medical attention for any type of illness. The elderly population is increasing globally and so does the number... more
Advancements in medicine, better diagnostics and zeal for a high quality of life have enabled many geriatric patients seeking medical attention for any type of illness. The elderly population is increasing globally and so does the number of such patients in hospital and critical care units. However, increased incidence of debilitating diseases in elderly makes them more prone to develop malnutrition and thus supplementation of nutrition plays an important role in care of these patients. The parenteral nutrition is usually given if enteral nutrition is inadequate or cannot be given. The causes of malnutrition in elderly can be manifold and may be due to weight loss, loss of fat free mass and due to muscle wasting. The special considerations when formulating parenteral nutrition in elderly population is increased content of lipids, early supplementation of trace elements, minerals and vitamins. The outcomes of parenteral nutrition in elderly population have been found to be similar to that in young patients, however overall prognosis in these patients remain guarded due to more severity and guarded prognosis of the diseases found in these patients. The complications due to parenteral nutrition in elderly patients are similar to that of the young patients and are mainly mechanical (catheter related), infectious and metabolic. It has been recommended that the parenteral nutrition should be started early, if indicated, in geriatric patients and should follow the same guidelines as in younger patients with some modifications.
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Cancer has been the leading cause of mortality in both developed and developing countries. With the advancement in chemotherapeutic agents, the quality and lifespan of patients with advanced malignancies has improved. These patients often... more
Cancer has been the leading cause of mortality in both developed and developing countries. With the advancement in chemotherapeutic agents, the quality and lifespan of patients with advanced malignancies has improved. These patients often come to hospitals for various types of elective and emergency surgeries. The attending anaesthesiologist faces a daunting task while managing these patients as there can be gross physiological derangements in most of the organ systems. A careful and thorough preoperative assessment, optimisation of physiological milieu, vigilant intraoperative monitoring, anticipation of potential complications and postoperative pain control is essential for reducing perioperative mortality and morbidity in these patients. The toxicity of chemotherapeutic agents and potential drug interactions with selected anaesthetic drugs are of prime concern while anaesthetizing such patients. The build-up of nutrition in these patients is essential during preoperative period and should be continued during postoperative period also.
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Cancer has been the leading cause of mortality in both developed and developing countries. With the advancement in chemotherapeutic agents, the quality and lifespan of patients with advanced malignancies has improved. These patients often... more
Cancer has been the leading cause of mortality in both developed and developing countries. With the advancement in chemotherapeutic agents, the quality and lifespan of patients with advanced malignancies has improved. These patients often come to hospitals for various types of elective and emergency surgeries. The attending anaesthesiologist faces a daunting task while managing these patients as there can be gross physiological derangements in most of the organ systems. A careful and thorough preoperative assessment, optimisation of physiological milieu, vigilant intraoperative monitoring, anticipation of potential complications and postoperative pain control is essential for reducing perioperative mortality and morbidity in these patients. The toxicity of chemotherapeutic agents and potential drug interactions with selected anaesthetic drugs are of prime concern while anaesthetizing such patients. The build-up of nutrition in these patients is essential during preoperative period and should be continued during postoperative period also.
Research Interests:
The advancement in the technology of the cochlear implants has resulted in increasing trend of cochlear implantation in both the children and elderly population. The anesthesiologist is faced with the task of smoothly conducting the... more
The advancement in the technology of the cochlear implants has resulted in increasing trend of cochlear implantation in both the children and elderly population. The anesthesiologist is faced with the task of smoothly conducting the surgery without any interference in the stimulation techniques used. The preoperative evaluation is mainly focused on the presence of any congenital anomalies in these patients which may affect anesthetic technique. The reduction of anxiety of the patient as well as the parents of small children is an important aspect of the preoperative visit. Intraoperatively the anesthetic technique chosen should not interfere with the stimulation of the cochlear implant electrode assembly. The postoperative management is mainly focused at prevention of agitation and good analgesia. A close cooperation between the surgeon and the anesthesiologist is essential for a positive outcome in this surgery. The current review focuses on the important anesthesia aspects related to cochlear implant surgery.
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The advancement in the craniofacial surgery has imposed challenges on the attending anesthesiologist for the successful conduct reconstructive surgery. The anesthesiologist remains a key person in the multidisciplinary tasks involved in... more
The advancement in the craniofacial surgery has imposed challenges on the attending anesthesiologist for the successful conduct reconstructive surgery. The anesthesiologist remains a key person in the multidisciplinary tasks involved in such surgery. Most of these patients belong to smaller age group and have difficult airway due to various syndromes associated with it. The other major problems faced by the anesthesiologist in such surgery are intra-operative hypothermia due to prolonged surgery and significant blood loss as well as fluid shifts associated with it. A well-equipped intensive care unit is a must for the post-operative care of such patients. Even the adult patients coming for maxillofacial trauma surgery require careful vigilance both intra-operatively as well as post-operatively due to frequent difficult airway associated with it. A careful pre-operative evaluation and discussion with the surgeons, proper planning for airway management, intra-operative care and post-operative intensive care backup is required for the successful outcome in these surgeries. The current review is an attempt to describe in short the important anesthesia aspects and challenges related to various cranio-maxillary lesions.
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The advancement in the craniofacial surgery has imposed challenges on the attending anesthesiologist for the successful conduct reconstructive surgery. The anesthesiologist remains a key person in the multidisciplinary tasks involved in... more
The advancement in the craniofacial surgery has imposed challenges on the attending anesthesiologist for the successful conduct reconstructive surgery. The anesthesiologist remains a key person in the multidisciplinary tasks involved in such surgery. Most of these patients belong to smaller age group and have difficult airway due to various syndromes associated with it. The other major problems faced by the anesthesiologist in such surgery are intra-operative hypothermia due to prolonged surgery and significant blood loss as well as fluid shifts associated with it. A well-equipped intensive care unit is a must for the post-operative care of such patients. Even the adult patients coming for maxillofacial trauma surgery require careful vigilance both intra-operatively as well as post-operatively due to frequent difficult airway associated with it. A careful pre-operative evaluation and discussion with the surgeons, proper planning for airway management, intra-operative care and post-operative intensive care backup is required for the successful outcome in these surgeries. The current review is an attempt to describe in short the important anesthesia aspects and challenges related to various cranio-maxillary lesions.
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Nutrition in the critically ill patients has always been a difficult task for the intensivist. Unlike normal subjects, various physiological and pathological aspects have to be taken into consideration before initiating the nutrition in... more
Nutrition in the critically ill patients has always been a difficult task for the intensivist. Unlike normal subjects, various physiological and pathological aspects have to be taken into consideration before initiating the nutrition in this subset of patients. The associated morbidities in critically sick patient not only pose clinical difficulties to maintain a normal nutritional status but also create various limitations in selection of a particular nutrient. Various diseases commonly found in intensive care patients produces stress on the body and bring about changes in substrate metabolism thus leading to the deficiency of various nutrients. Numerous tools and methodologies are available nowadays to predict the assessment, screening, and monitoring of the nutritional status in critically ill patients. However, the nutritional status is a big decisive factor in predicting the outcome and malnutrition has been strongly associated with increased mortality and morbidity in these patients. The nutritional requirement also varies with regards to age, body mass index, co-morbid disease, duration in ICU, and many other factors and as such the calculation for nutritional supplementation has to be done strictly on an individual basis. In all these patients, it is also vital to achieve a strict glycemic control by using insulin so as to prevent any increase in morbidity and mortality. Enteral and parenteral nutritional controversies are as old as the concept of nutrition in Intensive Care Unit (ICU). Besides therapeutic merits, both enteral and parenteral nutrition are also associated with complications which can be prevented by set protocols as well as by education of nursing personnel involved in the care of critically ill. This article reviews all these aspects concerned with nutrition in critically ill patients so as to make an effort to build a comprehensive approach and strategies for designing the nutritional supplementation.
Research Interests:
Nutrition in the critically ill patients has always been a difficult task for the intensivist. Unlike normal subjects, various physiological and pathological aspects have to be taken into consideration before initiating the nutrition in... more
Nutrition in the critically ill patients has always been a difficult task for the intensivist. Unlike normal subjects, various physiological and pathological aspects have to be taken into consideration before initiating the nutrition in this subset of patients. The associated morbidities in critically sick patient not only pose clinical difficulties to maintain a normal nutritional status but also create various limitations in selection of a particular nutrient. Various diseases commonly found in intensive care patients produces stress on the body and bring about changes in substrate metabolism thus leading to the deficiency of various nutrients. Numerous tools and methodologies are available nowadays to predict the assessment, screening, and monitoring of the nutritional status in critically ill patients. However, the nutritional status is a big decisive factor in predicting the outcome and malnutrition has been strongly associated with increased mortality and morbidity in these patients. The nutritional requirement also varies with regards to age, body mass index, co-morbid disease, duration in ICU, and many other factors and as such the calculation for nutritional supplementation has to be done strictly on an individual basis. In all these patients, it is also vital to achieve a strict glycemic control by using insulin so as to prevent any increase in morbidity and mortality. Enteral and parenteral nutritional controversies are as old as the concept of nutrition in Intensive Care Unit (ICU). Besides therapeutic merits, both enteral and parenteral nutrition are also associated with complications which can be prevented by set protocols as well as by education of nursing personnel involved in the care of critically ill. This article reviews all these aspects concerned with nutrition in critically ill patients so as to make an effort to build a comprehensive approach and strategies for designing the nutritional supplementation.
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Research Interests: Medicine and Spinal Cord
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While the Highway Capacity Manual (HCM) 2000 does provide a separate procedure to estimate the back of queue for a lane group, its signalized intersection analysis procedure does not explicitly account for the impact to through movement... more
While the Highway Capacity Manual (HCM) 2000 does provide a separate procedure to estimate the back of queue for a lane group, its signalized intersection analysis procedure does not explicitly account for the impact to through movement traffic as a result of left-turn bay spillover. If the HCM methodology is used for an analysis of an intersection approach where left-turn spillover interferes with the discharge of through vehicles, the estimated delay results, and corresponding level of service, will be overly optimistic. Thus, the objective of this study was to determine the factors that significantly affect left-turn lane spillover and develop a model, or models, to predict the expected through movement capacity and discharge rate as a function of this spillover. Two approaches were used in this study: an analytical approach that developed a probability of left-turn spillover equation to incorporate into a capacity estimation equation, and an empirical approach incorporating the ...
Research Interests: Engineering, Civil Engineering, Computer Science, Transport Engineering, Urban And Regional Planning, and 13 moreComparative Study, Simulation, Microsimulation, Regression Analysis, Traffic Flow, Application, Highway Capacity Manual, Record, Intersection, Level of Service, Spillover Effect, Queue, and Probabilistic Model
While the Highway Capacity Manual (HCM) 2000 does provide a separate procedure to estimate the back of queue for a lane group, its signalized intersection analysis procedure does not explicitly account for the impact to through movement... more
While the Highway Capacity Manual (HCM) 2000 does provide a separate procedure to estimate the back of queue for a lane group, its signalized intersection analysis procedure does not explicitly account for the impact to through movement traffic as a result of left-turn bay spillover. If the HCM methodology is used for an analysis of an intersection approach where left-turn spillover interferes with the discharge of through vehicles, the estimated delay results, and corresponding level of service, will be overly optimistic. Thus, the objective of this study was to determine the factors that significantly affect left-turn lane spillover and develop a model, or models, to predict the expected through movement capacity and discharge rate as a function of this spillover. Two approaches were used in this study: an analytical approach that developed a probability of left-turn spillover equation to incorporate into a capacity estimation equation, and an empirical approach incorporating the ...