Ankur Khandelwal

All India Institute of Medical Sciences (AIIMS) Guwahati

Background In traumatic brain injuries (TBI), cerebral microdialysis (CMD)-derived parameters, especially the lactate to pyruvate ratio (LP ratio), have been utilized for cerebral perfusion optimization. The objectives were to identify cerebral ischemia as measured by CMD in TBI patients requiring decompressive craniectomy and to observe the correl...

A significant number of patients with trigeminal neuralgia (TGN) are refractory to first-line drugs and require interruption of the pain pathway by various percutaneous procedures. One such percutaneous technique involves an injection of absolute alcohol (AA) into the peripheral branches of the trigeminal nerve. This procedure is useful in elderly...

The role of Artificial Intelligence (AI) in medical science is growing immensely. Since AI contains features that can address both preventive and therapeutic aspects of non-communicable diseases (NCDs), it can potentially lessen the massive burden of morbidity and mortality associated with NCDs. AI can help in various ways in NCDs including predict...

Ventilatory management of patients with traumatic cervical spinal cord injury (CSCI) is a complex and controversial area of critical care medicine. Despite significant advances in our understanding of the pathophysiology of CSCI and the development of novel interventions, there remains a lack of consensus about the optimal approach to ventilatory m...

Autoimmune disorders (AIDs) are known to be associated with intracranial aneurysms; however, the coexistence of dual AIDs is a rare entity. Perioperative neuroanesthetic management of aneurysmal subarachnoid hemorrhage (aSAH) is typically complicated and challenging in such patients. In this report, we describe the successful management of a case o...

A bstract Paroxysmal sympathetic hyperactivity (PSH), a common sequelae of traumatic brain injury (TBI), is a clinical condition characterized by features of sympathetic hyperactivity. Though there is a substantial literature on adults, the data on children are lacking. We did a retrospective analysis of severe TBI (Glasgow Coma Scale [GCS] ≤8) ped...

Chin-on- chest deformity is not uncommon sequelae of ankylosing spondylitis. Apart from difficult airway, several other considerations might include co-existing cardio-respiratory embarrassment, osteoporotic bones, and neurological perturbations. We describe the successful anesthetic management of a case of chin-on-chest deformity with no access to...

Objective Cuff leak test is an effective and established maneuver to predict airway edema. Standard fluid therapy (SFT) based on conventional monitoring is often associated with postoperative airway edema after complex spine surgeries. We conducted this prospective randomized controlled study to compare the effect of SFT versus goal-directed fluid...

Traumatic brain injury (TBI) represents a global health problem causing significant disability and mortality among all age groups, particularly young children and adolescents. According to the Centers for Disease Control and Prevention, the young population most commonly affected by TBI has bimodal age distribution (0–4 and 15–19 years). Children u...

Surgery is one of the mainstays of treatment in breast cancers. Typically, modified radical mastectomy (MRM) is done under general anesthesia (GA). However, GA is not a reasonable choice in patients with multiple comorbidities and difficult airways. Thoracic epidural anesthesia (TEA) is a reasonable and safe alternative to GA as it involves bluntin...

A tourniquet is used during surgery to produce a bloodless surgical field and decrease intraoperative blood loss. Although useful, tourniquets are associated with various physiological alterations both during inflation and deflation phases which may be poorly tolerated in compromised patients. We report a case of transient neurological dysfunction...

Trigeminal neuralgia (TN) is a chronic facial pain condition that affects one or more divisions of the trigeminal nerve (5th cranial nerve). It can be idiopathic, primary, or secondary. The cornerstone of the therapy has been antiepileptic medications, peripheral nerve blocks with various neurolytic agents, and surgical procedures. With the advent...

Study design: This was a double-blind randomized study. Purpose: The primary purpose was to compare the effects of propofol and ketofol on amplitudes and latencies of transcranial motor evoked potentials (TcMEPs) during thoracolumbar spine surgery. In addition, intraoperative hemodynamics and muscle power were compared. Overview of literature:...

Intraoperative airway obstruction is not an uncommon life‑threatening emergency. Literature reveals a handful of case reports pointing out crucial respiratory catastrophic events in patients ventilated by double‑lumen tube (DLT). Most cases of blockage are detected due to vigilant monitoring; however, inadvertent blockage of the DLT during controll...

Background Intraoperative aneurysmal rupture (IAR) is a catastrophic complication; however, its impact on neurological outcome is debatable. We studied the effects of IAR on intraoperative and postoperative complications and neurological outcome. Methods In this retrospective study, adult patients who underwent aneurysmal clipping over a period of...

Anaesthesiology is an ever-changing science and amongst its sub-specialities, the field of neuroanaesthesia is making rapid strides. The fragility of the brain and spinal cord and the multitude of complexities involved in neurosurgery and interventional neuroradiological procedures demand dedicated training in neuroanaesthesia. With rapid advanceme...

Name: Pancuronium bromide

Various types of bronchial brush may be used during bronchoscopy to collect samples for both microbiological diagnosis and cleaning tracheobronchial secretions. Inadvertent breakage of this brush during any intervention or cleaning tracheostomy tube(TT) may go unnoticed. While most cases of airway foreign body (FB) are diagnosed readily from a clin...

Highlights •Robotic assisted neurosurgery is associated with precise excision of tumour with less scarring and minimal blood loss. •Perioperative anesthetic management may affect the outcome in robotic assited neurosurgery. •Pediatric patients, epilepsy surgery, lower GCS are associated with longer ICU and hospital stay.

Dengue fever in pregnancy can herald serious consequences if not managed timely and appropriately. The dreaded complication is the occurrence of Dengue Hemorrhagic Fever (DHF) characterized by thrombocytopenia (platelet count <100 × 109/L), hemorrhagic manifestations and increased vascular permeability and in its severe form progression to Dengue S...

Objective: To compare the clinical outcome following induction of general anaesthesia with intravenous (IV) injection of propofol (P), etomidate (E) or a 50% admixture of propofol and etomidate (PE). Methods: In this prospective, randomised, double-blind controlled study, patients 18–60 years of age who were undergoing elective surgery with general...

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions and is usually treated by simple burr-hole drainage. Prognosis is usually good unless complications occur. Use of infant feeding tube (IFT) for irrigation of hematoma in case of CSDH with septum is a common practice. However, it poses a significant risk. We present...

Patients with severe traumatic brain injury often presents with extracranial injuries, which may contribute to fatal outcome. Anesthetic management of such polytrauma patients is extremely challenging that includes prioritizing the organ system to be dealt first, reducing on-going injury, and preventing secondary injuries. Neuroprotective and neuro...

Multimodal neuromonitoring (NM) is the concept of integrating various tools and data to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury. There exists a range of invasive/noninvasive and global/regional monitors of cerebral hemodynamics, oxygenation, metabolism, and electrophysiology that can be used...

Therapeutic hypothermia (TH) or targeted temperature management (TTM) is one of the most encouraging tools that has conferred neuroprotection in cardiac arrest and ischemic encephalopathy. Further, it has been investigated in a variety of acute neurological disorders comprising intracranial hypertension, traumatic brain injury, intracerebral hemorr...

Gilbert's syndrome, a hereditary disorder characterized by mild unconjugated hyperbilirubinemia, poses multiple anesthetic challenges during major surgery. Despite an indolent course, it can manifest with severe jaundice in the postoperative period. Anesthetic strategies should be based on thorough preoperative planning, minimizing fasting period,...

Intraoperative cortical and subcortical bipolar or monopolar mapping is the gold standard for neurosurgical procedures that involve lesions near functional or "eloquent" cortex. However, the classic Penfield stimulation has a higher intraoperative seizure rate than high-frequency short-train stimulation. As a result, high-frequency monopolar stimul...

Severe brain swelling during routine neurosurgery can herald serious consequences. Failure to control brain swelling despite adequate measures warns of a surgical cause and should be dealt efficiently. We report a case of an adult female who developed intraoperative acute subdural haematoma (SDH) and consequent intractable brain swelling during sur...

Carbamazepine‑induced hypocalcemia is a known association but is usually mild and asymptomatic.However, its conversion to severe symptoms such as tetany is extremely rare and is not described in literature. We report a case of carbamazepine‑induced tetany in a patient with trigeminal neuralgia and its rapid reversibility following administration of...

Introduction and Aims Recognizing and treating nonneurological complications occurring in traumatic brain injury (TBI) patients during intensive care unit (ICU) stay are challenging. The aim is to estimate various nonneurological complications in TBI patients. The secondary aim is to see the effect of these complications on ICU stay, disability, an...

We report a 19-year-old male patient, an operated case of anterior cervical discectomy and fusion for traumatic C5–C6 vertebral injury, who developed persistent hypertension following dexmedetomidine infusion in the Intensive Care Unit to enable tolerance of noninvasive ventilation mask. This unusual side effect should be borne in mind when using t...

Pallidotomy is a surgical procedure done widely for Parkinson’s disease and various dystonias refractory to medical treatment. The technique involves radiofrequency (RF) thermal coagulation of globus pallidus internus, either unilaterally or bilaterally. The technique has been shown to produce good success. However, the involvement of nearby vital...

Background Intracranial pressure (ICP) monitoring is an essential component in management of traumatic brain-injured (TBI) patients. While invasive techniques are associated with many complications, noninvasive nature of ultrasonographic measurement of optic nerve sheath diameter (ONSD) is now becoming popular. Carbon dioxide (CO2) alters the ICP b...

Background The peak incidence of traumatic brain injury (TBI) has been reported in children and young adults. Intracranial pressure (ICP) as an important component can be measured with invasive technique, whereas noninvasive measurement of optic nerve sheath diameter (ONSD) is increasingly becoming popular. Positive end-expiratory pressure (PEEP) h...

Background: The peak incidence of traumatic brain injury (TBI) has been reported in children and young adults. Intracranial pressure (ICP) as an important component can be measured with invasive technique, whereas noninvasive measurement of optic nerve sheath diameter (ONSD) is increasingly becoming popular. Positive end-expiratory pressure (PEEP)...

High-dose continuous midazolam therapy has been used successfully for control of refractory status epilepticus. However, normal anion gap (AG) metabolic acidosis, a deleterious complication of this therapy is underrecognized. Even though previously reported in an isolated case report in a pediatric patient, we observed similar complication in an ad...

The significant advantages of percutaneous tracheostomy over surgical (open) tracheostomy has enabled its widespread acceptability and practice in intensive care units. Over the years, various modifications in the technique of percutaneous tracheostomy has increased its safety profile and reduced the overall complication rate. However, even though...

Background: Spinal instrumentation and fusion surgery presents the anaesthesiologist with multiple issues like intraoperative blood loss, hemodynamic changes, prolonged surgery etc, but the most probing aspect is analgesia. While both ketamine and dexmedetomidine as adjuvants have shown to decrease intraoperative anaesthetics and post operative ana...

Valsalva maneuver is associated with diverse physiological changes. These changes are used in various diagnostic and therapeutic clinical settings. Valsalva maneuver is also employed during various phases of neurosurgical procedures to achieve specific targets and confirm intraoperative findings. In this article, we attempt to describe the various...

Hyperglycaemia following surgical and anaesthetic stress is a well-established entity which might have undesirable clinical consequences in known diabetics. We encountered a rare event where an undiagnosed diabetic patient developed ketoacidosis in the immediate post-operative period which was her initial presenting symptom of deranged glucoregulat...

The existence of neural connection between the limbic system (hypothalamus, hippocampus, amygdala, and other adjacent areas) and the autonomic nervous system has been postulated to trigger severe hemodynamic responses. The hemodynamic consequences of stimulation of amygdala or hippocampus have been sporadically reported in animal studies and adult...

Central pontine myelinolysis (CPM) is a demyelinating disease of the pons which is also associated with the demyelination of extrapontine areas of the central nervous system. Although the aetiology and pathogenesis are unclear, CPM is usually associated with hyponatremia or its rapid correction. Malnutrition and chronic alcoholism are also the comm...

Aims: To compare the efficacy of IV Paracetamol versus IV Tramadol for post - operative pain relief in cases undergoing lower abdominal surgery. METHODS AND MATERIAL: The study included 150 patients aged between 18 - 50 years of ASA I and ASA II physical statu s who underwent elective lower abdominal surgery. The patients were divided into two grou...