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  • 1
    Online Resource
    Online Resource
    Assessment of Recent Tectonic Activity along the Yamuna Basin, Garhwal Region, NW-Himalaya, India: Based on Morphotectonic Analysis
    Scientific Research Publishing, Inc. ; 2021
    In:  Open Journal of Geology Vol. 11, No. 12 ( 2021), p. 734-755
    Details
    In: Open Journal of Geology, Scientific Research Publishing, Inc., Vol. 11, No. 12 ( 2021), p. 734-755
    Type of Medium: Online Resource
    ISSN: 2161-7570 , 2161-7589
    URL: Article
    DOI: 10.4236/ojg.2021.1112036
    Language: Unknown
    Publisher: Scientific Research Publishing, Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2645070-7
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  • 2
    Online Resource
    Online Resource
    Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
    Oxford University Press (OUP) ; 2019
    In:  British Journal of Surgery Vol. 106, No. 2 ( 2019-01-08), p. e73-e80
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e73-e80
    Abstract: The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.11025
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2006309-X
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  • 3
    Online Resource
    Online Resource
    Brain Monitoring and Protection During Pediatric Cardiac Surgery
    SAGE Publications ; 2007
    In:  Seminars in Cardiothoracic and Vascular Anesthesia Vol. 11, No. 1 ( 2007-03), p. 23-33
    Details
    In: Seminars in Cardiothoracic and Vascular Anesthesia, SAGE Publications, Vol. 11, No. 1 ( 2007-03), p. 23-33
    Abstract: With advances in medical care, survival after cardiac surgery for congenital heart disease has dramatically improved, and attention is increasingly focused on longterm functional morbidities, especially neurodevelopmental outcomes, with their profound consequences to patients and society. There are multiple reasons for concern about brain injury. Some cardiac defects are associated with brain anomalies and altered cerebral blood flow regulation. Brain imaging studies have demonstrated that injury to gray and white matter is quite frequent before heart surgery in neonates. Cardiopulmonary bypass and deep hypothermic circulatory arrest are associated with shortand longer-term adverse neurologic outcome. Additional brain injury can occur during the patient's recovery from surgery. Strategies to optimize neurologic outcome continue to evolve. With new technological developments, perioperative neurologic monitoring of small children has become easier, and data suggest these modalities usefully identify adverse neurologic events and might predict outcome. Monitoring methods to be discussed include processed electroencephalography, near infrared spectroscopy, and transcranial Doppler ultrasound. Alternative perfusion techniques to deep hypothermic circulatory arrest have been developed, such as regional antegrade cerebral perfusion during cardiopulmonary bypass. Other neuroprotective strategies employed during open-heart surgery include temperature regulation, acid-base management, degree of hemodilution, blood glucose control and anti-inflammatory therapies. Evidence of the impact of these measures on neurologic outcome is examined, and deficiencies in our current understanding of neurologic function in children with congenital heart disease are identified.
    Type of Medium: Online Resource
    ISSN: 1089-2532 , 1940-5596
    URL: Article
    DOI: 10.1177/1089253206297412
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
    detail.hit.zdb_id: 2233047-1
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  • 4
    Online Resource
    Online Resource
    Cognitive Dysfunction in Children with Heart Disease: The Role of Anesthesia and Sedation : Anesthesia and Neurotoxicity in CHD
    Computers, Materials and Continua (Tech Science Press) ; 2016
    In:  Congenital Heart Disease Vol. 11, No. 3 ( 2016-05), p. 221-229
    Details
    In: Congenital Heart Disease, Computers, Materials and Continua (Tech Science Press), Vol. 11, No. 3 ( 2016-05), p. 221-229
    Type of Medium: Online Resource
    ISSN: 1747-079X
    URL: Article
    DOI: 10.1111/chd.12352
    Language: English
    Publisher: Computers, Materials and Continua (Tech Science Press)
    Publication Date: 2016
    detail.hit.zdb_id: 2231467-2
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  • 5
    Online Resource
    Online Resource
    Natural history of nonimmune‐mediated thrombocytopenia and acute kidney injury in pediatric open‐heart surgery
    Wiley ; 2017
    In:  Pediatric Anesthesia Vol. 27, No. 3 ( 2017-03), p. 305-313
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 27, No. 3 ( 2017-03), p. 305-313
    Abstract: Thrombocytopenia and acute kidney injury (AKI) are common following pediatric cardiac surgery with cardiopulmonary bypass (CPB). However, the relationship between postoperative nadir platelet counts and AKI has not been investigated in the pediatric population. Our objective was to investigate this relationship and examine independent predictors of AKI. Design After IRB approval, we performed a retrospective review of the institution's medical records and database. Setting : This study was performed at a single institution over a 5‐year period. Patients : We included patients 〈 21 years of age undergoing cardiac surgery with CPB. Interventions : Demographics, laboratory, and surgical characteristics were captured, and clinical event rates were recorded. Measurements : Descriptive statistics were used to evaluate platelet and creatinine distributions. T ‐tests and chi‐squared tests were used to compare characteristics among Acute Kidney Injury Network groups. Multivariable logistic and ordinal logistic regression models were used to determine the association of our predictor of interest, postoperative nadir platelet count and AKI. Results Eight hundred and fourteen patients (23% infants and 23% neonates) were included in the analysis. Postoperative platelet counts decreased 48% from baseline reaching a mean nadir value of 150 × 10 9 ·l −1 on postoperative day 3. AKI occurred in 37% of patients including 13%, 17%, and 6% with Acute Kidney Injury Network stages 1, 2, and 3, respectively. The magnitude of nadir platelet counts correlated with the severity of AKI. Independent predictors of severity of AKI include nadir platelet counts, CPB time, Aristotle score, patient weight, intra‐operative packed red blood cell transfusion, and having a heart transplant procedure. Conclusions In pediatric open‐heart surgery, thrombocytopenia and AKI occur commonly following CPB. Our findings show a strong association between nadir platelet counts and the severity of AKI.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2017.27.issue-3
    DOI: 10.1111/pan.13063
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2008564-3
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  • 6
    Online Resource
    Online Resource
    Determination of the optimal depth of a left internal jugular venous catheter in infants: A prospective observational study
    Wiley ; 2017
    In:  Pediatric Anesthesia Vol. 27, No. 12 ( 2017-12), p. 1220-1226
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 27, No. 12 ( 2017-12), p. 1220-1226
    Abstract: Few reports exist regarding the optimal depth of a left‐sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight. Methods A two‐stage study was conducted. In the first observational study, infants aged ≤1 year and scheduled for elective surgery requiring a central venous catheter were enrolled. The tip of the central venous catheter was confirmed using transthoracic echocardiography. Linear regression modeling was performed to determine the association between the insertion depth of the central venous catheter and the I‐A‐B distance (I, the insertion point; A, the sternal head of the left clavicle; B, the midpoint of the perpendicular line drawn between the sternal head of the right clavicle and an imaginary line between the nipples), based on age, height, and weight. In the second study, the results of the first study were validated in another group of consecutive infants. Results In the first study, the data of 67 patients were analyzed. The infant's height and I‐A‐B distance were highly correlated with the level of the central venous catheter tip ( R 2 =0.763 and 0.772, respectively; all P  〈   .01), using the regression equations 0.11 ×  height (cm) + 0.19 and 1.02 ×  I‐A‐B (cm) + 1.55, respectively. In the second study, height was also highly correlated with the insertion depth of the central venous catheter in another 42 infants ( r  = .938, P  =   〈 .001). In a Bland‐Altman's analysis, the mean bias and precision of the actual insertion depth and predicted depth using height were 0.09 and 0.15 cm, respectively. The limits of agreement were −0.19 and 0.38 cm, respectively. Conclusion In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2017.27.issue-12
    DOI: 10.1111/pan.13258
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2008564-3
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  • 7
    Online Resource
    Online Resource
    Perioperative echocardiography in children: Is there a role for pediatric cardiac anesthesiologists?
    Wiley ; 2019
    In:  Pediatric Anesthesia Vol. 29, No. 5 ( 2019-05), p. 401-402
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 29, No. 5 ( 2019-05), p. 401-402
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2019.29.issue-5
    DOI: 10.1111/pan.13622
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2008564-3
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  • 8
    Online Resource
    Online Resource
    Anesthesia for bilateral pulmonary banding as part of hybrid stage I approach palliating neonates with hypoplastic left heart syndrome
    Wiley ; 2020
    In:  Pediatric Anesthesia Vol. 30, No. 6 ( 2020-06), p. 691-697
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 30, No. 6 ( 2020-06), p. 691-697
    Abstract: Neonatal management of patients with hypoplastic left heart syndrome and complex remains a challenging task, whereby the “hybrid” palliation is often reserved for high‐risk patients as a “rescue” procedure. Aim This study documents the anesthetic challenges and potential complications associated with the Giessen hybrid stage I approach. Methods The Giessen hybrid stage I approach is focused on surgical bilateral pulmonary artery banding. Retrospective perioperative data were analyzed. Contrary to a stable group A, inotropic treatment before surgery for treatment of postnatal shock classified patients as unstable (Group B). Clinical outcomes considered were inhospital mortality, duration of postoperative mechanical ventilation, postoperative time at the intensive care unit, perioperative vasoactive medication requirements, and red blood cell transfusion. Results From June 1998 to December 2015, 185 patients were allocated to Group A (n = 165) and Group B (n = 20). The inhospital mortality was 2.2% with no difference between the groups. There was also no difference in the postoperative time on mechanical ventilation and the time in the intensive care unit. Vasoactive medication was more often required in Group B (100%) compared to Group A (19%). In Group B, more red blood cells were transfused 6.0 ± 8.3 vs 2.0 ± 5.8 mL/kg in Group A ( P   〈  .05, 95% CI 0.0 ‐ 2.6). Conclusion Considering a learning curve, anesthesia for surgical bilateral pulmonary artery banding palliating patients with hypoplastic left heart syndrome and complex can safely be performed, independent from the preoperative clinical status.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.v30.6
    DOI: 10.1111/pan.13876
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2008564-3
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  • 9
    Online Resource
    Online Resource
    Adult congenital heart disease and anesthesia: An educational review
    Wiley ; 2021
    In:  Pediatric Anesthesia Vol. 31, No. 2 ( 2021-02), p. 123-131
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 31, No. 2 ( 2021-02), p. 123-131
    Abstract: Prognosis has dramatically improved among children with congenital heart disease (CHD), and the median survival for severe CHD is currently 25 years (ie, into adulthood). However, additional cardiac surgeries are often necessary in adults with CHD, whose unique cardiovascular anatomy and physiology necessitate specialized management by experts in adult CHD (ACHD) during the perioperative period. ACHD is characterized by a combination of congenital cardiac lesions, intervention‐related anomalies that have developed over time, comorbidities caused by long‐standing CHD, and comorbidities related to various syndromes and lifestyle factors. The present educational review discusses the transition from pediatric to adult cardiac care, comorbidities that develop as a result of ACHD, the assessments necessary for patients with ACHD prior to both cardiac and noncardiac surgeries, and the key ACHD lesions relevant to perioperative management.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.v31.2
    DOI: 10.1111/pan.13982
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008564-3
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  • 10
    Online Resource
    Online Resource
    Anesthetic management for percutaneous reverse Potts shunt creation in children with refractory idiopathic pulmonary arterial hypertension: A case series
    Wiley ; 2021
    In:  Pediatric Anesthesia Vol. 31, No. 6 ( 2021-06), p. 644-649
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 31, No. 6 ( 2021-06), p. 644-649
    Abstract: Percutaneous reverse Potts shunt improves right ventricular function in patients with suprasystemic idiopathic pulmonary arterial hypertension. There are no data regarding the anesthesia in this high‐risk procedure. We report our experience of the anesthetic management for the creation of percutaneous reverse Potts shunt in children with suprasystemic idiopathic pulmonary arterial hypertension. This study included 10 patients presenting with symptomatic idiopathic pulmonary arterial hypertension despite undergoing medical treatment. All patients underwent gradual induction of anesthesia to maintain hemodynamic stability (etomidate, n  = 8; ketamine, n  = 4). Four patients needed extracorporeal life support: 2 were rescued after cardiac arrest and 2 had elective extracorporeal life support due to preprocedural dysfunctional right ventricle and/or small left ventricle volumes with reduced cardiac output. All patients were admitted to the pediatric cardiac intensive care unit (4 [2–5] days). All patients with extracorporeal life support died. None of the six survivors needed pulmonary transplantation. Both ketamine and etomidate support hemodynamics. High‐dose opioid technique has the advantage of blunting noxious stimuli and subsequent increase in pulmonary vascular resistance. We recommend using multimodal monitoring with transesophageal echocardiography. The 100% mortality of extracorporeal life support patients, probably too sick to undergo such procedure, may question its usefulness. Further studies should identify suitable candidates for percutaneous reverse Potts shunt creation.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.v31.6
    DOI: 10.1111/pan.14169
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008564-3
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