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Biomedical subjects

M Tripathi

Publications and source records attributed to M Tripathi.

At least 55 records · Page 3Linked to original sources
PubMed2000

Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent displacement.

A method of fixing the epidural catheter by subcutaneous tunnelling and looping was devised. A prospective, randomised, double-blind, clinical trial was conducted in 68 adult patients, where postoperative pain relief was planned by thoracic epidural analgesia. In the tunnelled group (n = 34), the epidural catheter was fixed with a subcutaneous tunnel and loop, whereas in controls (n = 34), a simple loop of epidural catheter was left over the skin without tunnelling. An adhesive dressing was used to secure the epidural catheter. We observed that catheter dislodgement occurred in only one patient in the tunnelled group compared to seven control patients (21%). Despite local inflammation of the skin around the tunnel in nine patients (27%), no catheter infection (positive culture tip) was found in patients with subcutaneous tunnelling for the extended period of 4-5 days. The method described allows the catheter to lie flat on the skin and outward traction of the catheter during movement of patients is dampened by the interposed loop which protects it against dislodgement. At the time of removal, both ends of the catheter can be removed under direct vision. In conclusion, we recommend this fixation method in cases where epidural analgesia is to be used for postoperative pain relief.

Adult↗
PubMed2000

Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit.

OBJECTIVE: To evaluate carbamezapine (CBZ) for neuritic pain relief in Guillain-Barré syndrome (GBS) patients in the intensive care unit (ICU). DESIGN: Prospective, double-blind, randomly allocated cross-over study days. SETTING: ICU in a tertiary care university hospital. PARTICIPANTS: Twelve consecutive, conscious adult (22-54 yrs) patients with GBS during recovery from the muscular weakness and receiving pressure-support ventilation in the ICU. All patients complained of severe backache and/or leg cramps and tenderness in muscles, and they required opioids for pain relief. INTERVENTIONS: CBZ (100 mg every 8 hrs) or equivalent placebo was given to nursing staff in coded powder form. Medication was given to patients through a nasogastric feeding tube. The same coded medicine was given for 3 days, and after a 1-day omission, a second set of coded powder was given for the next 3 days in a randomized, double-blind, crossover fashion. Pethidine (1 mg x kg(-1)) was given intravenously in between, if the pain score was >2. Group 1 (n = 6) patients were given a placebo on the first 3 days, followed by CBZ. Group 2 (n = 6) patients were given CBZ on the first 3 days, followed by a placebo. MEASUREMENTS AND MAIN RESULTS: In these two study periods of different medications, we observed and scored pain (1, no pain; 5, severe pain), sedation (1, alert; 6, asleep, does not respond to verbal command), and total pethidine requirement per day. In group 1 patients, a significant (p < .001) improvement in the sedation score and a low requirement for pethidine was observed 3 days later, when CBZ was started. However, in group 2 patients, a gradual increase in the pethidine requirement and a high sedation score were noteworthy in the later days of placebo medication. Observations were also analyzed for CBZ days vs. placebo days. Overall, the pain score (1.7 +/- 0.8) during the CBZ period of both regimens was significantly (p < .001) lower than during the placebo days (3.1 +/- 0.9). Significantly higher doses of pethidine (3.7 +/- 0.9 mg/kg/day) were used on the placebo days than on the CBZ days (1.7 +/- 1.0 mg/kg/day). CONCLUSION: The pain in GBS has a dual origin, and we recommend CBZ as an adjuvant to treat pain in GBS patients, during the recovery phase in the ICU, to reduce the narcotic requirement.

Adult↗
PubMed2000

An unusual case of primary lymphoma of the skull base extending from cerebellopontine angle to cavernous sinus and orbit. A case report.

The authors describe a rare case of a primary central nervous system lymphoma of the cerebellopontine angle, extending into the right cavernous sinus and orbit. The patient presented with multiple right sided cranial nerve palsies and rapidly progressive proptosis and ophthalmoplegia of the right eye. Imaging revealed a cerebellopontine angle mass extending into cavernous sinus. Surgical decompression of the tumor was undertaken through a right sided retromastoid craniectomy. Histopathology revealed Non Hodgkin's lymphoma of diffuse large cell type. There was no evidence of systemic lymphoma. Primary lymphoma of cerebellopontine angle with direct extension into cavernous sinus and orbit is rare and to our knowledge this is the only case reported.

Adult↗
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

Plasma antithrombin III deficiency in ischaemic stroke in the young.

A deficiency of plasma antithrombin III has been identified as a potential risk factor for thrombosis. In a pilot study of 56 patients aged less than 40 years who presented with ischaemic stroke of unknown etiology, we detected only one case of plasma antithrombin III deficiency. Antithrombin III activity was estimated by a chromogenic assay. Hence, antithrombin III deficiency, though rare, should be considered while evaluating young patients with stroke of unknown etiology.

Adult↗
PubMed1999

Preceding infection as a risk factor of stroke in the young.

INTRODUCTION: The cause of stroke in the young remains unknown in 20-50% of the patients. Infections preceding stroke have been recently recognised to be an independent risk factor of stroke. MATERIAL AND METHODS: Sixty consecutive patients aged 40 years or less presenting with ischaemic completed stroke are taken up for the study. Patients with neurological deficit of less than 24 hours, evidence of haemorrhage on CT scan, infection occurring after the onset of stroke were excluded. Controls consisted of age and sex matched persons residing in the same area. Both the groups were enquired about preceding fever and infections and were examined for evidence of infections. Serum was examined for antibodies against measles, herpes simplex, and Japanese B encephalitis viruses. Cultures were put up from appropriate samples and CSF examined in patients only. RESULTS: Evidence of infection was noted in 26 (43.3%) of patients and 6 controls (p < 0.001). History of fever was elicited in 23 patients and 3 controls while 15 patients were febrile on examination at admission. Signs of local infection was observed in 14 patients and one control. The commonest site of infection was respiratory tract. Cultures were positive in 11 patients, commonest being beta haemolytic streptococci in six from throat. Conventional risk factors were identical in both groups of patients with and without evidence of preceding infection. Smoking and alcoholism were significantly higher in patients with preceding infection. CONCLUSION: Preceding infection is an important risk factor of stroke in the young. Smoking and alcoholism are more frequent in patients with preceding infection. Whether they predispose the individual for infection or infection increases the stroke risk in them needs to be examined.

Adult↗
PubMed1997

Accidental subdural injection of local anaesthetic: diagnosis by pressure measurement and response to aspiration of injectate.

A healthy 22-year-old man received an initial injection of 12 mL of lignocaine/bupivacaine solutions (2 mL test, then 10 mL) into an epidural catheter. This produced a satisfactory regional blockade that seemed to be epidural but, when a supplementary 6 mL injection was given 1 h later, the patient developed impaired motor function as far as the upper cranial nerves, with loss of pinprick sensation to the shoulder. The emergence of fluid dribbling freely from the catheter prompted measurement of the pressure, which was 36 mmHg. The fluid was proved not to be cerebrospinal fluid (CSF) by the absence of glucose (on dextrostix), by the appearance of turbidity with added thiopentone, and later by microscopy. Slow aspiration of 7 mL of the presumed injectate reduced the pressure in the catheter to 8 mmHg, which promptly reversed the additional excessive blockade, allowing surgery to proceed uneventfully. The retrieval of injectate argues strongly that the catheter tip had found its way subdurally, and the promptness of the reversal with aspiration argues for a mechanical rather than a pharmacological cause for the extensive neurological dysfunction after the second injection. Pressure measurement and aspiration may be helpful in other similar cases.

Adult↗
PubMed1997

Effect of antihypertensives on plasma potassium in end stage renal disease: a retrospective study.

The antihypertensive drug therapy and the peri-operative plasma potassium trend in end stage renal disease (ESRD) patients undergoing renal transplant were analysed. Out of consecutive 107 live related donor renal transplant, complete data available for 74 patients between June 1991 and March 1993, were entered in proforma and analysed. On the basis of antihypertensive or no antihypertensive drugs prescribed, patients were grouped in 6 categories. Group I patients taking no antihypertensives were taken as control. All patients were comparable for their age, sex, weight, immunosuppressive therapy, anaesthetic and fluid management during surgery. At the time of induction of anaesthesia, patients taking atenolol (plasma K+ levels being 5.34 +/- 0.75 mmol/l in group II and 5.44 +/- 0.63 mmol/l in group III) or captopril (serum K+ level being 5.05 +/- 0.94 mmol/l in group V) in combination with nifedipine and with or without clonidine had significant hyperkalaemia than the patient without antihypertensives (serum K+ level being 4.49 +/- 0.71 mmol/l). Patients, on these two antihypertensives, frequently needed active treatment of alarming hyperkalaemia (blood K+ more than 5 mmol/l and tall 'T' wave in lead II) and cardiac arrhythmias. In conclusion, ESRD patients taking atenolol or captopril are needed to be frequently monitored for blood potassium levels and it would be advisable to avoid these drugs to control hypertension in ESRD patients, especially, when scheduled for renal transplantation.

Adolescent↗
PubMed1996

Subclavian vein cannulation: an approach with definite landmarks.

An interesting observation, ie, the coracoclavicular line (from the lower border of the coracoid process to the upper border of the medial head of the clavicle) was parallel to the subclavian vein catheter in bedside chest roentgenograms (anteroposterior view), prompted us to use this subclavian approach. After supine positioning of the patient with the arm alongside the body and the left shoulder elevated 10 to 15 degrees, the puncture point was selected 1.5 cm away from the point where the coracoclavicular line crossed inferior border of the clavicle on the skin. The needle was moved horizontally in the direction of the aforesaid line. In 205 attempts in adult patients, 95.6% patients had successful cannulation in first attempt without significant complication. This technique appears to be promising as it is based on observation and is guided by constant landmarks and precise direction.

Adolescent↗
PubMed1996

Case-control study of serum lipoprotein(a) and apolipoproteins A-I and B in stroke in the young.

OBJECTIVES: Abnormalities of lipoprotein(a) and apolipoproteins A-I and B are being recognised as independent risk factors in ischaemic heart disease and atherosclerosis. There are no studies from India where stroke in the young constitutes nearly 20-30% of all strokes. SUBJECTS AND METHODS: Fasting serum lipids, lipoproteins, apolipoproteins A-I and B and lipoprotein(a) were measured in 50 patients aged less than 40 years presenting with completed stroke and 50 normal, age and sex-matched control subjects. Apolipoproteins A-I and B were measured by immunoturbidimetry and lipoprotein(a) by enzyme-linked immunosorbent assay. RESULTS: The serum total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, triglycerides and apolipoproteins A-I and B were not significantly different in the test group as compared to the controls. However, serum lipoprotein(a) was significantly higher in the young stroke patients. CONCLUSION: These findings confirm the hypothesis that an elevated serum lipoprotein(a) level is an important risk factor in the development of cerebral ischaemia in patients aged less than 40 years. It may be worthwhile to study whether it is useful in identifying patients most at risk for stroke.

Adolescent↗
PubMed1996

Evaluation of a simple technique for rapid access to left main bronchus.

A suction catheter with dual curvature at its tip was evaluated for its successful rapid access to left main bronchus. The catheter with dual curvature was passed through endotracheal tube in neutral position of head in 58 adult patients of both sexes in need of mechanical ventilation. Bedside x-ray (AP view) chest was taken to confirm its location. It is observed that this suction catheter had very high success rate of 95% in first attempt and 100% after repositioning endothracheal tube. It did not require any position alteration of head or body and easily allowed aspiration from left lung.

Adult↗
PubMed1994

Detection of site of air entry in venous air embolism: role of Valsalva maneuver.

Venous air embolism in posterior fossa surgery is a well-documented complication. Various highly sensitive devices help in early detection of air embolism. In management of air embolism, sealing the site of air entry is an important step in preventing further episodes. Here we discuss the importance of inspiratory hold after lung inflation (Valsalva maneuver) in helping to localize the site of air entry and its role in the management of venous air embolism observed in two cases of posterior fossa mass, operated in sitting position.

Astrocytoma↗
PubMed1994

A simple central venous puncture detector.

During central venous cannulation, percutaneous venous puncture is performed blindly using a variety of surface landmarks on the body for different puncture sites. To avoid vessel transfixion and injury to adjacent structures, the earliest detection of venous puncture is essential. A simple central venous puncture detector is described, which not only efficiently detects entry of the needle into the vein but also prevents air embolism and blood spillage.

Catheterization, Central Venous↗