Research & Innovation in Anesthesia

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2019 | July-December | Volume 4 | Issue 2

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Sunil Kumar Gvalani

Anesthesiologist and Critical Care

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ria-4-2-iv  |  Open Access |  How to cite  | 



Gauri R Gangakhedkar

Diabetic Ketoacidosis and Intensive Care

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:3] [Pages No:29 - 31]

Keywords: Complication, Diabetes, Diabetic ketoacidosis, Intensive care

   DOI: 10.5005/jp-journals-10049-0072  |  Open Access |  How to cite  | 


Diabetic ketoacidosis (DKA) is one of the most common hyperglycemic complications of diabetes mellitus (DM) that is encountered in clinical practice as anesthesiologists and intensivists. Various stressors can lead to DKA in a diabetic patient, but it also remains a common manifestation at the outset of the disease among young diabetics. Thorough knowledge of the disease pathophysiology and treatment modalities help to reduce both duration of ICU stay and the morbidity and mortality associated with DKA.



Sanjeevani R Zadkar

Hyperglycemic Hyperosmolar State

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:4] [Pages No:32 - 35]

Keywords: Hyperglycemia, Hyperglycemic hyperosmolar state, Hyperosmolality

   DOI: 10.5005/jp-journals-10049-0076  |  Open Access |  How to cite  | 


With increasing incidence of diabetes mellitus, complications associated with it are also increasing. The hyperglycemic hyperosmolar state (HHS) is one of the common complications seen in old diabetics where patients have markedly increased serum glucose concentrations and hyperosmolality in absence of significant ketosis. Most common precipitating factor is infection. In HHS, levels of insulin in circulation reduce significantly while counterregulatory or stress hormones such as cortisol, catecholamines, glucagon, and growth hormone increase along with greater degree of dehydration. Hence, these patients, in addition to typical features of diabetes, generally present with dehydration and progressive mental deterioration. Basic hematological, biochemical, and radiological investigations are important to find and rule out precipitating factors and complications. Aggressive correction of the fluid and electrolyte imbalance along with the maintaining levels of insulin are very important components of the treatment. Simultaneously, identification and treatment of any underlying precipitating events should be done. Awareness, early diagnosis, and aggressive proper treatment play very crucial role in preventing the morbidity and mortality associated with HHS, which is 10 times more than diabetic ketoacidosis.



Minal Harde, Bhadade Rakesh

Myasthenia Gravis and Anesthesia Challenges

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:4] [Pages No:36 - 39]

Keywords: Anesthesia, Muscle relaxants, Myasthenia gravis, Neuromuscular junction

   DOI: 10.5005/jp-journals-10049-0070  |  Open Access |  How to cite  | 


Myasthenia gravis (MG) is an autoimmune disorder affecting nicotinic acetylcholine receptors at the post-synaptic site in the neuromuscular junction (NMJ). Myasthenia gravis presents with muscle weakness and fatigability of varying degrees affecting many muscle groups, mainly proximal skeletal muscles, ocular, respiratory, and bulbar. Myasthenia gravis has many implications for safe management of anesthesia. They are due to the disease process, association with other autoimmune diseases [diabetes mellitus (DM), thyroid disorders, systemic lupus erythematosis (SLE), rheumatoid arthritis (RA)], the medications used for treatment, potential for respiratory compromise, interaction of many anesthetic drugs in particular being resistance to suxamethonium, and high sensitivity to nondepolarizing muscle relaxants [neuromuscular blockers (NMB)]. Hence, detailed knowledge of the disease is necessary to the anesthesiologist for successful perioperative management and outcome.



Samira Vithani

Nutrition in ICU Patients

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:5] [Pages No:40 - 44]

Keywords: Catabolism, Critical illness, Enteral, Guidelines, Multiorgan failure, Parenteral

   DOI: 10.5005/jp-journals-10049-0071  |  Open Access |  How to cite  | 


Critically ill patients need appropriate nutritional supplementation for their energy requirements during their intensive care unit (ICU) stay and even after ICU stay.1 Any critical illness is a catabolic state and all critically ill patients have an ongoing low-grade inflammation and protein catabolism referred to as persistent inflammatory catabolism syndrome (PICS).2 Adequate supplementation of nutrition attenuates the stress response and modulates immune responses. The aim of nutritional supplementation is to supplement both macro- and micronutrient requirements. Careful supplementation of protein and caloric intake can avoid under- and overfeeding and will decrease the hospital stay and morbidity. Route of supplementation, that is, oral, enteral, or parenteral depends on the patient's hemodynamic status and gastrointestinal functioning. Initiation of feeding within 24–48 hours of critical illness has been recommended. Also, early start of physical exercise has favorable effect on muscle preservation and reduces protein catabolism. The patient's outcome in intensive care depends upon the timing of nutrition, amount, and type of nutrition.



Suchita Kosare

Brain Death and Organ Donation

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:5] [Pages No:45 - 49]

Keywords: Apnea test, Brain death, Green corridor, Transplantation of Human Organs Act

   DOI: 10.5005/jp-journals-10049-0073  |  Open Access |  How to cite  | 


The number of organ transplantation has risen exponentially in the last few decades. The concept of brain death and the ability to harvest vital organs in a limited time have contributed to the recent success. In this review, we attempt to delineate the criteria for brain death as well as the testing methodology. The challenges and the legal aspects related to organ donation have also been discussed.



Maithili D Thakur

Analyzing the Arterial Blood Gases: A Comprehensive Approach

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:5] [Pages No:50 - 54]

Keywords: Anion gap, Metabolic acidosis, Metabolic alkalosis, Oxygenation, Respiratory acidosis, Respiratory alkalosis

   DOI: 10.5005/jp-journals-10049-0074  |  Open Access |  How to cite  | 


The arterial blood gas analysis provides extensive and crucial information to the intensivist. It indicates the state of alveolar ventilation, the oxygenation, as well as the acid–base balance. It is an invaluable tool in expert hands. This review attempts to clarify the concepts related to respiratory and metabolic acid–base disturbances with several examples.



Ventilator-associated Pneumonia

[Year:2019] [Month:July-December] [Volume:4] [Number:2] [Pages:5] [Pages No:55 - 59]

Keywords: Aspiration, Intubation, Mechanical ventilation, Ventilator-associated pneumonia

   DOI: 10.5005/jp-journals-10049-0075  |  Open Access |  How to cite  | 


Ventilator-associated pneumonia (VAP) is the most frequent intensivecare unit (ICU)-acquired infection for patients on mechanical ventilators. There are no goal standards for VAP diagnosis and this makes it the leading cause of death in critically ill patients. The prediction of its outcome is important in the decision-making process and management. This article reviews the various aspects of VAP such as definition, risk factors, etiological agents, diagnosis, treatment, and prevention with emphasis on the recent advances.


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