Karen Ruby Lionel
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View article: A Child with a Large Posterior Mediastinal Mass with Intraspinal Extension—Perioperative Anesthetic Challenges and Importance of Postoperative Analgesia
A Child with a Large Posterior Mediastinal Mass with Intraspinal Extension—Perioperative Anesthetic Challenges and Importance of Postoperative Analgesia Open
A 4-year-old girl child with a large posterior mediastinal mass with intraspinal extension (T2–T5) presented with paraplegia and bowel and bladder dysfunctions. She was planned for T1 to T6 laminoplasty and excision of the intraspinal tumo…
View article: Anatomical considerations of cutaneous nerves of scalp for an effective anesthetic blockade for procedures on the scalp
Anatomical considerations of cutaneous nerves of scalp for an effective anesthetic blockade for procedures on the scalp Open
Objective: The anatomy of the scalp nerves varies widely with age, race, and individuals of the same race and even within the same individual and hence need to be studied extensively to avoid complications and improve effectiveness during …
View article: Knowledge, attitude, and practice of the use of personal protective equipment and its psychological impact among Indian anesthesiologists during the COVID-19 pandemic
Knowledge, attitude, and practice of the use of personal protective equipment and its psychological impact among Indian anesthesiologists during the COVID-19 pandemic Open
Background: Anesthesiologists, with their skills and expertise at performing various aerosol-generating procedures such as tracheal intubation and extubation, tracheostomies, and bronchoscopy-guided procedures, serve as frontline workers d…
View article: Virtual Airway Assessment—So Far and Yet So Close!
Virtual Airway Assessment—So Far and Yet So Close! Open
Coronavirus disease 2019 (COVID-19) has brought into focus the occupational hazards that healthcare workers face. Since the risk of acquiring aerosol-transmitted diseases is directly proportional to the proximity to patients and the length…
View article: Lumbar Erector Spinae Plane Block for Posterior–Superior Iliac Spine Bone Graft Site Pain in Patients Undergoing Occipitocervical and C1–C2 Fusion for Atlantoaxial Dislocation/Odontoid Fracture—A Case Series
Lumbar Erector Spinae Plane Block for Posterior–Superior Iliac Spine Bone Graft Site Pain in Patients Undergoing Occipitocervical and C1–C2 Fusion for Atlantoaxial Dislocation/Odontoid Fracture—A Case Series Open
Pain at the autologous bone graft site from the posterior–superior iliac spine (PSIS) is severe enough to affect the postoperative ambulation. It adds to the morbidity of the surgical procedure. Inadequate pain management at the graft site…
View article: Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial Open
Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and he…
View article: Intraoperative Lumbar Subarachnoid Drain Placement—Challenges and Complications
Intraoperative Lumbar Subarachnoid Drain Placement—Challenges and Complications Open
Background: Lumbar subarachnoid drain (LSAD) is a closed sterile catheter system placed in the lumbar subarachnoid space to drain cerebrospinal fluid (CSF) perioperatively to assist in endoscopic skull base surgeries. The placement and use…
View article: Anesthetic Management of Encephaloduroarteriosynangiosis (EDAS) for Moyamoya Disease: A Retrospective Study
Anesthetic Management of Encephaloduroarteriosynangiosis (EDAS) for Moyamoya Disease: A Retrospective Study Open
Background: Moyamoya Disease (MMD) is a chronic cerebrovascular disease with progressive stenosis/occlusion of terminal portions of ICA and development of cerebral ischemia. Encephaloduroarteriosynangiosis (EDAS) is performed to improve th…
View article: Airway Management in Frontonasal Encephalocele
Airway Management in Frontonasal Encephalocele Open
Background: Frontonasal encephalocele is a congenital malformation, involving the herniation of intracranial contents from foramen cecum at the junction of nasal and frontal bones. Apart from inherent anesthetic implications of pediatric p…
View article: Role of NIRS in a Child with Moyamoya Disease for Encephaloduroarteriomyosynangiosis (EDAMS): A Case Report
Role of NIRS in a Child with Moyamoya Disease for Encephaloduroarteriomyosynangiosis (EDAMS): A Case Report Open
Background: Moyamoya, “puff of smoke” disease (MMD), is a rare cerebrovascular disease with progressive stenosis of intracranial blood vessels. Anesthetic goal of revascularization surgery is to maintain the cerebral oxygen supply and dema…
View article: Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block (QLB) for Anterior Iliac Crest Graft Site Pain in Patients Undergoing Cervical Corpectomy with Iliac Bone Grafting: A Retrospective Case Control Study
Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block (QLB) for Anterior Iliac Crest Graft Site Pain in Patients Undergoing Cervical Corpectomy with Iliac Bone Grafting: A Retrospective Case Control Study Open
Background: Pain after anterior iliac crest bone graft (AICBG) harvesting is severe enough to limit the postoperative ambulation and recovery and can also lead to chronic pain. Quadratus lumborum block (QLB) provides analgesia by depositin…
View article: Anaesthetic management of craniosynostosis repair – A retrospective study
Anaesthetic management of craniosynostosis repair – A retrospective study Open
INTRODUCTION Craniosynostosis, the premature fusion of skull sutures, results in failure of normal bone growth perpendicular to the suture and the compensatory growth at other suture sites resulting in an abnormally shaped head. Eighty per…
View article: Ultrasound-guided transmuscular quadratus lumborum block for anterior iliac crest bone graft promotes early ambulation in patients undergoing cervical corpectomy and fusion
Ultrasound-guided transmuscular quadratus lumborum block for anterior iliac crest bone graft promotes early ambulation in patients undergoing cervical corpectomy and fusion Open
Context: The iliac crest (IC) is widely used as an autograft for bony fusion in spine surgeries. The pain after IC harvesting is severe enough to delay ambulation and thus hospital discharge. Aim: This study aimed to determine the effect o…
View article: Effect of Pregabalin on Perioperative Headache in Patients with Aneurysmal Subarachnoid Hemorrhage: A Randomized Double-Blind, Placebo-Controlled Trial
Effect of Pregabalin on Perioperative Headache in Patients with Aneurysmal Subarachnoid Hemorrhage: A Randomized Double-Blind, Placebo-Controlled Trial Open
Background Patients with acute aneurysmal subarachnoid hemorrhage (aSAH) experience excruciating headache that is difficult to manage in resource-constrained settings. Pregabalin’s (β-isobutyl-GABA) analgesic, antiepileptic, and antiemetic…
View article: An Infant with Apert Syndrome and Tetralogy of Fallot for Craniosynostosis Correction: Anesthetic Challenges
An Infant with Apert Syndrome and Tetralogy of Fallot for Craniosynostosis Correction: Anesthetic Challenges Open
Apert syndrome (AS) is an autosomal dominant disorder characterized by craniosynostosis, craniofacial anomalies, and symmetrical syndactyly of hands and feet. Ten percent children with AS can have associated congenital cardiac anomalies. A…
View article: Anaesthetic Challenges in a Rare Syndrome: Perioperative Management of a Patient with POEMS Syndrome Who Underwent Umbilical Hernioplasty
Anaesthetic Challenges in a Rare Syndrome: Perioperative Management of a Patient with POEMS Syndrome Who Underwent Umbilical Hernioplasty Open
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome also known as 'Crow Fukase syndrome' is a rare paraneoplastic disorder, first described by Crow and Fukase with distinctive features of …
View article: Anoxic Brain Injury: The Abominable Malady
Anoxic Brain Injury: The Abominable Malady Open
Anoxic brain injury (ABI) is an important cause of prolonged hospital stay and morbidity across the globe. It is a sequel of major systemic insults resulting from various etiologies, such as reduced oxygen availability, insufficient cerebr…
View article: A0018 Anesthetic Management of Children with Craniosynostosis for Corrective Surgery: A 10-Year Experience
A0018 Anesthetic Management of Children with Craniosynostosis for Corrective Surgery: A 10-Year Experience Open
Background: Craniosynostosis is a developmental defect characterized by premature fusion of one or more skull sutures leading to deformity and restricted growth of brain. It is associated with different syndromes and compounded by the vari…
View article: A006 Anesthetic Challenges of an Infant with Apert Syndrome and Tetralogy of Fallot for Craniosynostosis Correction
A006 Anesthetic Challenges of an Infant with Apert Syndrome and Tetralogy of Fallot for Craniosynostosis Correction Open
Background: Apert syndrome (ApS) is characterized by craniosynostosis, craniofacial anomalies, and symmetrical syndactyly. Approximately 10% of Apert syndrome children can have associated congenital cardiac anomalies. It is rare to see ApS…
View article: Post intubation high airway pressure’s: An uncommon case of kinked tube
Post intubation high airway pressure’s: An uncommon case of kinked tube Open
High airway pressure’s post intubation is a critical event which requires the urgent intervention of the attending anesthesiologist. We report a case of high peak pressure and plateau pressure after intubation which was actually due to the…
View article: Anesthetic Challenges of a Child with Sturge–Weber Syndrome for Epilepsy Surgery: A Case Report
Anesthetic Challenges of a Child with Sturge–Weber Syndrome for Epilepsy Surgery: A Case Report Open
Sturge–Weber syndrome is a rare congenital disease, also called encephalotrigeminal angiomatosis, caused by persistence of transitory primordial arteriovenous connections of the fetal intracranial vasculature. It is characterized by vascul…
View article: Efficacy of clonidine as an additive on the duration of action of brachial plexus block performed under ultrasound and nerve locator guidance: A prospective randomized study
Efficacy of clonidine as an additive on the duration of action of brachial plexus block performed under ultrasound and nerve locator guidance: A prospective randomized study Open
The inclusion of 100 μg of clonidine with bupivacaine in ultrasound-guided supraclavicular brachial plexus blocks prolongs both sensory and motor blockade. It also provides significant postoperative analgesia and mild sedation which is ben…
View article: Head Rules Over the Heart: Cardiac Manifestations of Cerebral Disorders
Head Rules Over the Heart: Cardiac Manifestations of Cerebral Disorders Open
Hrishi AP, Lionel KR, Prathapadas U. Head Rules Over the Heart: Cardiac Manifestations of Cerebral Disorders. Indian J Crit Care Med 2019;23(7):329-335.
View article: Perioperative Challenges in an Infant with Uncorrected “Pink-Tetralogy of Fallot”—for Excision of Choroid Plexus Papilloma: A Case Report
Perioperative Challenges in an Infant with Uncorrected “Pink-Tetralogy of Fallot”—for Excision of Choroid Plexus Papilloma: A Case Report Open
Perioperative management of an infant with intracranial tumor and congenital cyanotic heart disease poses a lot of challenges to the neuroanesthesiologist and neurointensivist. Maintaining both the cardiovascular and cerebrovascular homeos…
View article: A study comparing propofol auto-coinduction and standard propofol induction in patients undergoing general anesthesia without midazolam pretreatment: A prospective randomized control trial
A study comparing propofol auto-coinduction and standard propofol induction in patients undergoing general anesthesia without midazolam pretreatment: A prospective randomized control trial Open
In our study, we found that the induction dose requirement of propofol was significantly lower in the auto-coinduction group when compared to the conventional induction group. The auto-coinduction technique offered a stable hemodynamic pro…
View article: Epiglottic cyst in von Hippel-Lindau syndrome: Shared pathology or a separate entity?
Epiglottic cyst in von Hippel-Lindau syndrome: Shared pathology or a separate entity? Open
Madam, Von Hippel-Lindau (VHL) syndrome is a genetic disorder characterized by hemangioblastomas involving central nervous system and cysts in the liver, kidney, and pancreas.[1] We encountered a cyst in the upper airway of a patient with …
View article: Intraoperative Hyperthermia: A Harbinger of Hypothalamic Injury?
Intraoperative Hyperthermia: A Harbinger of Hypothalamic Injury? Open
Introduction:Intraoperative hyperthermia portends some of the most dreaded anesthetic emergencies such as malignant hyperthermia, septicemia, neuroleptic malignant syndrome, thyroid storm, and transfusion reactions.However, hypothalamic in…