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Madan Mohan Maddali

Publications and source records attributed to Madan Mohan Maddali.

9 recordsLinked to original sources
PubMed2006

Extubation time, hemodynamic stability, and postoperative pain control in patients undergoing coronary artery bypass surgery: an evaluation of fentanyl, remifentanil, and nonsteroidal antiinflammatory drugs with propofol for perioperative and postoperative management.

STUDY OBJECTIVE: To compare three anesthetic strategies with respect to the time of extubation after coronary artery bypass graft (CABG) surgery and to assess patient satisfaction with the procedure. DESIGN: Prospective, randomized, clinical study. SETTING: Tertiary-care referral center. PARTICIPANTS: 180 cardiac surgical patients undergoing primary CABG from January through June 2004. INTERVENTIONS: After induction of general anesthesia, patients were allocated to one of three groups. All three groups received a continuous infusion of intravenous (IV) propofol perioperatively and postoperatively. Group 1 (fentanyl infusion group, n = 60) received continuous IV fentanyl infusion perioperatively and postoperatively for analgesia. Group 2 (diclofenac group, n = 60) received fentanyl bolus doses intraoperatively and diclofenac suppository postoperatively. Group 3 (remifentanil group, n = 60) received continuous infusion of IV remifentanil perioperatively and IV fentanyl as an immediate postoperative bolus followed by continuous fentanyl infusion. Duration of postoperative ventilation up to the time of extubation, inotrope requirement, time at which analgesic infusion was discontinued, postextubation arterial blood gas analysis, pain evaluation via visual analog scale, need for rescue analgesia, awareness during surgery, and length of postcardiac surgical unit stay, were evaluated in each patient. MAIN RESULTS: The diclofenac group exhibited the shortest time to extubation, the least inotrope use, and the fewest rescue doses of analgesic than did patients of the other two groups. CONCLUSION: Intravenous propofol with bolus doses of IV fentanyl intraoperatively in combination with postoperative nonsteroidal antiinflammatory drugs had the best recovery profile in patients undergoing primary CABG than did the other two regimens studied.

Anesthesia, General↗
PubMed2005

Myocardial protection during neonatal cardiac surgery.

Myocardial protection is of major concern in neonatal cardiac surgery where coronary ostial transfer is required as part of the surgical procedure. Retrograde coronary sinus perfusion (RCSP) of cold cardioplegic solution was evaluated in infants undergoing arterial switch operations. Hemodynamic measurements and postoperative cardiac troponin I (cTnI) levels were estimated in addition to transthoracic echocardiography to assess the extent of myocardial injury. The results were compared with a similar cohort of patients where ante grade selective coronary artery perfusion (ASCP) was used during coronary ostial transfer. Our experience suggests that RCSP is a useful option in this subset of patients.

Cardioplegic Solutions↗
PubMed2005

Diastolic dysfunction complicating anesthetic management.

Coronary artery disease combined with constrictive pericarditis results in diastolic dysfunction with a well-preserved systolic function. A case of constrictive pericarditis with a restrictive filling pattern and a well-established preoperative diastolic dysfunction, that had an elective pericardiectomy and an off pump coronary artery by pass graft, is discussed. Once revascularization was performed, introduction of Inj. nitroglycerine resulted in a dramatic improvement in the hemodynamics, along with a drop in the intra chamber filling pressures, indicating an improvement in the diastolic function. The role of revascularization and vasodilators as therapeutic tools in the management of diastolic dysfunction in such cases, is highlighted.

Anesthesia↗
PubMed2003

A prospective study of incidence of postoperative nausea and vomiting in a tertiary care hospital in Oman.

INTRODUCTION: This is a pilot study conducted in a tertiary referral center in Oman, to assess the incidence of postoperative nausea and vomiting (PONV) so that an institutional policy towards its alleviation could be evolved. METHODS AND MATERIALS: This is a prospective study of 491 patients undergoing obstetric and gynecological, general surgical, pediatric and urological surgical procedures that received general anesthesia, regional anesthesia or a combination of both. Data regarding the incidence of PONV was collected and was documented in a standardized questionnaire based on the patient history, anesthetic protocol, a postoperative interview of the patient and a review of the nursing records. RESULT: The over all incidence of PONV in our institution was 19.6%. The occurrence of vomiting compared to nausea or retching was high (p < 0.01). PONV was less in urological cases (p < 0.05) compared to general surgical cases. The incidence of PONV was similar (p > 0.05) in both groups, whether the patients received anti emetics along with pre-medication or not. PONV occurrence was significant in the first 6 hrs postoperatively (p < 0.01). In those patients who received propofol the prevalence of PONV was significantly less (p < 0.01). CONCLUSIONS: There should be a reassessment of the existing anti emetics in the institution. Propofol was found to be a good anti emetic.

Adolescent↗
PubMedDate not supplied

Off-pump bidirectional Glenn shunt by active decompression of the superior vena cava.

We report 2 cases of infants in whom off-pump bidirectional Glenn shunts were performed. A technique of decompressing the superior vena cava by active manual aspiration has been described. The challenges of maintaning the hemodynamic status, and cerebral protection maneuvers in association with mild hypothermia and a high transcranial pressure have been highlighted.

Anastomosis, Surgical↗