Sandeep Chauhan

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (85)57.96 Total impact

  • Journal of cardiothoracic and vascular anesthesia 02/2012; 26(1):e3-5. · 1.06 Impact Factor
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    ABSTRACT: The objective of this study was to assess the effectiveness of 0.5% ropivacaine used for parasternal intercostal blocks for postoperative analgesia in pediatric patients undergoing cardiac surgery. A randomized, controlled, prospective, double-blind study. A tertiary care teaching hospital. Thirty children scheduled for cardiac surgery with a median sternotomy. A 0.5% ropivacaine injection with 5 doses of 0.5 to 2.0 mL on each side in the 2nd to 6th parasternal intercostal space with a total dose of ropivacaine below 5 mg/kg or the same volume of saline before sternal wound closure. The time to extubation was significantly lower in patients administered the parasternal blocks with ropivacaine than in the control group; the mean values were 2.66 hours and 5.31 hours, respectively (p < 0.001). The pain scores were lower in the ropivacaine group compared with the saline group; mean values were 2.20 for the ropivacaine group and 4.83 for the saline group on a scale of 10. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine group (p < 0.001). Parasternal blocks with ropivacaine appear to be a simple, safe, and useful technique of supplementation of postoperative analgesia in pediatric patients undergoing cardiac surgery with a median sternotomy.
    Journal of cardiothoracic and vascular anesthesia 12/2011; 26(3):439-42. · 1.06 Impact Factor
  • Heart Lung &amp Circulation 12/2011; 20(12):777. · 1.25 Impact Factor
  • Journal of cardiothoracic and vascular anesthesia 11/2011; · 1.06 Impact Factor
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    ABSTRACT: The internal jugular vein continues to be the preferred site for cannulation to monitor central venous pressure despite the reported evidence of the accuracy of external jugular venous pressure (EJVP) to reliably predict internal jugular venous pressure (IJVP). Internal jugular venous cannulation carries a risk of thrombosis that can be life-threatening in children undergoing superior cavopulmonary anastomosis and a subsequent Fontan procedure. The present study compared IJVP and EJVP in children undergoing superior cavopulmonary anastomosis and found no statistical and clinical difference between IJVP and EJVP. Thus, external jugular vein cannulation reliably predicts IJVP and pulmonary artery pressures in children undergoing superior cavopulmonary anastomosis, and may obviate the risk of life-threatening cavopulmonary thrombosis.
    Interactive Cardiovascular and Thoracic Surgery 09/2011; 13(6):566-8. · 1.11 Impact Factor
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    ABSTRACT: A 45-year-old patient with known history of Aortic arch aneurysm presented in the emergency ward with features of rupture of the aneurysm into the left lung with compressive signs in the pulmonary parenchyma. Diagnosis was confirmed by magnetic resonance imaging. The patient underwent repair of thoracic aortic aneurysm with left upper lobectomy under general anesthesia and cardio-pulmonary bypass support. Transesophageal echocardiography (TEE) was used for an intraoperative monitoring. While imaging the thoracic aorta with TEE was underway, we accidentally visualized an image that was confirmed to be the spinal cord. So, in this article we discuss how the spinal cord monitoring can be made possible with TEE.
    Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 09/2011; 49(3):114-5.
  • Journal of cardiothoracic and vascular anesthesia 04/2011; 25(2):383-5. · 1.06 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the effects of combined low-dose ketamine and etomidate on hemodynamics during cardiac catheterization in children with congenital cardiac shunts. Sixty children undergoing routine diagnostic cardiac catheterization were included: 30 had a right-to-left shunt, and 30 had a left-to-right shunt. Both groups were given a single dose of etomidate 0.3 mg·kg(-1) with ketamine 1 mg·kg(-1). There were no hemodynamic changes in the group with a right-to-left shunt. In cases of left-to-right shunt, there were significant differences in heart rate, right atrial pressure, mean arterial pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, and systemic vascular resistance index. Decreases in pulmonary blood flow and pulmonary-systemic shunt ratio were also observed. Further studies are required with dose titration of this anesthetic combination in pediatric patients with congenital heart disease involving a left-to-right shunt.
    Asian cardiovascular & thoracic annals 04/2011; 19(2):143-8.
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    ABSTRACT: We report an adult patient with anomalous right pulmonary artery (RPA) from the ascending aorta with origin stenosis, a secundum type of atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) in the left lung, and a protected right lung. Restoration of the continuity between the RPA and the left pulmonary arterial system was achieved without cardiopulmonary bypass.
    Journal of Cardiac Surgery 03/2011; 26(2):201-4. · 1.35 Impact Factor
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    ABSTRACT: We present the case of a young man diagnosed with a right atrial mass and a large pericardial effusion. The patient had presented in the emergency department with chest pain, shortness of breath, pedal oedema and loss of appetite. A transthoracic echocardiogram showed a bright echodensity in the right atrium with a large pericardial effusion. He was treated for presumed tubercular pericardial effusion. Pericardiocentesis showed a straw-coloured non-tubercular pericardial effusion. Surgical removal of the right atrial tumour was planned with cardiopulmonary bypass support. The tumour could only be partially resected due to large adhesions with the myocardium. The patient suffered a cardiorespiratory arrest in the intensive care unit 3 hours after surgery due to persistent bleeding in the pericardial cavity with refractory hypovolemic shock and could not be revived. The pathological examination performed later revealed a primary cardiac angiosarcoma. The case highlights the initial clinical presentation, current diagnostic modalities, and anaesthetic management options for cardiac angiosarcoma.
    Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 01/2011; 52(3):273-7. · 1.23 Impact Factor
  • Annals of Cardiac Anaesthesia 01/2011; 14(1):60-1.
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    ABSTRACT: Indications for extra corporeal membrane oxygenation (ECMO) after pediatric cardiac surgery have been increasing despite the absence of encouraging survival statistics. Modification of ECMO circuit led to the development of integrated ECMO cardiopulmonary bypass (CPB) circuit at the author's institute, for children undergoing repair of transposition of great arteries among other congenital heart diseases (CHD). In this report, they analyzed the outcome of children with CHD, undergoing surgical repair and administered ECMO support in the last 10 years. The outcome was analyzed with reference to the timing of intervention, use of integrated ECMO-CPB circuit, indication for ECMO support, duration of ECMO run and the underlying CHD. The results reveal a significantly improved survival rate with the use of integrated ECMO-CPB circuit and early time of intervention rather than using ECMO as a last resort in the management. The patients with reactive pulmonary artery hypertension respond favorably to ECMO support. In all scenarios, early intervention is the key to survival.
    Annals of Cardiac Anaesthesia 01/2011; 14(1):19-24.
  • European Journal of Cardio-Thoracic Surgery 12/2010; 38(6):707-713. · 2.67 Impact Factor
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    ABSTRACT: The surgical management of infants older than 2 weeks with d-transposition of great arteries and intact ventricular septum (IVS) is a matter of debate. Some studies have presented good results of primary arterial switch operation (ASO) in these children. The aim of this study was to assess the surgical outcome of the primary ASO in children with d-transposition of great arteries and IVS presenting beyond 6 weeks of age. The clinical records of the children (more than 6 weeks age) with d-transposition of great arteries and IVS, who underwent primary ASO at our institute between January 2003 and June 2009 were reviewed. Left ventricular geometry and interventricular septal motion on the transthoracic cross-sectional echocardiogram were taken to assess the left ventricle preparedness. Fifty-five children (age ranging from 42 days to 9 years) with d-transposition of great arteries and IVS underwent primary ASO. The mean cardiopulmonary bypass time was 94.7±21.3 min, while mean aortic cross-clamp time was 53.2±8.1 min. Seven (13%) of these children died during their hospital stay. The children who had severely regressed left ventricle (banana-shaped left ventricular geometry) were operated with integrated extra corporeal membrane oxygenation-cardiopulmonary bypass (ECMO-CPB) circuit for left ventricular re-training. The children with regressed left ventricle required longer ventilatory time and inotropic support. Recovery of left ventricular geometry has taken 1-6 months depending on age at surgery. The children older than 6 weeks with d-transposition of great arteries and IVS can benefit from primary ASO with acceptable results. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2010; 38(6):707-13. · 2.40 Impact Factor
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    ABSTRACT: Over the years the age limit for the arterial switch operation (ASO) is being redefined with increasing expertise and adoption of extra-corporeal membrane oxygenator (ECMO) in the surgical program. We conducted a study to see the differences in ultrastructural features in eight children with transposition of the great arteries, four with prepared and the remaining four with regressed left ventricle (LV) during the ASO. Children with prepared LV had prominent Z bands with uniform and round mitochondria, few fat vacuoles and minimal collagen in the background, whereas children with regressed LV had Z band disruption with non-uniform elliptical mitochondria and myofibrillary disarray and an abundance of fat vacuoles and collagen in the background. Children with regressed LV and abundance of collagen had a prolonged postoperative course. Collagen deposition in the LV may point to the situation where the postoperative course following ASO may be prolonged due to the increased time required for the regressed LV to increase its mass and to sustain the systemic circulation.
    Interactive Cardiovascular and Thoracic Surgery 12/2010; 11(6):768-72. · 1.11 Impact Factor
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    ABSTRACT: D-Transposition of great arteries with an aortopulmonary window is a rare congenital anomaly. We describe a case of D-Transposition of great arteries with an aortopulmonary window and multiple ventricular septal defects in a 5-month boy who underwent successful surgical repair.
    Brazilian Journal of Cardiovascular Surgery 12/2010; 25(4):585-7.
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    ABSTRACT: The objectives of the study were to measure magnesium levels in neonates and infants undergoing arterial switch operation and to ascertain the role of magnesium supplementation in the prevention of postoperative arrhythmias. Group I (n=25): magnesium was administered in the dose of 30 mg/kg over 10 minutes in normal saline (5 ml) immediately after cessation of cardiopulmonary bypass (CPB). Group II (n=25): normal saline (5 ml) was administered over 10 minutes immediately after cessation of CPB. Samples of arterial blood were collected at four time points: 1) after induction of anaesthesia; 2) 10 minutes after initiation of CPB; 3) at rewarming during CPB; and 4) 4 hours after shifting the patient to the intensive care unit. Samples were measured for ionized magnesium (iMg), blood gases, haematocrit level, electrolytes, ionized calcium and glucose. Continuous ECG rhythm analysis and documentation of arrhythmias was performed for 24 hours after surgery. The mean preoperative iMg levels were below the normal level in both the groups. A significant increase in iMg levels (P=0.00) was seen in both groups during rewarming. There is no statistically significant difference in the incidence of arrhythmias between the magnesium supplemented group (4%) and the control group (20%) in the postoperative period, a tendency towards reduction in arrhythmias was only observed in the magnesium supplemented group.
    Interactive Cardiovascular and Thoracic Surgery 11/2010; 11(5):573-6. · 1.11 Impact Factor
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    ABSTRACT: The authors investigated the effects of intravenous etomidate on hemodynamics in children with congenital cardiac shunts. Prospective observational study. Catheterization laboratory in tertiary referral cardiac center. Thirty children with congenital cardiac shunt lesions. Fifteen children having congenital right to left shunts (group A) and 15 children with left to right shunts (group B) were studied. Systemic mean arterial pressure (SMAP), mean pulmonary artery pressures (MPAP), right atrial pressures (RAP), and pulmonary artery wedge pressure (PAWP) were recorded. Systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), and pulmonary-to-systemic blood flow ratio (Qp/Qs) were calculated on room air at baseline and following a single dose of 0.3 mg/kg of etomidate. Heart rate (HR), SMAP, RAP, systemic blood flow (Qs), Qp/Qs, and SVRI did not show any significant change; whereas systemic arterial saturation increased from 77.3% to 79.3%, which was statistically but not clinically significant in the authors' opinion following etomidate in group A. No significant differences in HR, SMAP, MPAP, PAWP, PVRI, SVRI, Qs, pulmonary blood flow (Qp), and Qp/Qs ratio were seen; whereas RAP, systemic, and pulmonary artery saturation decreased in group B after etomidate. Although statistically significant, the decreases were not clinically significant. Etomidate at 0.3 mg/kg produces very minimal changes in hemodynamic parameters and shunt fraction in children with congenital shunt lesions.
    Journal of cardiothoracic and vascular anesthesia 10/2010; 24(5):802-7. · 1.06 Impact Factor
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    ABSTRACT: An alternative technique of coronary button transfer and Lecompte maneuver for anomalous left coronary artery (ALCAPA) arising from left lateral pulmonary sinus is described. This technique was used by us successfully in four patients aged 6 months to 3.5 years, weighing from 4.7 to 16 kg. The importance of trapdoor technique and Lecompte maneuver is discussed.
    Journal of Cardiac Surgery 02/2010; 25(2):225-7. · 1.35 Impact Factor
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    ABSTRACT: To determine the most effective dose regimen of aprotinin for infants undergoing arterial switch operation for transposition of the great arteries in reducing blood loss and postoperative packed red blood cell (PRBC) requirements. A total of 24 infants scheduled for arterial switch operation for transposition of the great arteries were included in the study. The infants were randomly assigned to one of the three groups. Group I (n = 8) patients received aprotinin in a dose of 20,000 kallikrein inhibiting units (KIU)/kg after induction of anesthesia, 20,000 KIU/kg was added to the pump prime, and 20,000 KIU/kg/hour infusion for three hours after weaning from bypass; group II (n = 8) patients received aprotinin 30,000 KIU/kg after induction of anesthesia, 30,000 KIU/kg was added to the pump prime and 30,000 KIU/Kg/hour infusion for three hours after weaning from bypass; group III patients (n = 8) received aprotinin 40,000 KIU/kg after induction of anesthesia, 40,000 KIU/kg was added to the pump prime and 40,000 KIU/kg/hour infusion for three hours after weaning from bypass. Postoperatively, the cumulative hourly blood loss and PRBC requirements were noted up to 24 hours from the time of admission in the intensive care unit (ICU). Use of blood and blood products were noted. Coagulation parameters such as hematocrit, activated clotting time (ACT), fibrinogen, prothrombin time (PT), international normalized ratio (INR), platelet count, and fibrin degradation products (FDP) were investigated before cardiopulmonary bypass (CPB), after protamine administration, and at four hours postoperatively in the ICU. The number of infants reexplored for increased mediastinal drainage was recorded. Renal functions were monitored by measuring urine output (hourly) and serum urea (mg%) and serum creatinine (mg%) at 24 hours. The sternal closure time was comparable in all the three groups. Cumulative blood loss (ml/kg/24 hours) was greatest in group I (17.30 +/- 7.7), least in group III (8.14 +/- 3.17), whereas in group II, it was 16.45 +/- 6.33 (P = 0.019 group I versus group III; (P = 0.036 group II versus group III). Postoperative PRBC requirements were significantly less in high dose group III (P = 0.008, group I versus III; p = 0.116, group II versus group III) . Tests for coagulation performed at four hours postoperatively, viz. ACT, PT, INR, FDP, and platelets were comparable in the three groups. Urine output on CPB was comparable in all the groups. Serum urea and creatinine showed no significant difference between the three groups twenty four hours postoperatively. Aprotinin dosage regimen of 40,000 KIU/kg at induction, in CPB prime and postoperatively for three hours was most effective in reducing postoperative blood loss and PRBC transfusion requirements. Aprotinin does not have any adverse effect on renal function.
    Annals of Cardiac Anaesthesia 01/2010; 13(2):110-5.

Publication Stats

269 Citations
57.96 Total Impact Points

Institutions

  • 1998–2014
    • All India Institute of Medical Sciences
      • Department of Cardiac Anaesthesiology
      New Dilli, NCT, India
  • 2010
    • Jawaharlal Institute of Postgraduate Medical Education & Research
      • Department of Cardiothoractic & Vascular Surgery
      Pondichéry, Pondicherry, India