Venkateswara Karuparthy

University of Iowa Children's Hospital, Iowa City, Iowa, United States

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Publications (7)18.3 Total impact

  • Robert Shontz · Venkateswara Karuparthy · Robert Temple · Timothy J Brennan
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    ABSTRACT: Patients undergoing liver resection may have marginal preoperative liver function, extensive intraoperative blood loss, and perioperative hepatic dysfunction. We evaluated the prevalence and types of coagulopathic conditions that occur in patients with epidural catheters undergoing hepatic resection. A retrospective chart review was conducted of all patients undergoing hepatic surgery who received epidural analgesia between June 1995 and September 2003 at our institution. Forty-nine surgical cases had an epidural catheter placed preoperatively. Data were collected included age, weight, American Society of Anesthesiologists physical status; preoperative partial thromboplastin time (PTT), international normalized ratio (INR), and platelet count (PLT); estimated blood loss (EBL); and volume of hepatic resection. Forty-nine cases received an epidural catheter before hepatic resection. Preoperative PTT, INR, and PLTs were within reference ranges in 47 of 49 patients. Twenty-three (47%) of 49 patients were coagulopathic in the postoperative period. The most common abnormality was an INR greater than 1.4 in 16 patients. Nine patients had a PLT of less than 100,000/microL, and 4 patients had a PTT of greater than 40 secs. Patients who developed a hemostatic abnormality were likely to have greater median EBL (400 vs 1400 mL; Mann-Whitney = 100.5, P = 0.0004) and have a greater median volume of liver resected (166 vs 1688 cm; Mann-Whitney = 57.0, P = 0.0004). There was no causal relationship to preoperative laboratory values, age, weight, or American Society of Anesthesiologists classification. A high prevalence of hemostatic abnormalities in patients undergoing major hepatic resection while receiving epidural analgesia occurred. Important considerations may include discussion with the surgical team, measuring coagulation, and heightened clinical monitoring in the postoperative period.
    No preview · Article · Aug 2009 · Regional anesthesia and pain medicine
  • Venkateswara Karuparthy · Kotaro Kaneda · Anke Bellinger · Tae-Hyung Han

    No preview · Article · Feb 2009 · Journal of Anesthesia
  • R S Ravindran · V R Karuparthy

    No preview · Article · Sep 1999 · Regional Anesthesia and Pain Medicine
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    F.J. Husain · N.L. Herman · V.R. Karuparthy · K.G. Knape · J.W. Downing
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    ABSTRACT: It is generally believed that bolus injections of local anesthetic through an epidural needle produce a more rapid onset of blockade, but at the expense of an increased incidence and severity of hypotension, whereas intermittent injections through a catheter take longer to achieve adequate anesthesia but with a lower risk of hypotension. The present study investigated two commonly used needle and catheter epidural injection techniques for differences in speed of onset of surgical anesthesia and incidence and severity of hypotension. Term parturients scheduled for elective cesarean section were randomized into two groups to receive epidural anesthesia with intermittent injection either through the epidural needle (n = 44) or via a previously placed catheter (n = 44). The incidence and severity of hypotension was similar in the two groups. No significant difference was found for the time to onset of surgical anesthesia. In the absence of benefits of needle injection, incremental catheter administration of local anesthetic with its multiple safety advantages is the technique of choice for induction of epidural anesthesia for cesarean section.
    Full-text · Article · May 1997 · International Journal of Obstetric Anesthesia
  • N. L. Herman · K G. Knape · F. J. Husain · V. R. Karuparthy · J. W. Downing

    No preview · Article · Sep 1990 · Anesthesiology
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    ABSTRACT: One hundred healthy parturients were divided at random into two demographically similar groups and were positioned for cesarean section either horizontally or flexed 5 to 10 degrees head up, with a 15 degrees lateral tilt. A Doppler ultrasound transducer was positioned over the fourth intercostal space parasternally. Initially, two patients received spinal, three general, and 95 epidural anesthesia. Two patients subsequently needed general for failed epidural anesthesia. Changes in Doppler heart tones (greater than 15 sec duration) indicative of venous air embolism (VAE) were identified 15 times in 11 patients--seven in supine and four in head-up patients (no statistically significant difference). Six awake patients (three horizontal, three head-up) developed chest tightness or pain during surgery, but only one episode correlated with VAE. No patient developed breathlessness. Moderate hypotension (greater than 10% decrease in systolic arterial pressure [SAP]) occurred in seven of 11 (63.6%) patients with, and in 26 (29.2%) of 89 patients without, VAE (P less than 0.001). More severe hypotension (SAP less than 90 mm Hg) due to bleeding occurred once. We conclude that a modest (5-10 degrees) head-up position does not influence the occurrence of VAE in patients having cesarean section. An 11% incidence of clinically insignificant VAE, although low, is still worrisome, as even small air bubbles in the circulation are potentially harmful, especially if the foramen ovale is patent. VAE during cesarean section should be anticipated and the anesthetic management planned accordingly.
    No preview · Article · Dec 1989 · Anesthesia & Analgesia
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