Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present ... more Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present with respiratory insufficiency and stridor of insidious onset and progressive nature. Immediate management includes securing the airway which requires anesthesia. We present successful management of a case of post intubation tracheal stenosis using rigid bronchoscopy under a combination of regional and general anesthesia
Journal of Obstetric Anaesthesia and Critical Care, 2015
Background: Ketofol is a combination of ketamine and propofol in a single syringe which can be pr... more Background: Ketofol is a combination of ketamine and propofol in a single syringe which can be prepared in any desired concentration. Several gynecological procedures like tubal sterilization are of short duration and just require analgesia and moderate sedation. A study was conducted to compare two different proportions of ketofol, with reference to the duration and level of sedation, quality of analgesia, hemodynamic and respiratory profiles, and to compare all the above effects with the well-tried propofol-fentanyl combination. Materials and Methods: This prospective randomized double-blind study was conducted on 60 adult females scheduled for elective tubal sterilization by minilaparotomy. Patients received a slow bolus injection followed by small aliquots of ketofol containing ketamine: Propofol (1:1) (group A), ketamine: Propofol (1:2) (group B), and fentanyl: Propofol (group C) to a predetermined sedation level using Ramsay Sedation Scale. Vital signs, oxygen saturation, and incidence of any side effects were recorded. Results: Ketofol in groups A and B was comparable in onset of sedation (A: 1.59 ± 0.58 min, B: 1.60 ± 0.72 min), intraoperative sedation scores (A: 5.60 ± 0.5, B: 5.85 ± 0.3), and recovery times (A: 4 ± 1 min, B: 3.5 ± 0.67 min). There was no significant difference in the hemodynamic and respiratory profile of ketofol in groups A, B, and C. Considering the onset of sedation, intraoperative sedation score, and recovery time, group C (fentanyl-propofol) patients were less sedated than their counterparts in ketofol group A and B. Furthermore, considering the verbal rating scale for pain at 15 min postoperatively, group C patients had poor analgesia compared to group A and B. Conclusion: Though ketofol in a ratio of 1:2 provides better sedation level compared to the other groups, both ketofol ratios (1:1 and 1:2) were similar in terms of providing hemodynamic and respiratory stability and producing adverse effects.
Molar pregnancy is a gestational trophoblastic disease wherein the swollen chorionic villi grow i... more Molar pregnancy is a gestational trophoblastic disease wherein the swollen chorionic villi grow in a way that resembles a cluster of grapes. Patients with molar pregnancies very often need anesthesia for suction evacuation. Though molar pregnancy is usually uncomplicated, few cases may be associated with perioperative complications. Various anesthetic techniques have been used for molar evacuation. We present here a case of molar pregnancy with hyperthyroidism, in which general anesthesia (GA) was administered to the patient with laryngeal mask airway. Six hours after evacuation, she went into acute cardiopulmonary distress. She was fortunate enough to be picked up early and was managed successfully.
Henoch-Schonlein purpura (HSP) is an autoimmune, multisystem, acute vasculitis of childhood commo... more Henoch-Schonlein purpura (HSP) is an autoimmune, multisystem, acute vasculitis of childhood commonly involving the skin, gut, joints and the kidneys. Fatal complications involving various systems can occur in this disease and careful perioperative management is advocated. We report here the occurrence of postoperative bradycardia and the successful perioperative management of a 12-year-old boy with HSP for diagnostic laparoscopy.
Abstarct Haemophilia is the oldest known rare genetic bleeding disorder that disrupts the blood c... more Abstarct Haemophilia is the oldest known rare genetic bleeding disorder that disrupts the blood clotting process. Although the level of haemophilia care has improved substantially, the problems of management in developing countries are poor awareness, high costs of treatment, inadequate diagnostic and coagulation screening facilities and scarce factor concentrates for therapy. We present here the problems in the perioperative management of a case of haemophilia A in India. It portrays the current picture of haemophilia management in many developing countries around the world.
Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present ... more Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present with respiratory insufficiency and stridor of insidious onset and progressive nature. Immediate management includes securing the airway which requires anesthesia. We present successful management of a case of post intubation tracheal stenosis using rigid bronchoscopy under a combination of regional and general anesthesia
Journal of Obstetric Anaesthesia and Critical Care, 2015
Background: Ketofol is a combination of ketamine and propofol in a single syringe which can be pr... more Background: Ketofol is a combination of ketamine and propofol in a single syringe which can be prepared in any desired concentration. Several gynecological procedures like tubal sterilization are of short duration and just require analgesia and moderate sedation. A study was conducted to compare two different proportions of ketofol, with reference to the duration and level of sedation, quality of analgesia, hemodynamic and respiratory profiles, and to compare all the above effects with the well-tried propofol-fentanyl combination. Materials and Methods: This prospective randomized double-blind study was conducted on 60 adult females scheduled for elective tubal sterilization by minilaparotomy. Patients received a slow bolus injection followed by small aliquots of ketofol containing ketamine: Propofol (1:1) (group A), ketamine: Propofol (1:2) (group B), and fentanyl: Propofol (group C) to a predetermined sedation level using Ramsay Sedation Scale. Vital signs, oxygen saturation, and incidence of any side effects were recorded. Results: Ketofol in groups A and B was comparable in onset of sedation (A: 1.59 ± 0.58 min, B: 1.60 ± 0.72 min), intraoperative sedation scores (A: 5.60 ± 0.5, B: 5.85 ± 0.3), and recovery times (A: 4 ± 1 min, B: 3.5 ± 0.67 min). There was no significant difference in the hemodynamic and respiratory profile of ketofol in groups A, B, and C. Considering the onset of sedation, intraoperative sedation score, and recovery time, group C (fentanyl-propofol) patients were less sedated than their counterparts in ketofol group A and B. Furthermore, considering the verbal rating scale for pain at 15 min postoperatively, group C patients had poor analgesia compared to group A and B. Conclusion: Though ketofol in a ratio of 1:2 provides better sedation level compared to the other groups, both ketofol ratios (1:1 and 1:2) were similar in terms of providing hemodynamic and respiratory stability and producing adverse effects.
Molar pregnancy is a gestational trophoblastic disease wherein the swollen chorionic villi grow i... more Molar pregnancy is a gestational trophoblastic disease wherein the swollen chorionic villi grow in a way that resembles a cluster of grapes. Patients with molar pregnancies very often need anesthesia for suction evacuation. Though molar pregnancy is usually uncomplicated, few cases may be associated with perioperative complications. Various anesthetic techniques have been used for molar evacuation. We present here a case of molar pregnancy with hyperthyroidism, in which general anesthesia (GA) was administered to the patient with laryngeal mask airway. Six hours after evacuation, she went into acute cardiopulmonary distress. She was fortunate enough to be picked up early and was managed successfully.
Henoch-Schonlein purpura (HSP) is an autoimmune, multisystem, acute vasculitis of childhood commo... more Henoch-Schonlein purpura (HSP) is an autoimmune, multisystem, acute vasculitis of childhood commonly involving the skin, gut, joints and the kidneys. Fatal complications involving various systems can occur in this disease and careful perioperative management is advocated. We report here the occurrence of postoperative bradycardia and the successful perioperative management of a 12-year-old boy with HSP for diagnostic laparoscopy.
Abstarct Haemophilia is the oldest known rare genetic bleeding disorder that disrupts the blood c... more Abstarct Haemophilia is the oldest known rare genetic bleeding disorder that disrupts the blood clotting process. Although the level of haemophilia care has improved substantially, the problems of management in developing countries are poor awareness, high costs of treatment, inadequate diagnostic and coagulation screening facilities and scarce factor concentrates for therapy. We present here the problems in the perioperative management of a case of haemophilia A in India. It portrays the current picture of haemophilia management in many developing countries around the world.
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Papers by radhika deva