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Prabhat Kumar Sinha

Publications and source records attributed to Prabhat Kumar Sinha.

29 records · Page 2Linked to original sources
PubMed2004

Ondansetron in prophylaxis of postoperative nausea and vomiting in patients undergoing breast surgery: a placebo-controlled double blind study.

The present study was to evaluate the efficacy of ondansetron, 5-HT3 receptor antagonist, versus placebo in the prevention of postoperative nausea and vomiting (PONV) in a homogenous group of female patients undergoing breast reduction surgery under general anaesthesia. Approximately one hour before skin closure, 70 patients were randomly divided into two groups of 35 each. In a double blind manner each group of patients received either intravenous ondansetron (4mg) or a matching placebo. The overall incidences of PONV during first 24-hour were 60% and 20% in placebo and ondansetron group respectively (p<0.05). However, there was no significant difference after 24-hour postoperatively. In placebo group 42.9% of patients received rescue anti-emetic (metoclopramide) for the treatment of severe PONV (ie, 2 or more episodes of PONV), whereas, only 8.6% patients were administered such intervention in the ondansetron group (p<0.05). It is, therefore, concluded that prophylactic administration of intravenous ondansetron (4mg) one hour before skin closure is safe and effective in preventing PONV in female patients undergoing breast surgery and routine use of ondansetron in the patient population is recommended.

Adult↗
PubMed2004

Anesthesia and intracranial arteriovenous malformation.

Anesthetic management of intracranial arteriovenous malformation (AVM) poses multiple challenges to the anesthesiologist in view of its complex and poorly understood pathophysiology and multiple modalities for its treatment involving different sub-specialties. The diagnosis of AVM is based on clinical presentation as well as radiological investigation. Pregnant patients with intracranial AVM and neonates with vein of Galen malformation may also pose a special challenge and require close attention. Despite technological advancement, reported morbidity or mortality after AVM treatment remains high and largely depends on age of the patient, recruitment of perforating vessels, its size, location in the brain, history of previous bleed and post-treatment hyperemic complication. Anesthetic management includes a thorough preoperative visit with meticulous planning based on different modalities of treatment including anesthesia for radiological investigation. Proper attention should be directed while transporting the patient for the procedure. Protection of the airway, adequate monitoring, and maintaining neurological and cardiovascular stability, and the patient's immobility during the radiological procedures, appreciation and management of various complications that can occur during and after the procedure and meticulous ICU management is essential.

Anesthesia↗
PubMed2002

Should one rely on capnometry when a capnogram is not seen?

Capnography is one of the basic monitoring techniques in day-to-day anesthesia practice that provides information not only regarding the patient's ventilation, circulation, and metabolism, but also regarding proper functioning of a closed-circle system. The authors report a case in which after endotracheal intubation the end-tidal capnometric reading rose very high, but the capnogram was not seen on the monitor. The unexpectedly high capnometric reading with absent waveform during intermittent positive pressure ventilation without any apparent cause and consequent delayed institution of corrective measures resulted in severe brain bulge. There was severe hypercarbia as a result of a malfunctioning expiratory unidirectional valve that allowed rebreathing. Retrospective retrieval of data showed that a fraction of inspired carbon dioxide was also high and the baseline was raised beyond the usual range of 0 to 40 mm Hg, giving the impression of an absent waveform on the existing scale. In conclusion, one should keep in mind the possibility of expiratory valve malfunction resulting from dislodgment while wheeling the anesthesia machine, the view becoming obscured as a result of condensation of water vapor on the under surface of the plastic case, and one should rely on the capnometric reading unless proved otherwise. Thus, one can prevent potential hazards of rebreathing.

Adult↗