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Biomedical subjects

S P Ambesh

Publications and source records attributed to S P Ambesh.

14 recordsLinked to original sources
PubMed2000

Neuroendoscopic procedures: anesthetic considerations for a growing trend: a review.

The recent trend in neurosurgery is shifting toward further reduction in invasiveness to minimize trauma to the brain. Endoscopy holds the promise of shortened hospital stay with improved postoperative outcome. An important minimally invasive technique is neuroendoscopy. The ventricular system and subarachnoid space of the brain provide suitable conditions for the use of an endoscope. The currently available literature focuses only on recent advances in neuroendoscopy from the surgical perspective. To date, there is paucity of anesthetic literature emphasizing the implications for this growing trend. The surgical technique, instrumentation, anesthetic requirements, potential pitfalls and complications of this technique must be completely understood to ensure a successful outcome. The purpose of this review is to provide knowledge of indications, instrumentation, and anesthetic considerations in anticipation of complications steming from this procedure.

Anesthesia↗
PubMed1999

Ondansetron pretreatment to alleviate pain on propofol injection: a randomized, controlled, double-blinded study.

UNLABELLED: We used a randomized, controlled, double-blinded design to study the effect of ondansetron (OND) pretreatment on the pain produced by the IV injection of propofol. Eighty patients were randomly assigned to one of two groups: Group I received 2 mL of IV 0.9% saline pretreatment, and Group II received OND (4 mg in 2 mg/mL solution) pretreatment in the dorsum of the hand, followed by propofol 1 min later. Pain was reduced significantly in the OND group (P<0.05). Approximately one third of the patients in each group had myoclonic movements or skin rashes in the limb that received propofol. We conclude that the OND pretreatment may be used to reduce the incidence of pain on injection of propofol and to prevent postoperative nausea and vomiting. IMPLICATIONS: In a double-blinded, controlled study, IV ondansetron (4 mg) pretreatment was used to alleviate pain on injection of propofol. Ondansetron was successful in relieving pain without any adverse effect in a significant number of patients.

Adolescent↗
PubMed1999

Efficacy of ondansetron in prophylaxis of postoperative nausea and vomiting in patients following infratentorial surgery: a placebo-controlled prospective double-blind study.

In a prospective double blind placebo-controlled study, 45 patients scheduled for infratentorial surgery were randomly allocated into two groups. Five patients were later excluded from the study because of various reasons. Out of 40 analyzable patients, 20 received IV Ondansetron (4 mg), whereas the other 20 received the matching placebo approximately 1 hour before the skin closure. After conclusion of surgery and tracheal extubation, all patients were monitored in the recovery room for post operative nausea and vomiting (PONV) for 48 hours. The incidence of PONV within the first 24 hours was found to be 50% and 10% in the placebo and ondansetron groups, respectively (p<0.05). After 24 hours, however, both groups were comparable in relation to the incidence of emesis. Rescue antiemetic (RAE) was required in nine (45%) patients in the placebo group and in two (10%) patients in the Ondansetron group (p<0.05). A significantly higher number of patients remained sedated postoperatively in the Ondansetron group than in the placebo group (p<0.05). One patient in the Ondansetron group had protracted diarrhea for 48 hours postoperatively. These results indicate that administration of IV Ondansetron (4 mg) 1 hour before skin closure effectively reduces PONV after infratentorial surgery, and does not have significant adverse effects.

Adolescent↗
PubMed1999

Internal jugular vein cannulation in neurosurgical patients: a new approach.

A new approach to internal jugular vein (IJV) cannulation with the head and neck placed in the neutral position is described. The junction of the medial two thirds and lateral one third between the angle of the mandible and symphysis menti is identified. A vertical line is drawn from this point to join another line drawn between the mastoid process and the medial end of the clavicle. The junction is the puncture point. In 120 patients studied, the failure rate was 1.66%, and there were no complications. We propose this technique as a safe and reliable alternative in neurosurgical patients.

Adolescent↗
PubMed1999

Pneumoencephalus and convulsions after ventriculoscopy: a potentially catastrophic complication.

A nine-year-old boy with hydrocephalus underwent ventriculoscopy under general anesthesia. After introduction of ventriculoscope the patient had sudden bradycardia, hypotension, and shrinkage of ipsilateral cerebral hemisphere. The ventriculostomy was abandoned. At the end of anesthesia and endotracheal extubation, the patient developed generalized convulsions. Reexploration of wound did not reveal anything significant; however, postoperative CT scan of head showed massive pneumoencephalus. The patients received elective ventilation of lungs for 24 hours and made complete recovery. The authors describe the reasons for these complications and further management.

Bradycardia↗
PubMed1998

Percutaneous dilational tracheostomy: the Ciaglia method versus the Portex [correction of Rapitrach] method.

UNLABELLED: In a prospective study, we performed percutaneous dilational tracheostomy (PDT) using either the Ciaglia method (gradual dilation) or the Portex [corrected] method (single dilation) in 80 patients. We encountered difficulty in dilating the tracheal stoma of three (7.5%) patients in the Ciaglia group because of tight pretracheal fascia. It was difficult to insert the tracheostomy tube in four (10%) patients in the Portex [corrected] group even after appropriate tracheal dilation. However, the tracheal cannulation was successfully completed in all patients in subsequent attempts. The mean time for completion of the procedures, from skin incision to insertion of the tracheostomy tube, was 14+/-5.5 min with the Ciaglia method and 6.5+/-3.5 min with the Portex [corrected] method. PDT with either method has not been associated with clinically significant hemorrhage, infection at the stoma site, or cosmetic deformity. In a follow-up period of 9 mo, none of our decannulated patients presented with clinical tracheal stenosis. Our results indicate that PDT with both methods is as safe and easy to organize and perform as a bedside procedure, obviating the need to transport critically ill patients from the critical care unit. IMPLICATIONS: The tracheas of 80 patients were cannulated through an artificial opening using either the Ciaglia (gradual dilation) or the Portex [corrected] (single dilation) method. Both techniques were successful with no significant complications. After 9 mo of closure of this opening, none of the survivors had significant scarring or narrowing of the trachea.

Adolescent↗