Nidhi Panda

Post Graduate Institute of Medical Education and Research

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Hemant Bhagat

Post Graduate Institute of Medical Education and Research

Kiran Jangra

Post Graduate Institute of Medical Education and Research

Ankur Luthra

Post Graduate Institute of Medical Education and Research

Rajeev Chauhan

Command Hospital Air Force

Shalvi Mahajan

Post Graduate Institute of Medical Education and Research

Narender Kaloria

Post Graduate Institute of Medical Education and Research

Shiv Lal Soni

Post Graduate Institute of Medical Education and Research

Navneet Singla

Post Graduate Institute of Medical Education and Research

Yatindra Kumar Batra

Post Graduate Institute of Medical Education and Research

Summit Bloria

Shri Mata Vaishno Devi University

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Post Graduate Institute of Medical Education and Research

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All India Institute of Medical Sciences

University of Milano-Bicocca

Azienda Ospedaliera San Gerardo

Institute of Medical Sciences

Institute of Post Graduate Medical Education and Research

Intensive Care Foundation

National Institute of Mental Health and Neurosciences

Istituti di Ricovero e Cura a Carattere Scientifico

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Cerebral hemodynamics and oxygenation during brain tumour resection: A comparative study between normal saline versus plasma-lyte A

Journal of Neuroanaesthesiology and Critical Care (2017)

Shiv Lal Soni Vijay Grover Hemant Bhagat Nidhi Panda Kiran Jangra

Introduction: During craniotomy, it is important to maintain adequate intravascular volume and at the same time to reduce ICP. Intraoperative fluids determine the serum osmolarity which governs the fluid shift in the brain. Normal saline (NS) and Plasma-Lyte A (PA) have different compositions, osmolality, acidic activities, oxygen-carrying capacity and electrolyte constituents. These differences can affect the integrity of the delicate cerebral hemodynamics and metabolism. So, the aim of this study was to evaluate the effect of both fluids on cerebral hemodynamics and oxygenation during brain tumour resection. Methods: A prospective, double- blind, randomized trial was conducted in 110 adult patients scheduled for elective resection of the brain tumour. (NS group, n = 55 or PA group, n = 55). This study commenced from preinduction period till 24 hours following extubation or till the time patients started receiving oral fluids, whichever was earlier. Both the groups received the assigned fluid in the perioperative period. The following parameters were recorded: brain relaxation (at the time of bone flap elevation), cerebral metabolism variables (SjvO2, AVDO2, CERO2, and eCMRO2), arterial blood gases including serum electrolyte and serum osmolality (after induction, bone flap elevation, after tumor resection and 24 hours after surgery). Results: Both the group were comparable with respect demographic and clinical characteristics of tumors. Brain relaxation was similar in both the groups. (p = 0.51). The cerebral metabolic parameters were comparable in both the groups [SjvO2, (p = 0.12), AVDO2 (p = 0.40), CERO2 (p = 0.06), and eCMRO2 (p = 0.73)]. No significant difference in serum osmolality (p = 0.20), serum electrolyte, blood urea and serum creatinine were observed in both the groups. Conclusion: We conclude that both NS or PA appear to have similar physiological, metabolic and clinical profile in patients undergoing craniotomy for supratentorial tumors.

Plasma osmolality

10.1055/s-0038-1646256

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Prevalence and Predictors of Preoperative Anxiety in Patients With An Intracranial Supratentorial Neoplasm Undergoing Surgery

Journal of Neurosurgical Anesthesiology (2022)

Ritu Malik Preethy J. Mathew Nidhi Panda Hemant Bhagat Aakriti Gupta

Background: Preoperative anxiety is common among patients, particularly in neurosurgical patients. The aim of the study was to evaluate the incidence and predictive factors of preoperative anxiety using the state anxiety scale of the State-Trait Anxiety Inventory (STAI-S) among patients undergoing elective craniotomy for a supratentorial neoplasm. This study also determined the optimal Amsterdam Preoperative Anxiety and Information Scale (APAIS) score for the identification of preoperative anxiety in this cohort. Methods: Sixty patients aged 18 to 65 years with American Society of Anesthesiologists physical status score I/II scheduled for elective craniotomy for a supratentorial neoplasm were recruited into this prospective, observational study. Preoperative anxiety was assessed using STAI-S and APAIS questionnaires. Using STAI-S ≥37 to define preoperative anxiety, the optimal APAIS to identify preoperative anxiety was determined using receiver operating characteristic curve analysis. Logistic regression was performed to identify independent predictive factors for preoperative anxiety. Results: Sixty percent of patients had preoperative anxiety (STAI-S ≥37). An APAIS score of 10 identified preoperative anxiety with a sensitivity, specificity, and positive predictive value of 97%, 96%, and 97%, respectively. Right-sided tumor location ( P =0.047) and need-for-information on surgery ( P =0.007) were independent predictors of preoperative anxiety. Conclusions: Patients with supratentorial neoplasms have a high incidence of preoperative anxiety; an APAIS score of 10 is the optimal cutoff to identify anxious patients in the preoperative period. Need-for-information about surgery and right-sided tumor laterality are independent predictors of preoperative anxiety.

Preoperative care

Elective surgery

10.1097/ana.0000000000000896

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Effect of anesthetic agents on cognitive function and peripheral inflammatory biomarkers in young patients undergoing surgery for spine disorders

Asian Journal of Neurosurgery (2019)

Asish Sahoo Nidhi Panda Pranshuta Sabharwal Ankur Luthra Mukilan Balu

Exposure to anesthesia has been postulated to affect the cognitive function by inciting central nervous system inflammation. Hence, we planned to compare the psychometrical effects of anesthetic agents propofol, desflurane, or sevoflurane on postoperative cognitive function and also measure the change in concentration of serum S-100β, interleukin (IL)-6, and tumor necrosis factor (TNF)-α to look for the contribution of systemic inflammation.This was a prospective, double-blind, randomized controlled trial. Intuitional ethical committee approval and consent from patients were obtained. We enrolled 66 patients, allocated into three equal groups to receive either sevoflurane (n = 22), desflurane (n = 22), or propofol (n = 22). Standard anesthesia protocol was followed titrated to a bispectral index of 40-60. Patients with preoperative mini-mental state examination ≤23 were excluded. Each patient was assessed thrice with battery of cognitive tests in preoperative period (baseline), after 72 h (early postoperative cognitive dysfunction [POCD]), after 3 months (delayed POCD) of surgery. Serum levels of IL-6, TNF-α, and S-100β were measured preoperatively and 72 h after surgery.Mean scores of various psychometric tests improved slightly in early postoperative period which was not statistically significant (P > 0.5). In delayed postoperative period, there was significant improvement in scores as compared to baseline (P < 0.5) in all the groups. There was nonsignificant change in the levels of biomarkers S-100β, TNF-α, and IL-6 between baseline and postoperative period in all the groups.In young patients, there is no effect of anesthesia on postoperative cognitive functions. There is no association of inflammatory markers with respect to the patient's cognitive status.

Desflurane

Bispectral index

Postoperative cognitive dysfunction

10.4103/ajns.ajns_173_19

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Effect of Fluid Therapy on Acid–Base Balance in Patients Undergoing Clipping for Ruptured Intracranial Aneurysm: A Prospective Randomized Controlled Trial

Asian Journal of Neurosurgery (2024)

Senthil Kumaran Sundaram Nidhi Panda Narender Kaloria Shiv Lal Soni Shalvi Mahajan

Neurosurgical patients often receive 0.9% normal saline (NS) during the perioperative period. Theoretically, a balanced salt solution (BSS) is better than 0.9% saline. We compared the effects of two different fluids on acid-base balance, renal function, and neurological outcome in patients who underwent clipping following subarachnoid hemorrhage from a ruptured intracranial aneurysm.

Clipping (morphology)

Acid–base homeostasis

10.1055/s-0044-1787086

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Desperate Measures: Shunt Insertion under Local Anesthesia

Journal of Neurosciences in Rural Practice (2017)

Sonia Kapil Manjul Tripathi Nidhi Panda Kanchan K. Mukherjee Sivashanmugam Dhandapani

Neurological compromise, when added to complex cyanotic heart disease (CHD), poses a challenge for both surgeon and anesthesiologist. General anesthesia (GA) in such cases comes with inherent risks of compromised hemodynamic parameters and chances of prolonged recovery from anesthesia requiring postoperative mechanical ventilation and related complications. Regional anesthesia with sedation has already been successfully tried in awake craniotomy, carotid endarterectomy, and evacuation of chronic subdural hematoma in neurosurgery.[[1] [2]] We present successful ventriculoperitoneal shunt insertion in a case of complex cyanotic congenital heart disease under local anesthetic (LA) infiltration and dexmedetomidine infusion.

Dexmedetomidine

Local anesthesia

Shunting

10.4103/jnrp.jnrp_7_17r1

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Effect of General Anesthetics on Caspase-3 Levels in Patients With Aneurysmal Subarachnoid Hemorrhage: A Preliminary Study

Journal of Neurosurgical Anesthesiology (2019)

Mukilan Balasubramanian Aswini Kuberan Amit Rawat Sivashanmugam Dhandapani Nidhi Panda

Background: General anesthesia has been associated with neuronal apoptosis and activation of caspases. Apoptosis is a crucial factor in early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). We conducted a double-blind, prospective, randomized pilot study to evaluate the effect of 4 anesthetic agents on cerebrospinal fluid (CSF) and serum caspase-3 levels in aSAH patients. Materials and Methods: A total of 44 good-grade aSAH patients with preoperative lumbar drain scheduled for surgical clipping or endovascular coiling were randomized to receive maintenance of anesthesia with propofol, isoflurane, sevoflurane, or desflurane. Caspase-3 levels were measured in CSF and serum samples collected at baseline, 1 hour after induction, and 1 hour after cessation of anesthesia. Results: Compared with baseline, there was a decrease in CSF caspase-3 levels and an increase in serum caspase-3 levels 1 hour after exposure to all 4 anesthetic agents; levels returned to baseline values after cessation of anesthesia. Median CSF caspase-3 levels at baseline, 1 hour after anesthesia exposure, and 1 hour after cessation of anesthesia were 0.0679, 0.0004, and 0.0689 ng/mL, respectively ( P <0.05). Median serum caspase-3 levels at baseline, 1 hour after anesthesia exposure, and 1-hour after cessation of anesthesia were 0.0028, 0.0682, and 0.0044 ng/mL, respectively ( P <0.05). Conclusions: Propofol, isoflurane, sevoflurane, or desflurane have similar effects on CSF and serum caspase-3. The reduction of intraoperative CSF caspase-3 levels suggests a possible role for general anesthesia in neuroresuscitation by slowing the neuronal apoptotic pathway.

Desflurane

10.1097/ana.0000000000000648

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An Indian facial database highlighting the Spectacle Problems

Zefree Lazarus Mayaluri Supratim Gupta Nidhi Panda

Spectacle

Source

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A Comparative Study of Opioid-free Anesthesia With Opioid-base Anesthesia for Recovery Characteristics and Postoperative Cognitive Dysfunction After Trans-sphenoidal Resection of Pituitary Tumors

Journal of Neurosurgical Anesthesiology (2022)

Hareesh Ayyawar Neerja Bharti Nidhi Panda Rajesh Chhabra

Ayyawar, Hareesh MD; Bharti, Neerja DNB; Panda, Nidhi MD; Chhabra, Rajesh MCh Author Information

10.1097/ana.0000000000000839

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Comparison of propofol and desflurane for postoperative neurocognitive function in patients with aneurysmal subarachnoid hemorrhage: A prospective randomized trial

Surgical Neurology International (2024)

Shalvi Mahajan Tanavi Sharma Nidhi Panda Rajeev Chauhan Steve Joys

Background: Following aneurysmal subarachnoid hemorrhage, 40–50% of survivors experience cognitive dysfunction, which affects their quality of life. Anesthetic agents play a pivotal role in aneurysm surgeries. However, substantial evidence regarding their effects on neurocognitive function is lacking. This study evaluated the effects of propofol and desflurane on postoperative neurocognitive function and serum S-100B levels. Methods: One hundred patients were equally randomized to receive either propofol (Group P) or desflurane (Group D). Cognitive function was assessed using the Montreal Cognitive Assessment scale at three different time points: Preoperatively, at the time of discharge, and one month after surgery. Perioperative serum levels of S-100B were also measured. Results: The preoperative mean cognitive score in Group P was 21.64 + 4.46 and in Group D was 21.66 + 4.07 ( P = 0.79). At discharge, a significant decrease in cognitive scores was observed compared to preoperative scores (Group P- 20.91 + 3.94, P = 0.03 and Group D-19.28 + 4.22, P = 0.00); however, scores were comparable between the two groups ( P = 0.09). One month following surgery, mean cognitive scores were 22.63 + 3.57 in Group P and 20.74 + 3.89 in Group D, and the difference was significant ( P = 0.04). Higher memory and orientation scores were observed in Group P than in Group D at one month ( P < 0.05) in the subgroup analysis. Both groups had similar serum S-100B levels. Conclusion: The mean cognitive scores one month after surgery improved significantly with propofol compared with desflurane, but without clinical significance. Individual domain analysis demonstrated that orientation and memory scores were better preserved with propofol.

Desflurane

Neurocognitive

Postoperative cognitive dysfunction

10.25259/sni_788_2023

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A0023 Effect of Perioperative Hemoglobin Concentration on Cerebral Oxygen Extraction and Neurological Outcome following Aneurysmal Subarachnoid Hemorrhage

Journal of Neuroanaesthesiology and Critical Care (2019)

Deepak Rajappa Hemant Bhagat Nidhi Panda Ankur Luthra Ashish Aggarwal

Background: The decrease in hemoglobin concentration (Hb) levels has a better rheological and cerebral perfusion spectrum. However, reduced Hb levels are associated with decreased cerebral oxygenation as a result of reduction in oxygen carrying capacity. On the contrary, higher Hb levels compromise blood rheology and cerebral perfusion. Optimal Hb in subarachnoid hemorrhage (SAH) patients is still controversial for better outcome of the SAH patients. The study aimed to evaluate the effect of perioperative Hb levels on cerebral oxygen extraction and neurological outcome in SAH patients.

10.1055/s-0039-1684130

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