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1.  Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital 
Indian Journal of Anaesthesia  2014;58(1):11-17.
Background and Aims:
Organophosphorus (OP) compound poisoning is one of the most common poisonings in India. The aim of the study was to study the outcomes and predictors of mortality in patients with acute OP poisoning requiring mechanical ventilation.
Methods:
A retrospective study was conducted in the intensive care unit and 117 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives. Demographic data, month of the year, mode of poisoning, common age group, duration of mechanical ventilation, time of starting pralidoxime (PAM), and mortality were recorded. Chi square test, Pearson correlation test, and multivariate binary logistic regression analysis was used. Data are presented as mean ± SD.
Results:
91.86% (79/86) of cases were suicidal and remaining cases were accidental. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 33.3%, 7.2%, and 100% in those who required mechanical ventilation for more than 7 days, 5 to 7 days, and 2 to 4 days, respectively. Lag time was less than 6 hrs in 13 patients and all of them survived. 17.1% and 28.1% patients died in whom PAM was started 6 to 12 hrs and 13 to 24 hrs after poisoning, respectively. There was statistically significant positive correlation between lag time of starting of PAM with duration of mechanical ventilation and total dose of PAM (P < 0.0001). None of the predictors age, lag time, severity of poisoning, and duration of ventilation were independent predictors of death. Overall mortality rate was 18.6%.
Conclusion:
Mortality from OP compound poisoning is directly proportionate to the severity of poisoning, delay in starting PAM, and duration of mechanical ventilation. Death is not dependent on a single factor, rather contributory to these factors working simultaneously.
doi:10.4103/0019-5049.126780
PMCID: PMC3968644  PMID: 24700893
Atropine; intensive care unit management; organophosphorus poisoning; pralidoxime
2.  Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries 
Saudi Journal of Anaesthesia  2013;7(1):29-32.
Context:
Pharmacological agents are used to reduce postoperative blood loss.
Aims:
To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries.
Settings and Design:
A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital.
Methods:
Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid (TA) given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding (volume of blood in the drain), percentage fall of hemoglobin, transfusions and complications were recorded.
Results:
Mean volume of blood in the drain was 39.33±10.09 ml (mean±SD) as compared to 91.11±17.61 ml in placebo group showing a P<0.001. Mean percentage fall in Hb at day 0 was 2.99±3.45 in the study group as compared to 7.70±6.05 in the placebo group (P<0.001), and fall at day 2 in the study group was 0.35±0.74, compared to 2.72±2.70 in the placebo group (P<0.001). The number of patients required blood transfusions were lower in the study group than in the placebo group (P=0.01).
Conclusions:
We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries.
doi:10.4103/1658-354X.109803
PMCID: PMC3657919  PMID: 23717228
Blood loss; blood transfusion; hip and femoral surgery; tranexamic acid
3.  Comparison of Size 2.5 i-gel™ with Proseal LMA™ in Anaesthetised, Paralyzed Children Undergoing Elective Surgery 
Background:
The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA.
Aims:
This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children.
Materials and Methods:
Sixty ASA grade I – II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications.
Results:
There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cm H2O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cm H2O).
Conclusion:
Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.
doi:10.4103/1947-2714.101983
PMCID: PMC3482775  PMID: 23112965
I-gel; Pediatric patients; ProSeal laryngeal mask airway
4.  A prospective, randomized, Single-blinded, comparative study of Classic Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway in pediatric patients 
Context:
ProSeal Laryngeal Mask Airway (PLMA) is extensively being used in pediatric anesthesia.
Aims:
To evaluate the efficacy of PLMA as compared to Classic Laryngeal Mask Airway (CLMA) for airway maintenance in pediatric patients.
Settings and Design:
A prospective, randomized, Single-blinded study was conducted in a tertiary care teaching hospital.
Materials and Methods:
Sixty ASA I and II children were included. Patients were randomized to either size 2 PLMA or size 2 CLMA groups. Parameters noted were time for insertion, number of attempts, airway sealing pressure, blood pressures (systolic, diastolic, and mean), pulse rate, end-tidal carbon dioxide (EtCO2), peripheral oxygen saturation (SpO2), and postoperative change in abdominal circumference, and airway trauma.
Statistical analysis used:
Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the chi-square (χ2) test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05.
Results:
There was no statistical difference between the two groups for the success rates at the first attempt of insertion, airway sealing pressure, hemodynamic responses, SpO2, EtCO2 and postoperative changes in abdominal circumference. Patients in the PLMA group had longer time of insertion and higher incidence of airway trauma.
Conclusions:
The PLMA and the CLMA were comparable for hemodynamic and ventilatory parameters and change in abdominal circumference; however, the time taken for insertion and airway trauma was more with PLMA.
doi:10.4103/0970-9185.98323
PMCID: PMC3409939  PMID: 22869936
Classic laryngeal mask airway; pediatric patients; ProSeal laryngeal mask airway
5.  Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery 
Saudi Journal of Anaesthesia  2012;6(3):224-228.
Context:
The newest variation of the i-gel supraglottic airway is a pediatric version.
Aims:
This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children.
Settings and design:
A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital.
Methods:
Ninety ASA grade I–II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications.
Results:
There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH2O) was significantly higher than that of the PLMA group (22.73±1.2 cmH2O) and the cLMA group (23.63±2.3 cmH2O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups.
Conclusions:
Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.
doi:10.4103/1658-354X.101212
PMCID: PMC3498659  PMID: 23162394
Classic laryngeal mask airway; i-gel; pediatric patients; ProSeal laryngeal mask airway

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