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A Study to Observe Pulse Pressure Variation after Induction with Propofol for General Anesthesia

World Journal of Cardiovascular Diseases 2024年第5期14卷 343-350页

作者： kunal tewari Vibhu Raghuvanshi Deepak Mishra Nitin Pahuja Maj Jyotsna Om Bahadur Thapa Department of Anaesthesiology and Critical Care Armed Forces Medical College Pune India Chauhan Medicity and Trauma Centre Pathankot India Department of Anaesthesiology and Critical Care Command Hospital (Southern Command) Pune India

Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotensi

关键词： Pulse Pressure Variation (PPV) Propofol Fluid Responsiveness

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A Comparative Study between Landmark Based and Real Time Ultrasound Guided Sub Arachnoid Block

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Open Journal of Anesthesiology 2024年第4期14卷 118-125页

作者： kunal tewari Om Bahadur Thapa Deepak Mishra Manjot Multani Jyotsna Sharma Akash Ray Mohapatra Sandhya Khwaunju Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care AFMC Pune India

Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.

关键词： Sub Arachnoid Block (SAB) Real Time Ultrasound (RUS)

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Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of Anesthesiology 2024年第3期14卷 41-50页

作者： kunal tewari Sumanth Pelluru Deepak Mishra Nitin Pahuja Akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema Pleural effusion Lung ultrasound (LUS) Pneumothorax

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EPQ model with the effect of inflation and reliability for partial trade credit under fuzzy and cloudy fuzzy environment

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Journal of Management Analytics 2024年第1期11卷 110-134页

作者： Supriya Tiwari kunal Shah Kajal Bhimani Department of Science and Humanities Apollo Institute of Engineering&TechnologyGTUAhmedabadIndia Department of Mathematics SMMPISRKadi Sarva VishwavidyalayaGandhinagarIndia AVAerials 401 Swarnim Business Hub-1 New Chamunda SocietyGodrej Garden CityGotaAhmedabadIndia

The proposed study offers the first-of-its-kind economic production quantity model for deteriorating items having a demand rate to be price dependent under the effect of inflation and reliability with partial trade *** model is extended under an uncertain environment by assuming inventory parameters to be triangular fuzzy numbers and cloudy triangular fuzzy *** objective of the study is to maximize the profit of the inventory system and to identify the most suitable environment for the proposed *** are verified using the numerical ***,the comparative study is presented to justify the nature of fuzzy and cloudy fuzzy *** analysis under all environments is conducted to identify the most sensitive parameters of all.

关键词： EPQ partial trade credit inflation reliability triangular fuzzy number cloudy triangular fuzzy number

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A hybrid machine learning approach based study of production forecasting and factors influencing the multiphase flow through surface chokes

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Petroleum 2024年第2期10卷 354-371页

作者： Waquar Kaleem Saurabh tewari Mrigya Fogat Dmitriy A.Martyushev Department of Industrial and Manufacturing Engineering The Pennsylvania State University Department of Data Sciences Gyan Ganga Institute of Technology and Sciences Department of Petroleum and Geo-Engineering Rajiv Gandhi Institute of Petroleum Technology Jais Department of Oil and Gas Technologies Perm National Research Polytechnic University

Surface chokes are widely utilized equipment installed on wellheads to control hydrocarbon flow *** correlations have been suggested to model the multiphase flow of oil and gas via surface ***, substantial errors have been reported in empirical fitting models and correlations to estimate hydrocarbon flow because of the reservoir's heterogeneity, anisotropism, variance in reservoir fluid characteristics at diverse subsurface depths, which introduces complexity in production data. Therefore,the estimation of daily oil and gas production rates is still challenging for the petroleum ***, hybrid data-driven techniques have been reported to be effective for estimation problems in various aspects of the petroleum domain. This paper investigates hybrid ensemble data-driven approaches to forecast multiphase flow rates through the surface choke(viz. stacked generalization and voting architectures), followed by an assessment of the impact of input production control ***, machine learning models are also trained and tested individually on the production data of hydrocarbon wells located in North Sea. Feature engineering has been properly applied to select the most suitable contributing control variables for daily production rate forecasting. This study provides a chronological explanation of the data analytics required for the interpretation of production data. The test results reveal the estimation performance of the stacked generalization architecture has outperformed other significant paradigms considered for production forecasting.

关键词： Machine learning Tree-based methods Stacking ensemble Multiphase flow Data analytics Wellhead choke variables

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Intraoperative Auditory Evoked Potential Monitoring for Anaesthesia Depth and Utilization of Inhaled Isoflurane

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Open Journal of Anesthesiology 2017年第4期7卷 109-119页

作者： kunal tewari T. V. S. P. Murthy Department of Anaesthesia INHS Asvini Mumbai India Department of Anaesthesia Army Hospital (Referral and Research) New Delhi India

Background: Hypnosis monitoring has been shown to reduce the incidence of awareness. A-line ARX-IndexTM (AAI) derived from auditory evoked potentials (AEP) represents as a numerical variable depth of anaesthesia. Objectives: To study the efficacy of AEP as an indicator of anaesthetic depth and monitor intraoperative awareness in neurosurgical patients by using the AAI scale. Design: Prospective cohort study is used. Setting: The study is in Neurosurgical centre of Tertiary care hospital. Participants: Neurosurgical patients requiring general anaesthesia with duration of surgery between 90 - 150 minutes were enrolled for the study. Intervention: Patients in Group 1 (control) were monitored by conventional methods. Patients in Group 2 (study) underwent intraoperative monitoring by using the AEP monitor. Primary outcome: To study the efficacy of AEP monitoring and AAI index for monitoring the depth of anaesthesia and reducing the incidence of awareness. Results: There was no significant difference in the intraoperative haemodynamic responses measured between the two study groups (p > 0.5). There was no significant difference in the identification of intraoperative awareness by using conventional parameters between the two groups (p > 0.5). There was also a significantly faster time to recovery for patients in Group 2 (p < 0.05). Conclusion: Hypnosis monitoring using AEP monitor/AAI in neurosurgical patients under general anaesthesia did not show any significant difference in haemodynamic response and intraoperative awareness but had significant lower consumption of volatile anaesthetic with cost sparing effect and a faster recovery time as compared to conventional monitoring.

关键词： A-Line ARX-Index Anaesthesia Depth Auditory Evoked Potential Intraoperative Awareness Post-Traumatic Stress Disorder

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Liquid injectivity in a SAG foam process:Effect of permeability

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Petroleum Science 2024年第1期21卷 302-314页

作者： Jia-Kun Gong Yuan Wang Ridhwan-Zhafri B.Kamarul Bahrim Raj-Deo tewari Mohammad-Iqbal Mahamad Amir Rouhi Farajzadeh William Rossen College of Mechanics and Materials Hohai UniversityNanjing210098JiangsuChina College of Water Conservancy&Hydropower Engineering Hohai UniversityNanjing210098JiangsuChina PETRONAS Kuala Lumpur50088Malaysia Department of Geoscience and Engineering Delft University of Technology2628 CNDelftthe Netherlands Shell Global Solutions International B.V. 1031 HWAmsterdamthe Netherlands

Foam is utilized in enhanced oil recovery and CO_(2) ***-alternating-gas(SAG)is a preferred approach for placing foam into reservoirs,due to it enhances gas injection and minimizes corrosion in *** previous studies with similar permeability cores show that during SAG injection,several banks occupy the area near the well where fluid exhibits distinct ***,underground reservoirs are heterogeneous,often *** is crucial to understand the effect of permeability on fluid behaviour and injectivity in a SAG *** this work,coreflood experiments are conducted in cores with permeabilities ranging from 16 to 2300 *** observe the same sequence of banks in cores with different ***,the speed at which banks propagate and their overall mobility can vary depending on *** higher permeabilities,the gas-dissolution bank and the forced-imbibition bank progress more rapidly during liquid *** total mobilities of both banks decrease with *** utilizing a bank-propagation model,we scale up our experimental findings and compare them to results obtained using the Peaceman *** findings reveal that the liquid injectivity in a SAG foam process is misestimated by conventional simulators based on the Peaceman *** lower the formation permeability,the greater the error.

关键词： Foam Enhanced oil recovery Surfactant-alternating-gas Injectivity Permeability

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Hepatic vein reconstruction during hepatectomy:A feasible and underused technique

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 421-427页

作者： Manish Ahuja kunal Joshi Chris Coldham Paulo Muiesan Bobby Dasari Manuel Abradelo Ravi Marudanayagam Darius Mirza John Isaac David Bartlett Nikolaos A Chatzizacharias Robert P Sutcliffe Keith J Roberts Department of HPB and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Immunology and Immunotherapy University of BirminghamBirminghamUK

Complete surgical resection(R0)of liver tumors,primary or metastatic,remains the main objective in management of primary and metastatic liver tumors[1].Tumors invading to the proximity of the hepatic venous outflow pose a peculiar challenge to achieve R0 resections,because this location may render a tumor *** median survival of patients with liver tumor without surgery is less than 12 months[2].Even with surgery,post-hepatectomy liver failure and subsequently increased mortality are the main problems associated with complex resection[3].Moreover,when the vein is affected,vein resection and subsequent reconstruction are *** resection is a standard practice in liver resection and transplantation[4],for example,hepatic vein reconstruction during a living-donor liver transplant,porto-mesenteric axis reconstruction during resection of advanced pancreatic cancer and caval reconstruction during resection of retroperitoneal ***,novel techniques like total hepatic vascular exclusion(HVE)[5],veno-venous bypass[6]and ex vivo hepatic resection[7,8]have facilitated curative resections of tumors close to one or more major hepatic veins.

关键词： hepatectomy surgery mortality

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Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

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World Journal of Radiology 2024年第2期16卷 32-39页

作者： Binit Katuwal Amy Thorsen kunal Kochar Ryba Bhullar Ray King Ernesto Raul Drelichman Vijay K Mittal Jasneet Singh Bhullar Department of Surgery Ascension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States Department of Colon and Rectal surgery Alina Health Abbott Northwestern HospitalMinneapolisMN 55407United States Colon and Rectal Surgery Advocate Illinois MasonicPark RidgeIL 60068United States Volunteer Student Department of ResearchAscension Providence HospitalSouthfieldMI 48075United States Colon and Rectal Surgery University of WisconsinMadisonWI 53715United States General and Colorectal Surgery Ascension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States Department of Surgery Department of Medical EducationAscension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States

BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of *** modalities of treatment exist for *** nerve stimulation is a well-established treatment for *** the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI *** MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely *** To evaluate the efficacy,outcomes and complications of the MRI-compatible *** Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and *** demographics,clinical features,surgical techniques,complications,and outcomes were *** the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were *** Seventy-three patients had the InterStim *** mean age was 63.29±12.2 ***-seven(78.1%)patients were females and forty-two(57.5%)patients had *** addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant ***-two(43.8%)patients underwent rechargeable InterStim ***(4.1%)patients needed removal of the *** of the external lead connection was observed in 7(9.6%)patients after the stage I *** explanation for one patient was due to ***(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and *** mean follow-up was 6.62±3.5 ***-eight(93.2%)patients reported significant improvement of symptoms on

关键词： Fecal incontinence Sacral nerve stimulation InterStim Magnetic resonance imaging Sacral neuromodulation

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Spectral indices measured with proximal sensing using canopy reflectance sensor,chlorophyll meter and leaf color chart for in-season grain yield prediction of basmati rice

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Pedosphere 2022年第6期32卷 812-822页

作者： VARINDERPAL-SINGH kunal MEHTAB-SINGH BIJAY-SINGH Department of Soil Science Punjab Agricultural UniversityLudhiana 141004(India) Shree Guru Gobind Singh Tricentenary(SGT)University Chandu-Budhera RoadGurugramHaryana 122505(India) College of Agriculture Punjab Agricultural UniversityLudhiana 141004(India)

A number of optical sensing tools are now available and can potentially be used for refining need-based fertilizer nitrogen(N)topdressing *** for estimating field-specific fertilizer N needs are based on predictions of yield made while the crops are still growing in the *** present study was conducted to establish and validate yield prediction models using spectral indices measured with proximal sensing using GreenSeeker canopy reflectance sensor,soil and plant analyzer development(SPAD)chlorophyll meter,and two different types of leaf color charts(LCCs)for five basmati rice genotypes across different growth *** analysis was performed using normalized difference vegetation index(NDVI)recorded with GreenSeeker sensor and leaf greenness indices measured with SPAD meter and LCCs developed by Punjab Agricultural University,Ludhiana(India)(PAU-LCC)and the International Rice Research Institute,Philippines(IRRI-LCC).The exponential relationship between NDVI and grain yield exhibited the highest coefficient of determination(R^(2))and minimum normalized root mean square error(NRMSE)at panicle initiation stage and explained 38.3%–76.4%variation in yield using genotype-specific *** indices pooled for different genotypes were closely related to grain yield at all growth stages and explained53.4%–57.2%variation in grain *** different spectral indices with cumulative growing degree days(CGDD)decreased the accuracy of yield *** with days after transplanting(DAT),however,did not reduce or improve the predictability of *** ability of each model to predict grain yield was validated with an independent dataset collected from two experiments conducted at different sites with a range of fertilizer N *** NDVI-based genotype-specific models exhibited a robust linear correlation(R^(2)=0.77,NRMSE=7.37%,n=180)between observed and predicted grain yields only at 35 DAT(i.e.,panicle initiation stage)

关键词： GreenSeeker canopy reflectance sensor IRRI-LCC need-based nutrient management nitrogen optical sensing tools PAU-LCC SPAD meter

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