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Byline: Rajeeb. Mishra, Ashish. Bindra, Ankur. Khandelwal, Devjyoti. Sharma, Keshav. Goyal, Girija. Rath, Deepak. Gupta Background: In traumatic brain injuries (TBI), cerebral microdialysis (CMD)-derived parameters, especially the lactate to pyruvate [...]

Byline: Ashutosh. Kaushal, Rajendra. Chouhan, Ashish. Bindra, Shailesh. Gaikwad, Vivekanandhan. Subbiah Background: Radiocontrast administration during interventional neuroradiology (INR) procedures for aneurysmal subarachnoid haemorrhage (aSAH) can add to renal insult. Serum [...]

Byline: Davinder. Singh, Sumit. Chowdhury, Ashish. Bindra Dear Editor, Correct placement of the endotracheal tube (ETT) is always a challenge in children, with endobronchial intubation being more common due to [...]

Byline: Sumit. Chowdhury, Ashish. Bindra Dear Editor, Indian Journal of Anaesthesia (IJA) is showing a steady improvement under the aegis of many renowned editors over the past few years. The [...]

Byline: Ashish. Bindra, Hirok. Roy Airway management remains challenging even with various evolving tools and strategies in the airway management armamentarium. Recent years have seen remarkable progress, emphasising a holistic [...]

Byline: Ashutosh. Kaushal, Ashish. Bindra, Surya. Dube Background and Aims: Anaesthetic agents can affect the neuroendocrine response to surgical stress. Along with affecting other parameters, this can affect blood glucose [...]

Byline: Mayank. Tyagi, Megha. Bir, Akanksha. Sharma, Pankaj. Singh, Ashish. Bindra, P. Chandra We report the strategy of anesthesia and intraoperative neurophysiological monitoring (IONM) in a 29-year-old, 22 weeks pregnant [...]

Byline: Deep. Sengupta, Ashish. Bindra, Indu. Kapoor, Purva. Mathur, Deepak. Gupta, Maroof. Khan Background: There is scant literature comparing high tidal volume ventilation (HTV) over low tidal volume (LTV) ventilation [...]

Byline: Saman. Fatima, Ajay. Garg, Leve. Joseph, M. Padma Srivastava, Deepti. Vibha, Raghav. Bansal, Ashish. Bindra, Manjari. Tripathi, Rajesh. Singh, Arunmozhimaran. Elavarasi Carotid artery stenting (CAS) is performed in patients [...]

Purpose Chest physiotherapy and tracheal suction cause sympathetic stimulation and increase heart rate (HR), mean arterial pressure (MAP) and intracranial pressure (ICP) which may have deleterious effect in the head injured. We planned to compare the effect of intravenous dexmedetomidine and lidocaine on intracerebral and systemic hemodynamic response to chest physiotherapy (CP) and tracheal suctioning (TS) in patients with severe traumatic brain injury (sTBI). Methods Prospective, randomized study in patients with sTBI, 18-60 years of age, undergoing mechanical ventilation and intraparenchymal ICP monitoring. Patients were randomized to receive either iv dexmedetomidine 0.5 mcg/kg (group I; n = 30) or iv lidocaine 2 mg/kg (group II; n = 30) over 10 min. After infusion of test drug, CP with vibrator and manual compression was performed for 2 min and TS was done over next 15-20 s. The hemodynamic response was recorded before, during and at interval of 1 min for 10 min after CP and TS. A 20% change in hemodynamic parameters was considered significant. Results The baseline hemodynamic (HR, MAP), intracranial (ICP, CPP) and respiratory (SPO.sub.2, AWP.sub.peak) parameters were normal and comparable in both the groups. After dexmedetomidine infusion, MAP and CPP decreased significantly from baseline value. In group II, there was no significant change in HR, MAP, ICP and CPP. At end of CP and TS, HR, MAP and CPP in group I was lower as compared to group II. During the 10-min observation period following CP and TS, MAP and CPP in group I remained significantly lower as compared to baseline and group II. There was no significant change in value of other measured parameters. Conclusions Both dexmedetomidine and lidocaine were effective to blunt rise in HR, MAP and ICP in response to CP and TS in patients with sTBI. However, intravenous dexmedetomidine caused significant decrease in MAP and CPP as compared to the baseline and lidocaine., Author(s): Shalendra Singh [sup.1] , Rajendra Singh Chouhan [sup.1] , Ashish Bindra [sup.1] , Nayani Radhakrishna [sup.2] Author Affiliations: (Aff1) 0000 0004 1767 6103, grid.413618.9, Department of Neuroanaesthesiology and Critical [...]

Byline: Vattipalli. Sameera, Ashish. Bindra, Girija. Rath Sir, The unfortunate incident of 2001, where an oxygen cylinder accidentally brought into the vicinity of a magnetic resonance (MR) scanner resulted in [...]

Background Prolonged mechanical ventilation is associated with weaning failure in severe TBI patients. Ultrasound is a noninvasive modality for evaluating diaphragm function. On ultrasonography (USG), diaphragm thickness is observed to decrease over time in mechanically ventilated patients. However, little literature exists on the severity of diaphragmatic dysfunction in traumatic brain injury (TBI) patients. This study aimed to observe the changes occurring in diaphragmatic function in mechanically ventilated TBI patients. Methods TBI patients aged 18 to 65 years, requiring mechanical ventilation, were included. USG assessment of diaphragm function was done on days 0, 3, 5 and 7 of neurotrauma intensive care unit (NICU) admission in the supine position, during sedation holiday and spontaneous breathing trial. Measurements were done at end expiration (T E) and at maximal inspiration (T I) using 7- to 13-MHz linear array probe for three consecutive times and then averaged. Thickness fraction was calculated as (T I – T E /T E) × 100. Diaphragmatic excursion (DE) was measured in the M mode using 1- to 5-MHz phased array probe, as maximal height of inspiration. Results Forty patients were evaluated. The mean diaphragmatic thickness fraction (DTF) at days 0, 3, 5, and 7 was 33.58 ± 10.08, 33.4 ± 9.76, 32.32 ± 8.36, and 31.65 ± 8.23, respectively. Change in DTF was statistically significant on day 7 (p = 0.040). The mean DE at days 0, 3, 5, and 7 was 9.61 ± 3.99, 9.02 ± 3.46, 8.87 ± 2.63, 8.56 ± 2.74, respectively. Changes in DE over days 3, 5, and 7 were statistically significant (p < 0.001). The mean DTF was lower on day 3 in patients who were admitted for less than 20 days than those who required hospital admission for more than 20 days (p = 0.044). Conclusion Decrease in DTF and DE over the period of 7 days was observed with a significant decrease occurring on the 7th day following TBI. [ABSTRACT FROM AUTHOR]

Byline: Ashish. Bindra, Ashutosh. Kaushal, Chander. Yadav Sir, We would like to convey our gratitude to the readers for showing interest in our article. Authors raised a very valid point [...]

Byline: Ashish. Bindra, Ashutosh. Kaushal, Hemanshu. Prabhakar, Arvind. Chaturvedi, Poodepedi. Chandra, Manjari. Tripathi, Vivekanandan. Subbiah, Sandeep. Sathianathan, Jyotirmoy. Banerjee, Chander. Prakash Purpose: Long standing temporal lobe epilepsy (TLE) causes cerebral [...]

Author(s): Ashish Bindra [sup.1], Rajendra S. Chouhan [sup.1], Hemanshu Prabhakar [sup.1], P. Sarat Chandra [sup.2], Manjari Tripathi [sup.3] Author Affiliations: (1) grid.413618.9, 0000000417676103, Department of Neuroanesthesiology, Neurosciences Center, All India [...], Purpose Drug-resistant epilepsy (DRE) occurs in about 30 % of individuals with epilepsy. For seizure control, a wide range of surgical procedures are performed, depending on the underlying pathology. To address the anesthetic and perioperative concerns in these patients, we analyzed the data of persons with DRE who underwent epilepsy surgery at our institute. Methods A retrospective analysis of patients who underwent epilepsy surgery from 2005-2010 was performed. For data collection and analysis, patients were divided into three groups: Group I (temporal lobe epilepsy), Group II (extratemporal lobe epilepsy), and Group III (multilobar epilepsy and others). Results A total of 241 surgical procedures were performed on 235 persons with DRE. The procedures included temporal (149) and extratemporal (47) lobe resection, hemispherotomy (31), corpus callosotomy (5), vagus nerve stimulation (3), and implantation of invasive cerebral electrodes (6). General anesthesia was the more common anesthetic technique; awake craniotomy was performed in only five cases. Intraoperative neuromonitoring was used most frequently in Group II. Patients in Group III had the longest intraoperative course and the greatest blood loss. The overall incidence of postoperative mechanical ventilation was 17.84 %, with 53.84 % of patients in Group III alone. At one-year follow-up, a good outcome was seen in 78 % of temporal lobe resection, 55 % of extratemporal cortical resection, 82 % of hemispherotomy, and 80 % of corpus callosotomy procedures. Conclusions Careful preoperative selection and meticulous perioperative management are the most significant factors for success of epilepsy surgery. Although temporal and extratemporal lobe surgeries have a fairly stable perioperative course, multilobar epilepsy requiring disconnective surgery poses a greater challenge.

Background: Smooth uneventful extubation and prevention of postoperative complications such as cough and sore throat adds to the quality of perioperative care and patient outcome. This study was designed to compare tube tolerance and hemodynamics during extubation, as well as the incidence of postoperative cough and sore throat, in patients operated under general anesthesia of more than 2-h duration. Materials and Methods: This prospective double-blinded, randomized controlled study included 100 patients posted for elective surgical procedures with expected duration of more than 2 h, under general anesthesia. Patients were divided randomly into two equal groups, namely Group A and Group B. In Group A, endotracheal tube (ETT) cuff was filled with lignocaine with sodium bicarbonate as an adjuvant, while in Group B, dexamethasone was added as an adjuvant to intracuff lignocaine. ETT tolerance at the time of extubation was recorded and compared. Other parameters such as rate pressure product, volume of drug diffused through cuff, and incidence of postoperative cough and sore throat were also compared. Data analysis was done using unpaired t-test and Chi-square test as appropriate, where P < 0.05 was considered statistically significant. Results: Eighty-two percent of patients in Group A while 78% of patients in Group B were categorized as tube tolerant during extubation (P = 0.62). The incidence of postextubation sore throat at 1 h was 30% versus 16% (P = 0.09) while at 24 h was 20% versus 6% (P = 0.03) in Group A and Group B, respectively. The incidence of cough postextubation at 1 h was 6% versus 0 (P = 0.07) while at 24 h was 18% versus 4% (P = 0.02) in Group A and Group B, respectively. The volume of intracuff drug diffused during anesthesia was 0.71 ± 0.27 (mean ± standard deviation [SD]) ml in Group A and 0.5 ± 0.23 (mean ± SD) ml in Group B (P = 0.02). Majority of patients (>85%) in both the groups remained hemodynamic stable during emergence with no statistical difference between the groups. Conclusion: Both bicarbonate and dexamethasone as an adjuvant to 2% intracuff lignocaine offer smooth emergence in terms of tube tolerance and hemodynamic stability during extubation. However,dexamethasone when used as an adjuvant has a better effect on prevention of development of postoperative cough and sore throat. [ABSTRACT FROM AUTHOR]

Byline: Ashutosh. Kaushal, Ashish. Bindra, Shalendra. Singh Sir, We would like to convey our gratitude to the readers for showing interest in our article.[1] We agree that intravenous (i.v.) cannula [...]

Byline: Keshav. Goyal, Amarjyoti. Hazarika, Ankur. Khandelwal, Navdeep. Sokhal, Ashish. Bindra, Niraj. Kumar, Shweta. Kedia, Girija. Rath Introduction and Aims: Recognizing and treating nonneurological complications occurring in traumatic brain injury [...]

Byline: Ashutosh. Kaushal, Ashish. Bindra, Shalendra. Singh Sir, Ultrasonography (USG) is a rapidly emerging medical imaging technique, and in the field of anaesthesiology, it is frequently used for gaining vascular [...]

Byline: Ashutosh. Kaushal, Ashish. Bindra, Shalendra. Singh, Zakia. Saeed Sir, Arterial cannulation is an important procedure for continuous arterial pressure monitoring and repeated blood gas sampling in perioperative and critical [...]