Devdas S Divekar’s research while affiliated with Pravara Rural Engineering College Loni and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (15)


Career choice influences in Indian anaesthetisiologists: A cross sectional survey
  • Article

April 2012

·

38 Reads

·

7 Citations

Sri Lankan Journal of Anaesthesiology

·

·

Gourav Goel

·

[...]

·

DS Divekar

Background: Many factors influence the decision of a graduate to pursue his postgraduate studies. Method: A questionnaire was used to find out the career choice of the interns and the various practicing anaesthesiologists and their experience in this field. Results: It is shown that radiology (21%) is the first choice of postgraduate study. Practicing anaesthesiologists cite enthusiasm or commitment (50%) as their top reason for joining anaesthesiology as a postgraduate.


Fig 1: Comparison of HRs before and after laryngoscopy and intubation in two groups
Figure 1: CT scan abdomen showing hydatid cyst in thespleen
Figure1: The injection site for greater occipital nerve block Figure2: The injection for greater occipital nerve block
Table 1 : The organisms cultured
Table 2 : The assistance available to anesthesiologists

+4

Influence of working conditions on job satisfaction in Indian anesthesiologists: A cross sectional survey
  • Article
  • Full-text available

June 2011

·

1,283 Reads

·

17 Citations

Anaesthesia Pain & Intensive Care

Background: Studies related to job satisfaction in Indian anesthesiologists are very limited which prompted us to design this study to quantify the level of job satisfaction among Indian anesthesiologists and to identify the factors responsible for satisfaction/dissatisfaction. Study Type and Design: Cross-sectional study based upon a confidential survey. Location: Pravara Institute of Medical Sciences, Loni (India). Duration: One year Methods: A set of questions was handed over personally to the anesthesiologists at National and state level anesthesiology conferences and CMEs, and filled proformas were collected. Confidentiality and anonymity of the participants was maintained. Main outcome measures were demographics, anesthesia practice, overall job satisfaction, anaesthetic assistance, surgeons’ perceived attitude, attitude towards other colleague anesthesiologists, and patients’ perceived attitude towards them. Results: Response rate was 96%. Seventy eighty percent respondents reported full satisfaction. Female anesthesiologists and male anesthesiologists working in teaching hospitals were more satisfied. (P < 0.01). Forty nine percent respondents were satisfied with the assistance in operating rooms; 51% felt they were duly respected by the surgeons; and 50% expressed satisfaction with recognition of their services by patients. Two main factors for the dissatisfaction were lack of resources/equipment and low recognition of anesthesia services by the patients. Conclusions: Although job satisfaction level in Indian anesthesiologists is quite high, still there is a need to set the standards related to number of working hours, number of night call duties per week, enforcing proper assistance, raising the profile of anesthesiologists among general public, improving funding and resources for OT, which would help reduce occupational stress and further improve efficiency and job satisfaction among anesthesiologists.

Download

A randomized, double blind, controlled study on the effects of addition of clonidine to bupivacaine used for patients undergoing spinal anaesthesia

March 2011

·

213 Reads

·

15 Citations

Sri Lankan Journal of Anaesthesiology

Background: Spinal anaesthesia provided by bupivacaine alone may be too short for the planned surgery. The addition of clonidine 1 µg/kg to bupivacaine provides a prolonged anaesthetic action. The aim of this randomized double-blinded controlled study was to investigate the effects of addition of low dose clonidine to hyperbaric bupivacaine 0.5%, for spinal anaesthesia in patients undergoing lower abdominal and lower limb surgeries, on analgesic efficacy, quality of block, duration of analgesia and adverse effects. Methods: Forty adult ASA Grade I and II patients of either sex posted for lower abdominal and lower extremity surgeries were randomly divided equally in to clonidine or control group. Control group received intrathecal 3.5ml of 0.5% hyperbaric bupivacaine with 0.5 ml of normal saline and Clonidine group received identical volume of intrathecal clonidine 1 µg/kg with 0.5% hyperbaric bupivacaine.



A clinical study of low flow anaesthesia by conventional strategy vis a vis by computer simulation derived strategy

December 2010

·

43 Reads

·

3 Citations

Anaesthesia Pain & Intensive Care

Objectives: To achieve an optimal anaesthetic condition by using low flows in short duration procedures is not easy and it needs consideration of many factors to detail. Hence, a prospective, randomized study was conducted to develop an easily memorised dosing strategy by computer simulation study and it was compared with conventional strategy of low flow anaesthesia. The main target was to achieve an end-tidal concentration of isoflurane of 0.8-1.2 vol% within 5 minutes of the start of low fresh gas flow and to maintain it for at least 30 minutes. Methodology: We selected sixty patients and randomly divided them into two equal groups. Ethics committee approval and informed consent from the selected patients was obtained. In Group-I patients, conventional strategy was used, in which fresh gas flow (FGF) was set at 5.5 L/min (O2 1.5 L plus N2O 4 L) and isoflurane 1.5 Vol% was given for fifteen minutes followed by 2.5 L/min. (O2 1 L plus N2O 1.5 L) and isoflurane 2 Vol % for next five minutes. After twenty minutes flow was reduced to a final 0.8 L (<1 L) (O2 0.4 L plus N2O 0.4 L) and isoflurane 2.5 Vol% till the end of surgery. In Group-II, one of the three schemes designed by computer simulation studies fulfilling our objective of reaching the therapeutic window in less then five minutes was taken for clinical validation and comparison. Selected scheme had one fixed vaporizer setting, e.g. 2.5 vol% Isoflurane, with varying FGF rates of 4.5 L/min for first 3 minutes, 2.5 L/min for next 3 minutes, and 0.8 L/min thereafter. The ratio of N20:02 was 2:1,3:2, and 1:1 consecutively. Results: In Group-I patients time to achieve an end-tidal concentration of isoflurane of 0.8 -1.2 vol% (9.27±2.46 minutes) was longer as compared to Group-II patients (4.24±2.09 minutes) (p<0.01). Number of manipulations needed were more in Group-I (5.47±1.57) than in Group-II patients (3±0) (p<0.01). Dosing strategy obtained by computer simulation was found to be more economical, costing Indian Rupees 289.22±36.37 as compared to conventional dosing strategy which costed Rs.327.54±36.86.(p<0.01) Conclusion: Three-step scheme derived by computer simulation study in which varying FGF rates with fixed vaporizer setting for isoflurane is an easily memorised, economical and effective dosing strategy for low flow anaesthesia.


Table 1 : Key Points
Table 2: Team Model 
Table 3: The ANTS system 
Table 5: ANTS system rating options 
Impact and implications of nontechnical skills in anaesthesiology

November 2010

·

216 Reads

·

4 Citations

Sri Lankan Journal of Anaesthesiology

Crucial role of Non technical skills (NTS) in the dynamic environment of day to day anaesthetic practice is emerging. Rather than mere acceptance, efforts are being made world over to identify and assess them to overcome their negative effects by structured taxonomy both in real time and simulated conditions. Reduction in anaesthetic accidental mishaps and near misses is the prime concern from the point of patient safety and towards that end training and education have a pivotal role.


A randomized clinical trial to compare small frequent boluses technique with that of traditional intermittent top-ups and continuous epidural infusion, for maintenance of epidural labour analgesia

November 2010

·

72 Reads

·

3 Citations

Sri Lankan Journal of Anaesthesiology

Background Prospective randomized study was designed to compare the safety and efficacy of administering small, frequent boluses of Bupivacaine and Fentanyl mixture epidurally for labour analgesia maintenance, with that of continuous infusion and traditional intermittent boluses. Methods Sixty patients having full term uncomplicated pregnancies in active labour were selected randomly after ethics committee approval. Initial block was established by injecting loading dose of 10 ml of Bupivacaine 0.125 % with Fentanyl (2 μg/ml) mixture epidurally and maintained by 3 ml at 15 minutes interval (SFB), or 10 ml hourly as bolus (TIT) or continuous infusion 10 ml/hr (CEI). Analgesia quality, VAS, level of overall satisfaction, duration of labour, and total dose required were compared. Results Overall quality of analgesia was very good in all techniques. Difference in cumulative analgesia score percentage for 0 (No pain, pressure or tightening) was significant. Average VAS was 0.9 ± 0.87 in SFB 2.55 ± 0.91 in TIT and 0.4 ± 0.79 in CEI Group. 30 % of patients from SFB 5 % from TIT and 50 % from CEI expressed the analgesia as excellent. Total dose required and duration of labour was similar in all groups. Conclusions Our study revealed that the technique of small frequent boluses at fifteen min intervals is superior to the technique of traditional intermittent top-ups but not to the technique of continuous epidural infusion as regards quality of analgesia. Nevertheless it can be a better alternative for maintenance of epidural labour analgesia in hospitals with limited resources.



Comparative study of acute normovolaemic haemodilution and acute hypervolaemic haemodilution in major surgical procedures

June 2010

·

29 Reads

Anaesthesia Pain & Intensive Care

Background: Ready availability of human blood for transfusion is limited, especially in case of rare blood groups and fraught with many risks necessitating a search for methods of blood conservation. Acute Normovolemic Hemodilution (ANH) and Acute Hypervolemic Hemodilution (HHD) have been found to be useful in this respect but studies related to a direct comparison between the two as regards to time, cost effectiveness in autologous blood conservation, effect on blood loss, hematocrit values and on hemodynamic stability are limited. Methodology: A prospective, randomized study was designed to compare ANH with HHD at Pravara Hospital, a teaching hospital attached to Pravara Institute of Medical Sciences during a period of six months from July 2008 to January 2009. Sixty adult patients of ASA Grade I and II with haemoglobin percentage ≥10 Gms posted for major surgeries, with an estimated blood loss around 1200 to 1500 ml were randomly distributed into two groups, ANH (n = 30) and HHD (n = 30). In ANH group autologous blood was removed using a predefined formula and simultaneously an equal amount of 6% hydroxyethyl starch was infused. Perioperative retransfusion was done after perfect surgical haemostasis. In HHD group 15 ml/kg of 6% hydroxyethyl starch was infused without removing any blood. Mean time required, cost, intra operative blood losses, hemodynamic stability, hematocrit changes, homologous blood requirements and complications (if any) were compared between two groups and data was analyzed statistically. Results: ANH was found to be costlier (Rs.761.10 ± 61.35) and more time consuming (539.33 ± 128.75 minutes) than HHD (Rs.445.43 ± 32.28 and 20.7 ± 3.34 minutes). (p-value < 0.05) Intraoperative blood loss was comparable (ANH : HHD = 1293.67 ± 124.30 : 1253.67 ± 135.58 ml) between two groups. (p-value > 0.05) Patients in ANH group developed a higher pulse rate but had lower systolic and diastolic blood pressures in comparison to HHD Group patients. Hematocrit values were higher in HHD (29.30 ± 2.77 and 33.56 ± 2.75) than in ANH Group patients (27.00 ± 3.1 and 29.43 ± 2.49) on second and seventh postoperative day respectively. (P-value < 0.05) Conclusion: Acute hypervolemic hemodilution appears to be a simple, easier, hemodynamically more stabilising, time saving and cost effective alternative to acute normovolemic hemodilution.


A randomized clinical trial to compare continuous epidural infusion technique with that of intermittent boluses for maintenance of epidural labour analgesia in combined spinal epidural analgesia

January 2010

·

6 Reads

·

1 Citation

Background Prospective randomized study was designed to compare the safety and efficacy of administering small, frequent boluses of Bupivacaine and Fentanyl mixture epidurally for labour analgesia maintenance, with that of continuous infusion and traditional intermittent boluses. Methods Sixty patients having full term uncomplicated pregnancies in active labour were selected randomly after ethics committee approval. Initial block was established by injecting loading dose of 10 ml of Bupivacaine 0.125 % with Fentanyl (2 Zg/ml) mixture epidurally and maintained by 3 ml at 15 minutes interval (SFB), or 10 ml hourly as bolus (TIT) or continuous infusion 10 ml/hr (CEI). Analgesia quality, VAS, level of overall satisfaction, duration of labour, and total dose required were compared. Results Overall quality of analgesia was very good in all techniques. Difference in cumulative analgesia score percentage for 0 (No pain, pressure or tightening) was significant. Average VAS was 0.9 ± 0.87 in SFB 2.55 ± 0.91 in TIT and 0.4 ± 0.79 in CEI Group. 30 % of patients from SFB 5 % from TIT and 50 % from CEI expressed the analgesia as excellent. Total dose required and duration of labour was similar in all groups. Conclusions Our study revealed that the technique of small frequent boluses at fifteen min intervals is superior to the technique of traditional intermittent top-ups but not to the technique of continuous epidural infusion as regards quality of analgesia. Nevertheless it can be a better alternative for maintenance of epidural labour analgesia in hospitals with limited resources.


Citations (9)


... Risk factors for requiring a pacemaker include very slow heart rates (below 55 bpm), symptoms such as poor exercise tolerance, cardiomegaly, long QRS or QT durations, ectopy, syncope, or structural or functional heart disease [19]. According to Khadke et al. [20] temporary pacing should be done in patients with atropine-resistant bradycardia, 1st and 2° AV block, and atrial fibrillation with low ventricular rate. We inserted a temporary pacemaker in the morning of surgery in the cardiac Cath laboratory, under fluoroscopic guidance; the abdomen was protected with a lead apron. ...

Reference:

Congenital Complete Heart Block and General Anaesthesia for Caesarean Section 1 2 2
A parturient with complete heart block for caesarean section
  • Citing Article
  • January 2010

Journal of Anaesthesiology Clinical Pharmacology

... We will have to gain recognition not only from the general public and media, but also from our surgical and nursing colleagues. [1] Better communication with surgeons and good patient education will improve the image of an anaesthesiologist in the eyes of the layman. [2] Currently, the number of anaesthesiologists is increasing, and the job opportunities for them in tier 1 and 2 cities have decreased. ...

Career choice influences in Indian anaesthetisiologists: A cross sectional survey
  • Citing Article
  • April 2012

Sri Lankan Journal of Anaesthesiology

... We again assessed respondent's awareness of the various options of labour analgesia services available at the delivery unit of the Tamale Teaching Hospital. We observed that 2 (0.4%) of the respondents were informed of IV/IM injections (analgesic), 527 (97.6 %) were informed of epidural labour local anaesthetics or analgesics and overwhelming patient numbers [6,7]. ...

A randomized clinical trial to compare continuous epidural infusion technique with that of intermittent boluses for maintenance of epidural labour analgesia in combined spinal epidural analgesia
  • Citing Article
  • January 2010

... [5] Anatomical variation can also lead to phrenic nerve paresis after supraclavicular block. [6] Close to its origin, the phrenic nerve may give a communicating branch to C5 root of brachial plexus. Such an anatomical variation gains importance in supraclavicular nerve block. ...

Anatomical Variation Leads to Phrenic Nerve Palsy after Supraclavicular Block
  • Citing Article
  • January 2009

The Internet Journal of Pain Symptom Control and Palliative Care

... This is similar to the findings of Duncan et al [14], who reported that continuous and intermittent epidural injection of bupivacaine provided stable heart rate. In addition, Shidhaye et al [15] in their study of women receiving epidural labour analgesia reported that the administration of both CEA and IEA provided stable and comparable heart rate in their subjects. Heart rate is influenced by the autonomic nervous system and a lower heart rate indicates parasympathetic predominance [16]. ...

A randomized clinical trial to compare small frequent boluses technique with that of traditional intermittent top-ups and continuous epidural infusion, for maintenance of epidural labour analgesia

Sri Lankan Journal of Anaesthesiology

... 3 Clonidine, an α2-receptor agonist, prolongs the action of LA while avoiding opioid-related side effects. [4][5][6] Many studies have compared the two drugs, but with varying results, especially concerning the duration of sensory and motor block. Our study aimed to compare clonidine and fentanyl as an adjuvant to isobaric ropivacaine for the duration of analgesia, sensory and motor block characteristics, haemodynamic stability, sedation score and any adverse event in the intraoperative and 12-hour postoperative period, in patients undergoing vaginal hysterectomy under SAB. ...

A randomized, double blind, controlled study on the effects of addition of clonidine to bupivacaine used for patients undergoing spinal anaesthesia

Sri Lankan Journal of Anaesthesiology

... The proposed definition separates plainly among high and low stream strategies and is pertinent to both pediatrics and grownup patients. For most commonsense contemplations, use of a new gas stream under 2 L/min might be considered as low-flow sedation [2]. ...

A clinical study of low flow anaesthesia by conventional strategy vis a vis by computer simulation derived strategy
  • Citing Article
  • December 2010

Anaesthesia Pain & Intensive Care