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Biomedical subjects

G D Puri

Publications and source records attributed to G D Puri.

At least 19 recordsLinked to original sources
PubMed2006

Myocardial protection by nicorandil during open-heart surgery under cardiopulmonary bypass.

BACKGROUND: To evaluate the myocardial protective effect of nicorandil when used as an adjuvant to cold hyperkalaemic cardioplegia in open-heart surgery. METHODS: Patients who underwent surgery under cardiopulmonary bypass (CPB) for mitral valve replacement (MVR, 23 patients) or coronary artery bypass grafting (CABG, 24 patients) were entered in a double-blind study. The patients were randomized to a nicorandil Group (N) or placebo Group (P). Nicorandil 0.1 mg kg-1 (Group N), or normal saline (Group P), were administered at three time points: (1) after aortic cannulation, but prior to going on CPB, (2) 5 min before aortic cross-clamping and (3) 5 min before reperfusion. The following variables were studied: (a) time until electromechanical arrest after cardioplegia administration (Tarrest), (b) time until return of electromechanical activity after aortic cross-clamp removal (Trecovery), (c) incidence of postoperative myocardial infarction or low output syndromes (d) dysrhythmias requiring intervention after aortic cross-clamp removal and (e) haemodynamic changes after nicorandil administration. RESULTS: The Tarrest after cardioplegia administration was significantly faster in nicorandil group in both MVR and CABG patients (P 75 IU L-1 in MVR patients was significantly lower in the Group N than in placebo patients (P < 0.05). However, in CABG patients there was no such significant difference. The incidence of dysrhythmias requiring intervention after aortic cross-clamp removal was also less in Group N. Administration of 0.1 mg kg-1 boluses of nicorandil did not cause significant haemodynamic changes or precipitate dysrhythmias in any patient. CONCLUSION: Nicorandil enhances the myocardial protective effect of cold hyperkalaemic cardioplegia in cardiac surgery patients.

Adult↗
PubMed2006

Drug utilization pattern in the intensive care unit of a tertiary care hospital.

The authors studied the factors affecting drug use pattern, cost of therapy, and the association between the pattern of drug use and survival as well as the duration of stay in a prospective, observational study in an intensive care unit between February and May 2005. Data were collected regarding drugs used, severity of the disease, and their outcome. The mean +/- SD of the Acute Physiology and Chronic Health Evaluation (APACHE III) and Glasgow Coma Scale (GCS) scores of 84 patients were 52.2 +/- 19.4 and 7.5 +/- 2.4, respectively. Although the mean number of drugs at the time of admission to the intensive care unit was 5.3, it increased to 12.9 on the first day and 22.2 during the entire stay. More than 50% of the average expenditure on drugs and nutrition was accounted by antibiotics. Requirement of insulin or inotropes signified an adverse outcome on mortality (odds ratios of 3.43 and 8.44, respectively). In conclusion, there is a tremendous impact of antibiotic use on the cost of therapy in the intensive care unit. The requirement of certain drugs such as insulin and inotropes is of prognostic significance.

APACHE↗
PubMed2006

Feasibility of pre-operative autologous blood donation in Indian patients with elective orthopaedic surgery.

BACKGROUND & OBJECTIVES: Pre-operative autologous blood donation (PABD) in elective orthopaedic surgeries is a well known procedure in the West. We initiated this programme at a tertiary care hospital in north India to study its feasibility in Indian patients. METHODS: In a prospective case-control study, 144 patients undergoing primary total hip or knee replacement, inter-vertebral discectomy, mal-union and non-union reconstruction were educated and motivated to pre-donate. Patients fulfilling the inclusion criteria and making autologous donation formed the PABD group (n=22). Patients eligible for PABD, but unwilling to participate; age, sex, pre-operative haemoglobin and operative procedure matched acted as controls (n=27). Unit(s) collected was processed like an allogeneic unit. Unit(s) found reactive for infectious markers or not utilized was discarded. Mean blood losses, transfusion trigger, allogeneic exposure and wastage between the two groups were compared. RESULTS: Of the 144 patients motivated, 40 per cent of the eligible subjects pre-deposited. The main motivational factor was fear of getting infection from someone's blood. Cardiac events and anaemia prevented 61.8 per cent patients to participate. Of the 50 units ordered, autologous units with a mean of 1.4 units/patient contributed 62 per cent. For total hip and total knee replacement (THR and TKR), autologous units met 76.2 and 80 per cent respectively of the total blood requirement. A significant decrease in the allogeneic exposure was observed between PABD and control group (18.2 vs 66.7%); 32.3 per cent of the autologous units were discarded. INTERPRETATION & CONCLUSION: Comprehensive PABD programme may be an effective method for reducing the need for allogeneic transfusion in patients undergoing joint replacement surgeries in our country, where transfusion transmitted infections due to high percentage of replacement donations and lack of sensitive assays for testing are still a cause for concern.

Adult↗
PubMed2005

Arterial oxygenation changes in valvular heart disease patients with cardiomegaly in different recumbent positions.

BACKGROUND AND OBJECTIVE: We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio > or = 0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. METHODS: Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. RESULTS: Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 +/- 29.5 mmHg, SaO2 = 98.1 +/- 1.4%) than in supine (PaO2 = 111.0 +/- 30.6 mmHg, SaO2 = 97.6 +/- 2.2%) and left lateral positions (PaO2 = 109.7 +/- 32.0 mmHg, SaO2 = 97.6 +/- 1.7%; mean +/- SD; P 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). CONCLUSION: Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.

Adolescent↗
PubMed2003

Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass.

BACKGROUND AND OBJECTIVE: Monitoring the depth of anaesthesia by the bispectral index facilitates the titration of anaesthetic drugs during operation as well as assisting in early recovery. We planned to use this index to control the administration of anaesthetic agents in order to stabilize haemodynamics and promote recovery from anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Thirty adult patients undergoing valve replacement or coronary artery grafting under cardiopulmonary bypass were studied in a prospective, randomized, controlled study. Bispectral index monitoring was used in all patients. Patients received isoflurane anaesthesia and boluses of morphine: in the study group, anaesthetic depth was controlled using the bispectral index and clinical variables. In the control group, the bispectral index monitor could not be viewed by the anaesthesiologist. Bispectral index, mean arterial pressure and heart rate were noted every 5 min, and the incidence of hypotension, hypertension, tachycardia and bradycardia also noted. The time to recovery, when patients started obeying commands, was also recorded. RESULTS: Patients in the study group had significantly less hypertension and tachycardia (P < 0.05) than those in the control group. The time to recovery of consciousness was less in the study group than in the control group (n.s., P > 0.05). The bispectral index rose significantly in the control group at the time of institution and termination of cardiopulmonary bypass (P < 0.05). CONCLUSIONS: Anaesthesia controlled by bispectral index monitoring decreases the incidence of haemodynamic disturbances and facilitates titration of anaesthetic agents during cardiopulmonary bypass and thus may assist recovery from anaesthesia.

Adolescent↗
PubMed2003

Assessment of intraoperative blood transfusion practice during elective non-cardiac surgery in an Indian tertiary care hospital.

BACKGROUND: We assessed appropriate intraoperative use of whole blood during elective surgery. METHODS: This prospective observational audit by a team of anaesthetists over 3 months in a multi-speciality tertiary care teaching hospital used strict preset criteria to evaluate the use of blood transfusion during elective surgery by anaesthetists. The criteria used to evaluate the rate of appropriate transfusion were haemoglobin less than 8 g x dl(-1), haemoglobin less than 10 g x dl(-1) in patients with medical co-morbidities and blood loss greater than 20% of blood volume when more than 1000 ml. RESULTS: The overall rate of appropriate use of blood was 40.7%; it was inappropriate in 19.2% of cases (haemoglobin >11 g x dl(-1)). The primary trigger was low haemoglobin (measured intraoperatively or derived from blood loss). Patients in whom haemoglobin was measured intraoperatively had a significantly higher appropriate use of blood (P<0.05). There was a reduction in blood use over the 3-month audit period (P<0.05). CONCLUSIONS: Current intraoperative blood use is sub-optimal. Intraoperative haemoglobin estimation is an effective and simple measurement to improve appropriate use of blood. The indication for transfusion should be recorded in the case notes.

Adult↗
PubMed2002

Evaluation of induction doses of propofol: comparison between endstage renal disease and normal renal function patients.

Anaemia, hypoproteinaemia and acidic pH in renal failure patients can alter the pharmacokinetics and pharmacodynamics of anaesthetic agents, resulting in altered dose requirements. We evaluated the induction dose of propofol in adult patients with end-stage renal disease by titrating the hypnotic effect by means of a clinical parameter as well as using a more objective assessment of hypnosis, the Bispectral Index (BIS) monitor. The dose was compared with that for patients with normal renal function. Propofol doses that provided the clinical end-point of hypnosis (syringe drop method), as well as the end-point of a mean (SD) BIS value of 50 (5), were evaluated in 27 end-stage renal disease and 27 normal renal function patients. Propofol was administered at 0.2 mg/kg every 15 seconds until these end-points were achieved. End-stage renal disease patients required significantly higher propofol doses to achieve the clinical end-point of hypnosis (1.42 (0.24) mg/kg versus 0.89 (0.2) mg/kg in normal renalfunction patients, P<0.05 unpaired "t" test). Propofol dose required to achieve a BIS of 50 (5) was also higher in end-stage renal disease patients (2.03 (0.4) mg/kg versus 1.39 (0.43) mg/kg in normal renal function patients, P<0.05). There was a significant negative correlation of propofol dose with preoperative haemoglobin concentration. A hyperdynamic circulation in renal failure patients with anaemia may be responsible for the higher propofol dose requirement in this group.

Adult↗
PubMed2001

Paradoxical changes in bispectral index during nitrous oxide administration.

I report two patients undergoing open heart surgery, with nitrous oxide and isoflurane anaesthesia, for whom bispectral index (BIS) monitoring showed high BIS values with nitrous oxide and isoflurane anaesthesia. The BIS decreased immediately after nitrous oxide was stopped and increased again after nitrous oxide was restarted.

Adult↗
PubMed1999

Severe head injury patients in a multidisciplinary ICU: are they a burden?

OBJECTIVE: Patients with severe head injury (HI) are often considered to be a burden in a multidisciplinary intensive care unit (ICU). This study was undertaken to compare the severe closed HI patients with all other patients in the ICU in terms of age group involved, stay in the unit, complications and outcome. DESIGN: Retrospective analysis. SETTING: Multidisciplinary ICU of a tertiary care hospital in Northern India. PATIENTS AND PARTICIPANTS: All the patients admitted to the ICU between January 1995 and December 1997. The patients were classified into two groups: group A comprising patients with severe closed HI and group B consisting of all other patients. RESULTS: The mean age of the patients was around 30 years in both the groups. The average stay of the patients in the unit was 12.71 +/- 11.9 days in group A, compared to 9.9 +/- 14.4 days for group B (p < 0.05). The duration on the ventilator or on an endotracheal airway was not different between the groups (p > 0.05). The mortality in group A was 46.8 % and that in group B was 38.5 % (p > 0.05). The mortality was directly proportional to the age in group A. Hypotension, renal failure and septicaemia were the commonest complications in both the groups but the difference was not statistically significant. CONCLUSIONS: This study demonstrates that patients with severe HI do not pose an extra burden in a multidisciplinary ICU.

Adolescent↗
PubMed1999

Physiological deadspace during normocapnic ventilation under anaesthesia.

Respiratory physiological deadspace (VDphys) during normocapnic ventilation under anaesthesia was studied in 253 patients scheduled for elective non-thoracic surgery. Subjects were ventilated with SERVO 900B ventilator using CO2 analyser 930 (Siemens-Elema Sweden) to adjust minute volume sufficient to maintain end-tidal carbon dioxide fraction (FECO2) around 5.5kPa with normocapnic confirmation using arterial blood gas analysis. VDphys was calculated using Enghoff's modification of Bohr's equation. VDphys and deadspace to tidal volume ratios (VD/VT) in male patients were 142.6 +/- 28.4 ml and 0.37 +/- 0.068 respectively and were significantly higher than that in females (119.4 +/- 35.6 ml and 0.36 +/- 0.067). Males had significantly higher VDphys/mass (2.5 +/- 0.68 ml.kg) compared with females (2.2 +/- 0.54 ml/kg, P < 0.001) but significantly lower body mass index (BMI) (20.67 +/- 3.2 in males and 22.47 +/- 4.1 in females, P < 0.001). VDphys showed positive correlation with weight, height and body surface area (BSA) but VDphys/kg showed negative correlation with BMI. Multiple regression analysis produced a best fit equation for VDphys = 9.7 + 64.3 x BSA + 13.51S where S = 1 for females and 2 for males.

Adolescent↗