Rajini Kausalya

Publications (11)4.33 Total impact

• Article: Safe removal of epidural catheter--a dilemma, in patients who are started on dual anti platelet therapy postoperatively for acute coronary syndrome--a case report.

  Jyoti Burad, Rajini Kausalya, Mohammed Ismaili, Qutaiba Tawafic, Rohit Date
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  ABSTRACT: Epidural catheter insertion or removal in patients receiving antiplatelet therapy for acute coronary syndrome poses a high risk for epidural hematoma. Though practice guidelines suggest stopping clopidogrel for at least 7 days before such intervention. Withholding anti-platelet drugs for such a long duration represents a great risk to these patients. We present a case of a 53 year old male patient who underwent an exploratory laparotomy. He had an epidural catheter inserted for analgesia. He developed acute myocardial infarction on the first postoperative day, which was treated with dual antiplatelet therapy and percutaneous coronary angioplasty. The removal of epidural catheter in this patient required a clinical decision, balancing the risk of epidural hematoma with continuation of antiplatelet therapy against the risk of coronary re-thrombosis with discontinuation of the medication. We followed a strategy that combined a short duration of discontinuation of therapy, assessment of platelet functions by laboratory test, transfusion of platelets and removal of catheter, followed by restart of anticoagulation, which proved safe for the patient.
  Middle East journal of anaesthesiology 10/2012; 21(6):905-8.
• Article: Speechless after general anaesthesia for caesarean section.

  Aravind Narayanan, Qutaiba Amir Tawfic, Rajini Kausalya, Ahmed K Mohammed
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  ABSTRACT: 'Speechless' patient after general anesthesia may be a real horror for the anaesthetist as well as the patient and his relatives. Whatever the cause "functional or organic" the anaesthetist will be under pressure as his patient is not able to talk. Here we report a 40 years old patient who has no history of medical problems and developed aphemia after general anaesthesia for emergency caesarean section with an uneventful intra-operative course. Clinical examinations and investigations failed to reveal any clear cause and the patient returned her ability to talk and discharged home with normal voice.
  Middle East journal of anaesthesiology 06/2012; 21(5):739-42.
• Article: Adult Sickle Cell Disease: A Five-year Experience of Intensive Care Management in a University Hospital in Oman.

  Qutaiba Amir Tawfic, Rajini Kausalya, Dhuha Al-Sajee, Jyoti Burad, Ahmed K Mohammed, Aravind Narayanan
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  ABSTRACT: Sickle cell disease (SCD) is an inherited disease caused by an abnormal type of haemoglobin. It is one of the most common genetic blood disorders in the Gulf area, including Oman. It may be associated with complications requiring intensive care unit (ICU) admission. This study investigated the causes of ICU admission for SCD patients. This was a retrospective analysis of all adult patients ≥12 years old with SCD admitted to Sultan Qaboos University Hospital (SQUH) ICU between 1st January 2005 and 31st December 2009. A total number of 49 sickle cell patients were admitted 56 times to ICU. The reasons for admission were acute chest syndrome (69.6%), painful crises (16.1%), multi-organ failure (7.1%) and others (7.2%). The mortality for SCD patients in our ICU was 16.1%. The haemoglobin (Hb) and Hb S levels at time of ICU admission were studied as predictors of mortality and neither showed statistical significance by Student's t-test. The odds ratio, with 95% confidence intervals, was used to study other six organ supportive measures as predictors of mortality. The need for inotropic support and mechanical ventilation was a good predictor of mortality. While the need for non-invasive ventilation, haemofiltration, blood transfusions and exchange transfusions were not significant predictors of mortality. Acute chest syndrome is the main cause of ICU admission in SCD patient. Unlike other supportive measures, the use of inotropic support and/or mechanical ventilation is an indicator of high mortality rate SCD patient.
  Sultan Qaboos University medical journal 05/2012; 12(2):177-83.
• Source

  Available from: Pradipta Bhakta

  Article: Complications of Central Venous Catheterisation: Breakage of guidewire-a disaster averted.

  Qutaiba A Tawfic, Pradipta Bhakta, Jyoti Burad, Pragyandipta Mishra, Rajini Kausalya
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  ABSTRACT: Central venous catheterisation (CVC) is a common bedside invasive procedure done in medical practice. Even though it is a safe procedure when done with ultrasound guidance, difficulties and complications do occur even in experienced hands. Here, we describe the difficulties encountered in the form of the breakage of the guidewire while inserting a CVC in a patient with sickle cell disease.
  Sultan Qaboos University medical journal 11/2011; 11(4):519-21.
• Article: Diagnostic and therapeutic challenges in a critically ill patient in ICU with superior vena cava syndrome--case report.

  Pragny Adipta Mishra, Rajini Kausalya, Rajiv Jain
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  ABSTRACT: To highlight the diagnostic and therapeutic challenges associated with the treatment of a patient with superior vena cava syndrome and a coexisting coagulopathy. This case report describes a bone marrow transplant patient with graft versus host diseases (GVHD) who was admitted to our intensive care unit with bronchiectasis complicated with nosocomial pneumonia. When he was recovering from pneumonia after prolonged ventilatory support, he developed superior vena cava (SVC) syndrome due to mediastinal lymphadenopathy. The diagnosis was delayed due to associated confounding clinical factors. Because of the rapid deterioration in patient's condition, immediate tissue diagnosis of mediastinal lymph nodes and re-canalization of vena cava by stenting were our priority. He had many other medical problems such as thrombocytopenia, deranged coagulation profile, old cerebral infarction with hemiplegia, seizure disorder and cardiac arrhythmias which complicated the treatment plan. USG guided biopsy followed by stenting of the SVC was done after discussing the risks and benefits with patient's relatives. But, he had bleeding from biopsy site due to deranged coagulation profile. Again for the same reason, he was not given any anticoagulants. Within 24 hours the stent was blocked by clot which was diagnosed by the deteriorating clinical features and repeat CT scan. Then he was given enoxaparin in therapeutic dose and the clot cleared within a day possibly partly due to enoxaparin and partly coagulopathy. In a bone marrow transplant patient with GVHD, the associated complications can confound the diagnosis of SVC syndrome. Physician has to show high degree of suspicion as it may develop even if patient has coagulopathy due to other factors such mediastinal lymphadenopathy. SVC stent may clot even if the patient has coagulopathy. So, it is advisable to defer the invasive diagnostic procedures such as mediastinal lymph node biopsy till the patient is well stabilized after the stent placement in SVC as it will prevent further use of anticoagulants. Enoxaparin may be helpful in the treatment of stent thrombosis in such patients with multiple complications.
  Middle East journal of anaesthesiology 02/2011; 21(1):105-10.
• Source

  Available from: Qutaiba Tawfic

  Article: Liquid ventilation.

  Qutaiba A Tawfic, Rajini Kausalya
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  ABSTRACT: Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen, as the inert carrier of oxygen and carbon dioxide offers a number of theoretical advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future.
  Oman medical journal. 01/2011; 26(1):4-9.
• Article: Unexpected cause of esophageal obstruction due to accidental use of traditional medicine in a critically ill patient fed through naso-gastric tube.

  Qutaiba Amir Tawfic, Pradipta Bhakta, Rajini Kausalya
  Indian Journal of Critical Care Medicine 07/2010; 14(3):160-1.
• Source

  Available from: Pradipta Bhakta

  Article: Unexpected cause of esophageal obstruction due to accidental use of traditional medicine in a critically ill patient fed through naso-gastric tube

  Qutaiba Tawfic, Pradipta Bhakta, Rajini Kausalya
  Indian Journal of Critical Care Medicine 01/2010;
• Article: Missed congenital glottic web may mimic subglottic stenosis in a child.

  Qutaiba A Tawfic, Pragnyadipta Mishra, Pradipta Bhakta, Rajini Kausalya, Aravind Narayanan
  European Journal of Anaesthesiology 11/2009; 27(2):217-9. · 2.23 Impact Factor
• Article: Utility of LMA for emergency tracheostomy in an infant with pierre Robin syndrome.

  Pragnyadipta Mishra, Suresh Chengode, Aravind Narayanan, Rajini Kausalya, Sudesh Kumar
  Pediatric Anesthesia 05/2009; 19(4):409-10. · 2.10 Impact Factor
• Article: Superior vena cava syndrome: still a medical dilemma--a case report.

  Pragnyadipta Mishra, Rajini Kausalya
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this report is to highlight the dilemma and the associated clinical implications in treating a patient with superior vena cava syndrome (SVCS) with a coexisting coagulophathy. This case report describes a post-bone marrow transplant patient who was admitted to our ICU because of bronchiectasis complicated with nosocomial pneumonia. Following the recovery from pneumonia and long ventilatory support, he developed superior vena cava syndrome (SVCS) due to mediastinal lymphadenopathy. The diagnosis was delayed due to associated confounding clinical factors. Due to the rapid deterioration in patient's condition, the immediate tissue diagnosis of mediastinal lymph nodes and re-canalization of superior vena cava by stenting was not done though it was, our priority. He had many other medical problems as well such as thrombocytopenia, deranged coagulation profile, old cerebral infarction with hemiplegia, seizure disorder and cardiac arrhythmias that complicated the treatment plan. Ultrasonography (USG) guided biopsy followed by stenting of the SVC was done after discussing the risks and benefits with patient's relatives. But, he had bleeding from biopsy site due to deranged coagulation profile. He was not given any anticoagulants. Within 24 hours, the stent was blocked by clot that was diagnosed by the deteriorating clinical features and a repeat CT scan. Then he was given Enoxaparin in therapeutic dose and the clot cleared within a day, possibly partly due to Enoxaparin and partly coagulopathy. Meticulous care should be practiced in deciding the appropriate treatment of SVCS especially when it is associated with other complicating medical problems particularly coagulopathy.
  Middle East journal of anaesthesiology 03/2009; 20(1):115-9.