Biomedical subjects

Krishan Kant Sharma

Publications and source records attributed to Krishan Kant Sharma.

4 recordsLinked to original sources

PubMed2004

Spinal (subarachnoid) morphine for off-pump coronary artery bypass surgery.

OBJECTIVE: To study the effects of 8 microg/kg preoperatively administered intrathecal morphine sulfate on extubation time, postoperative pulmonary function, and postoperative analgesia after off-pump coronary artery bypass grafting (OPCAB). DESIGN: A prospective, randomized, double-blind, placebo controlled study. PARTICIPANTS: One hundred adult patients scheduled for elective primary OPCAB. INTERVENTIONS: Patients were randomized to preoperative administration of 8 microg/kg intrathecal morphine sulfate (group 1) with a 25-gauge spinal needle or to receive sterile normal saline placebo subcutaneously (group 2). Anesthetic induction and maintenance were standardized to allow planning for facilitating early tracheal extubation. Multivessel OPCAB was performed with an Octopus stabilizer. Patients were extubated in the intensive care unit by a blinded observer using predefined extubation criteria. MEASUREMENTS AND MAIN RESULTS: Postoperative times to extubation were 9.47 +/- 3.83 hours in group 1 versus 11.25 +/- 3.94 hours in group 2 (P = .025). Postextubation bedside spirometric lung volumes in percentage of preoperative lung volume showed significant differences in group 1 versus group 2 in forced vital capacity, 39.66% +/- 15.42% versus 31.85% +/- 11.65% (P = .016); forced expiratory volume in the first second, 44.8% +/- 16.18% versus 35.97% +/- 13.32% (P = .013); maximum voluntary ventilation, 39.40% +/- 13.57% versus 33.11% +/- 14.80% (P = .056); and expiratory flow rate, 47.76% +/- 24.61% versus 37.37% +/- 4.33% (P = .031). The visual analog pain scores at rest and during coughing at time intervals of 6, 12, 24, and 36 hours postoperatively showed significantly better results in group 1 compared with group 2. The total dose of fentanyl citrate required intraoperatively was significantly less in group 1 (P = .00). One patient in group 1 had a low respiratory rate, which responded to injection naloxone. There was no mortality or neurological complication in either group. CONCLUSION: Intrathecal morphine provided superior quality of analgesia that translated into better maintenance of postoperative lung volume determined by spirometry. This analgesic method also facilitated earlier tracheal extubation without any major respiratory or neurologic complications.

Analgesics, Opioid↗

PubMed2002

Robotically controlled video-assisted port-access mitral valve surgery.

From 1997 to 2000, 221 patients underwent mitral valve surgery through a mini-thoracotomy, using a port-access endovascular cardiopulmonary bypass system in 38 and a transthoracic clamp in 183. In 120 patients, exposure of the mitral valve was facilitated by an endoscope attached to a voice-controlled robotic arm (AESOP 3000). The mitral valve was repaired in 26 patients and replaced in 195; 24 were redo cases. Operating time was 3.5 +/- 1.2 hours, aortic crossclamp time was 58 +/- 16 minutes, intensive care unit stay was 22 +/- 7 hours, and hospital stay was 6.4 +/- 1.2 days. Median postoperative blood loss was 332 +/- 104 mL. There was 1 hospital death. On follow-up at 16.4 +/- 12.2 months, there was no late death or reoperation. New York Heart Association functional class improved from 2.6 +/- 0.5 to 1.4 +/- 0.8. Use of video and robotic assistance minimized incision length and allowed visualization of the whole mitral valve apparatus. The transthoracic clamp facilitated aortic crossclamping and injection of cardioplegia. These findings indicate that the procedure is safe and effective and suggest advantages over conventional surgery in terms of cost, cosmesis, blood loss, postoperative discomfort, intensive care unit and hospital stay.

Adult↗

PubMed2002

Neuroleptic malignant syndrome: uncommon postoperative diagnostic dilemma.

Neuroleptic malignant syndrome occurred in a 71-year-old man on haloperidol therapy for mild depressive dementia. After coronary artery bypass grafting, he developed hyperthermia, elevated creatine kinase without a corresponding rise in the MB-isoenzyme, leukocytosis, raised liver enzymes, urea, and creatinine. His condition responded to bromocriptine therapy.

Aged↗

PubMedDate not supplied

Minimally invasive mitral valve surgery.

BACKGROUND: To reduce surgical trauma and the drawbacks associated with sternotomy, we performed robotically controlled, video-assisted mitral valve surgery, using either the port-access or the transthoracic clamp technique. METHODS AND RESULTS: Between September 1997 and September 2000, 221 patients (78 males, 143 females) underwent mitral valve surgery through a small right minithoracotomy using the port-access endovascular cardiopulmonary bypass system. Mitral valve exposure was facilitated with an endoscope attached to a voice-controlled robotic arm (AESOP 3000) allowing stabilization and voice-activated camera positioning. Twenty-six patients underwent mitral valve repair and 195 had valve replacement. In 197 patients, mitral valve surgery was the primary operation, while 24 were redo cases. Skin-to-skin mean operating time was 3.5 +/- 1.2 hours and aortic cross-clamp time was 58 +/- 16 min, mean intensive care unit stay was 22 +/- 7 hours and hospital stay 6.4 +/- 1.2 days. There was no re-exploration for bleeding. There was no late death or re-operation on mean follow-up of 16.4 +/- 12.2 months. Patients showed improvement in their NYHA functional class from 2.6 +/- 0.5 to 1.4 +/- 0.8 postoperatively. Outcomes were compared with those of our previous 220 patients who underwent mitral valve surgery with the median sternotomy approach. CONCLUSIONS: The use of video and robotic assistance in port-access mitral valve surgery not only minimizes the length of the incision, but also gives full visualization of the entire mitral valve apparatus. This approach provides comparable results with the sternotomy approach, as well as marked advantages of reduced intensive care unit stay. ,ower blood transfusion requirement, better cosmesis and earlier hospital discharge.

Adult↗