Keshav Goyal

Keshav Goyal
All India Institute of Medical Sciences | AIIMS · Department of Neuroanaesthesiology

MD DM

About

99
Publications
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358
Citations
Citations since 2016
50 Research Items
281 Citations
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Introduction
Neurocritical Care Neuromoniotoring Prognostication prediction in Acute Brain Injury

Publications

Publications (99)
Article
Cyanotic congenital heart disease (CCHD) is often associated with more than one cardiac anomaly with unique hemodynamic pattern, hence presenting a plethora of challenges to non-cardiac anesthesiologists. Understanding the pathophysiology of the cardiac lesion and constructing a cardiac grid can help in determining intraoperative hemodynamic goals...
Article
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Descriptive retrospective. To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC). Jai Prakash Narayan Apex Trauma Center (JPNA...
Article
Retrospective chart review. The primary aim was to identify the number of patients requiring vasopressors beyond the first week of cervical spinal cord injury (SCI). Secondary objectives were to note the type, duration and doses of vasopressors and any association between prolonged vasopressors use and outcome. Neurosurgical intensive care of a ter...
Article
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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...
Article
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Background All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effecti...
Article
Background and Aims: Posterior vessel wall puncture (PVWP) is a common complication of ultrasound (US) guided central venous cannulation. We evaluated and compared the frequency of PWVP of internal jugular vein using short axis (SA) and long axis (LA) approach of US-guided needle cannulation. As a secondary objective incidence of carotid puncture w...
Article
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Background: Paroxysmal sympathetic hyperactivity (PSH) is a grave entity affecting patients following traumatic brain injury (TBI). It presents with cyclic and simultaneous fever, posturing, and other symptoms of sympathetic hyperactivity. Lack of diagnostic tests or biochemical markers and its propensity to mimic other common causes of fever in t...
Article
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Background: . Effective patient-doctor communication is a key component of patient-centred care, which is one of the six pillars of quality healthcare delivery. Structured and effective communication skills training for healthcare providers is the need of hour in medical education. We assessed the efficacy of role play and simulation in developing...
Preprint
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Background: The equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency are stored in resuscitation cart. There was no standardization of resuscitation cart as observed during ward rounds in our super specialty hospital. Hence the study was conducted with an aim of streamlining th...
Article
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Hiccups are usually self-limiting and benign but can be distressing when they become persistent or intractable and produce significant morbidity. In the intubated patients in neurocritical care, persistent hiccups may cause respiratory alkalosis and are also associated with an increased incidence of ventilator-associated pneumonia. Several pharmaco...
Article
Background Device-associated infections (DAIs) are an important cause of excessive stay and mortality in ICUs. Trauma patients are predisposed to acquire such infections due to various factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the rates and outcomes of DAIs...
Article
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The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be...
Chapter
A 25-year-old male was driving in SUV on Yamuna Expressway without seatbelt. He collided against a concrete divider at a speed of 90 km/h. There was no airbag in car and windshield was shattered. His initial GCS was 12 but on arrival to casualty after 1-h transfer, GCS score was 7.
Article
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Background Traumatic brain injury (TBI) is associated with majority of trauma deaths, and objective tools are required to understand the severity of injury. The application of a biomarker like procalcitonin (PCT) in TBI may allow for assessment of severity and thus aid in prognostication and correlation with mortality and outcome.AimsThe primary ob...
Article
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Fever is probably the most frequent symptom observed in neurointensive care by healthcare providers. It is seen in almost 70% of neurocritically ill patients. Fever of central origin was first described in the journal Brain by Erickson in 1939. A significant number of patients develop this fever due to a noninfectious cause, but are often treated a...
Article
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The loss of dopaminergic neurons from the substantia nigra pars compacta characterizes the classical pathology of Parkinson's disease (PD). Deep brain stimulation (DBS) has become an increasingly common treatment for PD. Sometimes excessive tremors due to exacerbated PD hinder the surgery and may almost make it impossible. This is a case report hig...
Article
Background: Despite advances in perioperative neuroscience, there is low interest among anesthesiology trainees to pursue subspecialty training in neuroanesthesiology. We conducted a pilot survey to assess attitudes about neuroanesthesiology fellowship training. Materials and methods: A confidential survey was distributed to an international coh...
Article
Central venous catheter (CVC) insertion is a commonly done procedure but associated with some potential complications. In our case, intraoperatively we placed a CVC into the right subclavian vein of the patient for a neurosurgical procedure. Subsequently, in the neurosurgical intensive care unit, on checking the patency of the CVC, only the distal...
Article
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Intraoperative neurophysiological monitoring (IONM) is an important tool for early detection of inadvertent damage and guide intra-operative manipulation during complex neurosurgical procedures. However trans-cranial stimulation can evoke an iatrogenic seizure and it remains a real concern while using Tc-MEP. We report a case of intra-operative sei...
Article
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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...
Article
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Background: There are studies comparing USG guided percutaneous dilatational tracheostomy (PDT) with bronchoscopy guided PDT. We have compared USG guided PDT to conventional landmark guided PDT using bronchoscopy in both the groups. Objective: The primary outcome was the time of procedure and the secondary outcome was incidence of complications...
Article
Patients with permanent pacemaker posted for cervical spine instrumentation pose special challenges for modern-day anesthesiologist since the field of surgery is in proximity to the pacing apparatus. The important considerations in this regard are pacemaker dependency, prior reprogramming to asynchronous mode, perioperative interference with pacema...
Poster
Prognosis in traumatic brain injury patients with or without extra cranial injury with the help of serially estimated serum procalcitonin levels
Article
Full-text available
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...
Article
Diffuse leptomeningeal glioneuronal tumor (DL-GNT) is a newly introduced tumor entity of uncertain prognosis characterised by a primary diffuse leptomeningeal growth pattern, oligodendroglial-like morphology and dual glial/neuronal differentiation. Predominantly occurring in children, these tumors present as chronic meningitis and mimic infectious/...
Article
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Topiramate is a potent antiepileptic drug with multiple modes of action including inhibition of carbonic anhydrase activity. Inhibition of this enzyme predisposes to non-anion gap metabolic acidosis which has been amply described in the literature. However, the severity is yet to be well defined. We encountered a case of topiramate-induced non-anio...
Article
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Topiramate is a potent antiepileptic drug with multiple modes of action including inhibition of carbonic anhydrase activity. Inhibition of this enzyme predisposes to non-anion gap metabolic acidosis which has been amply described in the literature. However, the severity is yet to be well defined. We encountered a case of topiramate-induced non-anio...
Article
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Background Decompressive craniectomy (DC) is done for the management of intracranial hypertension due to severe traumatic brain injury (sTBI). Despite DC, a number of patients die and others suffer from severe neurological disability. We conducted this observational study to assess functional outcome as measured by Glasgow outcome scale-extended (G...
Article
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Objective: Among newer neuroprotectant modalities, hypothermia and progesterone have shown a beneficial role in preliminary studies enrolling patients with severe traumatic brain injury (sTBI). The primary objective of this study was to evaluate the efficacy of progesterone with or without prophylactic hypothermia in acute sTBI patients. Material...
Article
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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...
Chapter
Paroxysmal sympathetic hyperactivity develops following acute brain insult from diverse pathological conditions. The episodic sympathetic hyperactivity results in hypertension, tachycardia, tachypnea, rise in body temperature, excessive diaphoresis, and dystonia. Its prevalence is more common in males, and is generally identified during patient’s l...
Article
A 25 years old female patient with pregnancy of 16 weeks (G2 P1), diagnosed to have distal anterior cerebral artery aneurysm (DACA) with Hunt & Hess grade I, subarachnoid hemorrhage (SAH) and coexisting atretic type of aortic coarctation posted for aneurysmal clipping under general anesthesia is a challenge to anesthesiologists in perioperative per...
Article
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Postoperative visual loss (POVL) is a rare but grave postoperative complication. It has been mainly reported in patients undergoing cardiac and spinal surgeries. Dorsal root entry zone (DREZ) is pain relieving procedure performed in patients with refractory neuropathic pain with minimal complication rate. We present a case of unilateral POVL follow...
Article
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Glanzmann thrombasthenia is a rare inherited coagulation disorder, manifesting itself in early childhood as bleeding episodes. The patients with this disease may present with uncontrollable bleeding following trauma. We report a patient of Glanzmann syndrome with head injury, who presented to us following fall from stairs. Platelet transfusion is t...
Chapter
The trigeminocardiac reflex (TCR) is a potent brain stem reflex that manifests as sudden bradycardia, hypotension, and asystole. This unique reflex is evoked during the stimulation of any sensory branch of the trigeminal nerve. Literature related to the TCR has reported mainly on its appearance during the intraoperative period; thus, it is importan...
Article
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Bilateral recurrent nerve palsy along with head injury is a rare clinical possibility and can be potentially fatal if not properly diagnosed. We report a case of a head injury patient with intact Glasgow Coma Scale requiring immediate re-intubation and tracheostomy after extubation failure as a result of stridor and severe dyspnoea with paradoxical...
Article
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Gum hypertrophy is a well-known and important adverse effect of phenytoin therapy in a neurosurgical patient. We present an interesting case of a 21-year-old man who, following head injury after a road traffic accident, developed status epilepticus diagnosed with gum hypertrophy in the jaws, with ongoing antiepileptics. He was managed conservativel...
Article
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Radioimaging is the gold standard for confirmation of the position of central venous catheter as well as its related complications. Use of ultrasound has been proven in guiding central venous cannulations, and it can also be used in detecting related complications. We report a case of a 2year old child with hydrothorax causing desaturation due to m...
Article
Elizabethkingia meningoseptica is an infrequent cause of hospital-acquired infections. The clinical and microbiological profiles of infections due to E. meningoseptica over a seven-year period at a Level I trauma centre are reported in this study. Medical records of patients from whose clinical samples E. meningoseptica was isolated on at least two...
Article
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In the era of day care surgery there is growing need for the anaesthetic technique which provides stable haemodynamics, adequate analgesia, and minimal complications and at the same time rapid recovery and early ambu lation. This prospective study is aimed to compare efficacy and safety of propofol with ketamine in short surgical/diagnostic procedu...
Article
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Autologous blood transfusion as a cause of intraoperative anaphylaxis is very rare. We encountered one such life-threatening event in a 72-year-old patient undergoing laminectomy and pedicle screw fixation. The probable cause identified was the floseal mixed autologous blood transfusion. Review of literature has been done, and measures to avoid suc...
Article
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1 Rate-dependent left bundle branch block (LBBB) in neurosurgical intensive care unit (NSICU) is a rare entity. We report an unusual presentation of heart rate-dependent transient, but intermittent LBBB in a patient with traumatic brain injury (TBI) without previous history of cardiac disease. A 41-year-old male patient without co-morbidities, suff...
Article
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The importance of ventilator graphics cannot be over emphasized that provide the useful information about airway, ventilation, compliance and lung mechanics. Some bizarre forms of graphics are usually overlooked in view of artifacts, but sometimes these tracings may in fact predict some relevant information.
Article
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Apert syndrome is an autosomal dominant disease characterized by craniosynostosis, midface hypoplasia and syndactyly. In general, patients present in early childhood for craniofacial reconstruction surgery. Anesthetic implications include difficult airway, airway hyper-reactivity; however, possibility of raised intracranial pressure especially when...
Article
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The placement of central venous catheter using Seldinger's technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and...
Article
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Aspiration of foreign bodies is common in a pediatric age group but adults can also be at risk. We describe management of two adult trauma victims with aspirated tooth. In the first case, foreign body went missing for sometime by intensive care physician and detected by radiologist while it was obvious in the second case. Both the patients were man...