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Vrushali C Ponde

Vrushali C Ponde
Children Anaesthesia Services Mumbai India

MD

About

84
Publications
7,605
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307
Citations
Introduction
National President and Ex founder secretary: Academy of Regional Anaesthesia, India. http://www.aoraindia.com Program Head: World Federation of Society of Anaesthesiologists. Pediatric Regional Anaesthesia Fellowship. Educational Committee Member.Paediatric Anaesthesia. World Federation of Society of Anaesthesiologists 2020-2024 E Education Chair. Asian Society of Paediatric Anaesthesiology Course Director.Post Doctoral national fellowship in pediatric regional anaesthesia. AORA
Additional affiliations
January 1998 - May 2019
Surya Children'S Hospital
Position
  • Head of Department

Publications

Publications (84)
Article
Full-text available
Anesthesiologists are amongst the front line warriors in this COVID-19 pandemic. We need to change our preferences and practices to reduce the spread to healthcare workers and patients in the hospital. General anesthesia involves aerosol-generating procedures while ventilating and intubating the patients. Regional anesthesia maintains respiratory f...
Article
A 3‐year‐old boy presented with episodes of uneasiness and transient loss of consciousness. Atrial tachyarrhythmias with rapid ventricular rate was diagnosed and initially unsuccessfully treated with oral antiarrhythmic drugs. Subsequent Holter monitoring revealed ventricular arrhythmias. Despite pharmacologic treatment, he needed numerous cardiove...
Article
Background and Aims: The most effective approach for infraclavicular brachial plexus block in adults is to target the posterior cord, usually situated posterior to axillary artery. However, we do not know if this can be extrapolated in children. Our primary objective was to compare the clinical success rate of ultrasound guided infraclavicular brac...
Article
Abstract Background Caudal epidural analgesia is the most common regional anesthetic performed in infants. Dural puncture, the most common serious complication, is inversely proportional to age. Measuring the distance from the sacrococcygeal membrane to the dural sac may prevent dural puncture. This study measures the sacrococcygeal membrane to dur...
Article
Full-text available
Video-assisted thoracoscopic surgery (VATS) is a frequently performed procedure in children which requires an efficient technique for lung isolation. Unavailability of appropriate size double-lumen tubes (DLT) for children and fiber optic scopes inspired us to create our own technique for lung isolation. This retrospective case series aims to descr...
Article
Full-text available
Objectives: Traditionally caudal epidurals are performed by landmark guided approach using the loss of resistance technique. Improvisations to increase the success rate can be attained by implementing modalities namely the neuro-stimulation and ultrasound but there is paucity of literature comparing these three approaches. Here we compare the thre...
Article
Full-text available
Caudal epidural block is one of the most commonly administered blocks in paediatric population. Continuous caudal technique offers several advantages like its ability to cater to long duration surgeries, higher thoracic procedures and to deliver extended, titratable post-operative pain relief. Current advances in this technique like use of fluorosc...
Article
Full-text available
“Team AORA” has come a long way in learning, teaching and researching and innovating regional anaesthesia. From hands on workshops to full fledge post-doctoral fellowships of a year's duration looks like a joyous journey done together. As I write this, the enthusiasm towards honing skills in regional anaesthesia, RA, is palpable. Even in the most t...
Article
Full-text available
A Quick Guide: Ultrasound Guided Nerve Blocks
Article
Full-text available
Annexure-II AORA Checklist: First Confirm Then Perform
Article
Background and objectives: While there are several published recommendations and guidelines for trainees undertaking subspecialty Fellowships in regional anesthesia, a similar document describing a core regional anesthesia curriculum for non-fellowship trainees is less well defined. We aimed to produce an international consensus for the training a...
Article
Full-text available
Background and aims: Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Sub...
Article
Full-text available
1 | INTRODUC TI ON Caudal regression syndrome is a broad term for a rare complex disorder characterized by abnormal development of the lower (caudal) end of the spine. It represents a spectrum ranging from asymptom-atic to mild symptoms to cases with severe, disabling or potentially life-threatening complications. 1 These children may have a wide v...
Article
Full-text available
The benefits of regional anaesthesia and the accompanying concerns of general anaesthesia in newborns make the former a safe and valuable addition. Multiple regional anaesthesia techniques, ranging from the central neuraxial blocks, truncal blocks, and peripheral nerve blocks are available. Empowering us to make the case to case decision to choose...
Article
Full-text available
Although rare, complications can occur in paediatric regional anaesthesia (PRA). An awareness of the various steps where things could go wrong, and the measures taken to rectify them, can go a long way in preventing and treating PRA effectively. Complications due to needle and its trajectory, The needle puncture point Infections, swellings, tendern...
Article
Full-text available
Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Currently, almost all paediatric patients posted for surgery could and should be given a regional block unless and until contraindicated. This is because the scope, techniques, and their benefits have a wide range and complications are rare. The first report that used regio...
Article
Full-text available
Rett syndrome is a genetic neurodevelopmental disorder which occurs in females and includes autism, spasticity, hypotonia, microcephaly, scoliosis, stereotyping, abnormal respiratory control and seizures. They are at an increased predisposition for QT interval prolongation and cardiac arrhythmias. An 8-year-old severely intellectually impaired girl...
Preprint
Full-text available
Background and Aims: Current concerns related to the anaesthetic neurotoxicity have brought a renewed interest in regional anaesthesia. Regional anaesthesia reduces the need for opioids and inhalational anaesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of an...
Preprint
Full-text available
Learning points Peripheral nerve blockade was used to induce vasodilatation of the peripheral vessels by means of a sympathetic blockade. Furthermore, it also stopped the afferent impulses and inhibited the peripheral vasoconstriction because of a reduction in the pain-induced release of catecholamines, cortisol, and antidiuretic hormone. When comp...
Preprint
Full-text available
Preoperative medication is used in children (a) to provide sedation and tranquility, (b) to supplement general anesthesia techniques, (c) to decrease airway secretions, and (d) to block unwanted autonomic responses. Sedatives/hypnotics and anxiolytics can be used for the first two, while anti-cholinergics may be useful to accomplish the third and f...
Article
Full-text available
Are we too focused on blocks, to care, for the patient as an individual who needs holistic care? “Work is love made visible” Khalil Gibran We feel very contented, useful and happy when our patients are safe and comfortable in the perioperative period. Learning new techniques and implementing fresh ideas add a lot of meaning and zeal to our daily...
Presentation
Full-text available
About what is ideally expected from a professional, working as a specialist in pediatric anaesthesia.
Article
Full-text available
Background and aims: The fascia iliaca compartment block (FICB) is commonly administered in children for anterolateral thigh surgery. The actual spread of the local anaesthetic (LA) beneath the fascial layers in children is not known. We hypothesised that in children there could be a possibility of the LA to reach lumbar plexus with the dose we us...
Article
Full-text available
ABSTRACT Paediatric regional anaesthesia today is one of the fastest growing and exciting aspects of paediatric anaesthesia, which requires an ongoing fervour to learn. Application of paediatric regional anaesthesia in neonates, infants, toddlers and children is undertaken to treat perioperative pain without disturbing the physiological milieu with...
Article
Full-text available
Background and Aims: Current concerns related to the anesthetic neurotoxicity have brought a renewed interest in regional anesthesia. Regional anesthesia reduces the need for opioids and inhalational anesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of anesth...
Book
Full-text available
Contents: Basic principles of ultrasound physics................................................................................1 2. Upper extremity blocks....................................................................................................23 • Cervical plexus block........................................................................
Presentation
Full-text available
This presentation gives a gist of recent trends in regional anaesthesia. Practical issues faced by the regional anaesthesia enthusiast to practise these modalities are discussed here, This applies more to the Indian work culture.
Article
Full-text available
A comfortable patient is the key for any successful regional technique. This is perhaps because the anesthesiologist gets maximum cooperation from the patient which puts us at natural ease for block procedure. Although not a must, this is welcome scenario. Axillary approach brachial plexus block is best suited for distal forearm and hand cases. The...
Article
Full-text available
A comfortable patient is the key for any successful regional technique. This is perhaps because the anesthesiologist gets maximum cooperation from the patient which puts us at natural ease for block procedure. Although not a must, this is welcome scenario. Axillary approach brachial plexus block is best suited for distal forearm and hand cases. The...
Article
Full-text available
Pediatric regional anesthesia, does it work??? This article was written for Win conclave
Presentation
"Current status and future challenges for regional anaesthesia practice in India". This topic was a didactic lecture delivered in the European Society of Paediatric Anaesthesiologist meeting held in Belgium on 7th,8th and 9th of september 2018
Presentation
Regional anaesthesia for neonatal population is a didactic lecture delivered in the annual conference held by the Mauritus Society of anaesthesiology
Presentation
''Complications in paediatric regional anaesthesia " was delivered as a didactic lecture in the meeting held by Mauritius Anaesthesiologist Association.
Article
Full-text available
Background: Children that have had a meningomyelocele repair often present for hip and bilateral lower limb surgeries. Due to vertebral, epidural, and nerve root abnormalities, placement of epidural catheter is difficult. Aims: We aim to describe the potential role of ultrasound in delineating the most appropriate intervertebral space for centra...
Article
Full-text available
Background: Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserte...
Article
Full-text available
Syngnathia, bony maxilla-mandibular fusion, is a rare anomaly and usually associated with cleft palate or other systemic anomalies. We herewith describe a method to maintain adequate depth of anaesthesia while managing airway by fibre-optic (FO) intubation
Article
Full-text available
Background and Aims: The cost effectiveness of ultrasound‑guided regional anesthesia is an issue which requires discussion. Based on our experience, we hypothesized that this is an economically viable option. Material and Methods: In this retrospective study, we included 90 patients who underwent upper extremity surgeries in our institute solely un...
Article
Full-text available
Background and Aims: The cost effectiveness of ultrasound‑guided regional anesthesia is an issue which requires discussion. Based on our experience, we hypothesized that this is an economically viable option. Material and Methods: In this retrospective study, we included 90 patients who underwent upper extremity surgeries in our institute solely un...
Article
Full-text available
Pediatric patients with complex multitudinous orthopedic problems undergoing complex, long duration, multiple limb procedures pose a unique challenge to the paediatric anaesthesiologist. The advances in pediatric regional anaesthesia, an ever evolving branch, have led to successful management of such patients throughout the perioperative period. Th...
Article
Full-text available
Background: There is a lack of information about the prevalence of pain among school going Indian children, and therefore, this study was conducted. A cross-sectional population survey was conducted in school children from Grades III to VI. The objective was to determine the prevalence of pain, including chronic pain. The secondary objectives were...
Article
Full-text available
Background The needle tip placed at the level of posterior cord under ultrasound guidance is described as the most effective way to obtain single shot successful block in adults, for forearm and hand surgeries.Objective The aim of this research was to study the spread of dye (depicting the local anesthetic) through catheters placed along the poster...
Book
Full-text available
CONTENTS Foreword-----------------------------------------------------------------VII Preface------------------------------------------------------------------- VIII Acknowledgement ------------------------------------------------------ IX 1. Basic Principles of Ultrasound Physics -------------------------- 1 2. Upper Extremity Blocks--------------...
Article
Full-text available
Background and objectivesArthrogryposis multiplex congenital is hallmarked with immobile joints and muscle fibrosis. The main objective of this study was to compare the success rate of ultrasound‐guided sciatic and femoral nerve blocks with nerve stimulations in children diagnosed with distal arthrogryposis multiplex congenita. Method Sixty childre...
Article
Full-text available
Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of...
Article
Full-text available
Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Almost all surgeries unless contradicted could be and should be supplemented with a regional block. The main objective of this review is to elaborate on the recent advances of the central neuraxial blocks, such as application of ultrasound guidance and electrical stimulatio...
Article
Full-text available
The aim of the study was to derive a clinically useful formula for paravertebral block for thoracic, lumbar (L1) and cervical level (C6) as per the ultrasound-guided measurements in neonates, infants and children up to 5 years of age. Observational study. Seventy-five patients from 2 days to 60 months were included. Paravertebral transverse ultraso...
Article
Full-text available
Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Forty ASA 1 and 2 patients aged 8 months-10 year...
Article
Full-text available
The primary objective of this study was to assess the success rate of ultrasound-guided sciatic needle placement regardless of the motor stimulation in infants and toddlers. Forty-five consecutive patients aged 7 months-2 years, scheduled for foot surgery, were included in this prospective, descriptive and blinded study. After induction of general...
Article
Full-text available
The classical response to nerve stimulation may be altered in cases of radial club hand. Ultrasound guidance may prove to be a useful tool in such situations. In this study, we compared the success rate of ultrasound-guided infraclavicular brachial plexus block with nerve stimulation for children undergoing radial club hand repair. Fifty children,...
Article
Full-text available
The infraclavicular approach to the brachial plexus provides suitable anesthesia and also lends itself well to stabilizing and securing a catheter for a continuous infusion. We describe an approach for continuous infusions using an infraclavicular approach in children. Twenty-five patients aged 8 mo to 3 yr, weighing 7-14 kg, scheduled for forearm...
Article
Full-text available
Radial club hand is a congenital deformity in which the radius is absent, the metacarpophylangeal and interphalayngeal joints are fused and muscles arising from the radius are absent. This can alter the motor response to peripheral nerve stimulation. The classical motor response to median nerve stimulation (contractions of the fingers) cannot be el...
Article
Full-text available
There are several issues that influence the anaesthetic care of children with cerebral palsy such as seizures , spasticity, and sensitivity to pain medications, scoliosis, mental retardation, inability to communicate, respiratory infections, variable patterns of breathing, excessive drooling and other associated medical conditions. A series of 62 c...
Article
Full-text available
Introduction: This study was undertaken to evaluate the quality of anesthesia provided by sciatic nerve & fascia iliaca compartment nerve blocks in pediatric patients undergoing lower limb surgery. Patients and methods: 75 paediatric patients in the age group of 8 - 24 months, of both sex belonging to ASA status 1&2, weighing 7 -15kg , posted for l...
Article
Full-text available
We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4-year-old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g.dl(-1) and blood chemistry was normal. She had no histor...

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Projects (4)
Project
The general anesthesia concerns in newborns accentuates the benefits of regional anesthesia . The use of Interscalene approach brachial plexus blocks is scarce neonates if at all. We report a case of an ultrasound guided interscalene brachial plexus block done under ultrasound guidance for a 24-day old neonate who presented with left septic shoulder. With the block rendering operability, it spared airway instrumentation, opioid use, muscle paralysis and avoided the consequential issues associated with each. To our knowledge this is the first case report of Interscalene approach brachial plexus blocks in a newborn.
Project
INTRODUCTION Brief Background and Rationale A comprehensive approach towards Paediatric anaesthesia comprises of many aspects. It ranges from a good preoperative visit to pain management until discharge. Every facet seems to be interconnected for a fulfilling and rewarding experience of the perioperative period. Out of these, if there is any feature that strikes a strong note, is the quality of the separation of the child from the family into the operation theatres. The “pulling off” the kid from family into the operation theatre can cause huge turbulence, enough to have strong repercussion for weeks after the experience. (1, 2) It is hardly a surprise that paediatric anaesthesiologists always strived to get that one premedication magic drug with all the essential qualities. These are, the drug should be good to taste, fast to act and sedate, safe, would not have many physiological changes, would make the separation pleasant, mask acceptability would be a cakewalk, not affect the cognition, could have analgesia would aid a pleasant recovery and would curb the post-surgical neurobehavioral changes. The most time tested gold standard we have is the midazolam (3) Midazolam has its own shortcomings, the most important as we experience in our everyday practice is its exceedingly bitter taste, requiring skill full camouflaging. The various agents that we use simply tell us that no one is ideal. Most recently Melatonin (4), a natural hormone has shown the promising results. Our practical experience clearly indicated that the separation anxiety and mask acceptance was not as good as it should have been. And we may as well trade it off with the bitter midazolam for its better qualities. This made us curious to look in to the literature evidence about the comparison of these two drugs. This explains the premise of the review. Objectives: To assess the effects of midazolam and melatonin as premedication for pediatric age group ranging from 1-15 years. Various outcome variables are medication acceptability, sedation, post drug intake anxiety, pre-procedure heart rate, BP, peripheral oxygen saturation, parental separation, mask acceptability, effect on induction agent dose, gender disparity, inrta-operative heart rate, BP, emergence/ recovery, post-op behavioural changes, analgesic consumption, psychomotor or cognitive dysfunction and complications including headache, dizziness, nausea, hallucinations, hiccups and sleep disturbances.
Project
INTRODUCTION Brief Background and Rationale A comprehensive approach towards Paediatric anaesthesia comprises of many aspects. It ranges from a good preoperative visit to pain management until discharge. Every facet seems to be interconnected for a fulfilling and rewarding experience of the perioperative period. Out of these, if there is any feature that strikes a strong note, is the quality of the separation of the child from the family into the operation theatres. The “pulling off” the kid from family into the operation theatre can cause huge turbulence, enough to have strong repercussion for weeks after the experience. (1, 2) It is hardly a surprise that paediatric anaesthesiologists always strived to get that one premedication magic drug with all the essential qualities. These are, the drug should be good to taste, fast to act and sedate, safe, would not have many physiological changes, would make the separation pleasant, mask acceptability would be a cakewalk, not affect the cognition, could have analgesia would aid a pleasant recovery and would curb the post-surgical neurobehavioral changes. The most time tested gold standard we have is the midazolam (3) Midazolam has its own shortcomings, the most important as we experience in our everyday practice is its exceedingly bitter taste, requiring skill full camouflaging. The various agents that we use simply tell us that no one is ideal. Most recently Melatonin (4), a natural hormone has shown the promising results. Our practical experience clearly indicated that the separation anxiety and mask acceptance was not as good as it should have been. And we may as well trade it off with the bitter midazolam for its better qualities. This made us curious to look in to the literature evidence about the comparison of these two drugs. This explains the premise of the review. Objectives: To assess the effects of midazolam and melatonin as premedication for pediatric age group ranging from 1-15 years. Various outcome variables are medication acceptability, sedation, post drug intake anxiety, pre-procedure heart rate, BP, peripheral oxygen saturation, parental separation, mask acceptability, effect on induction agent dose, gender disparity, inrta-operative heart rate, BP, emergence/ recovery, post-op behavioural changes, analgesic consumption, psychomotor or cognitive dysfunction and complications including headache, dizziness, nausea, hallucinations, hiccups and sleep disturbances.