Browsing by Author "Kapoor, Mukul Chandra"

Now showing 1 - 9 of 9
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    Cardiopulmonary bypass in pregnancy.
    (2014-01) Kapoor, Mukul Chandra
    Cardiac surgery carried out on cardiopulmonary bypass (CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non‑pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero‑placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre‑operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.
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    A comparative study of release of interleukin-6 and tumour necrosis factor during normothermic and hypothermic cardiopulmonary bypass.
    (2002-01-25) Naresh, Sandur Narasimhamurthy; Kapoor, Mukul Chandra; Ramchandran, Trichur Ramaswamy; Kale, Shailaja C
    The institution of cardiopulmonary bypass generates many pro-inflammatory cytokines and several clinical variables, including temperature, have been shown to influence cytokine release during and after cardiopulmonary bypass. The release of tumour necrosis factor and interleukin-6 are the best predictors of post-cardiopulmonary bypass related morbidity. Their release during normothermic and hypothermic cardiopulmonary bypass and the correlation with clinical parameters of organ injury was studied. This prospective study was carried out in 52 adult patients, scheduled for cardiac surgery, exposed to normothermic and 27 to hypothermic cardiopulmonary bypass. Samples for estimation of tumour necrosis factor and interleukin-6 were collected preoperatively, 1 hour and 24 hours post cardiopulmonary bypass and analysed by ELISA. Haemodynamic parameters and respiratory parameters were noted and lung injury scores calculated. Interleukin-6 levels were raised in both the groups at 1 hour and 24 hours post cardiopulmonary bypass and the response was higher in the normothermic group. Tumour necrosis factor response was, however, similar in both the groups, with a rise at 1 hour returning back to baseline by 24 hours post cardiopulmonary bypass. The normothermic group had a better respiratory index in the postoperative period, early extubation was possible, had better clinical haemodynamics, a shorter cardiopulmonary bypass time and had reduced requirement of defibrillation after the release of aortic cross clamp. We conclude that the release of interleukin-6 was thermo-dependant but did not correlate with the clinical signs of organ injury. Tumour necrosis factor levels were significantly raised after the cardiopulmonary bypass but the rise was not thermo-dependant.
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    Inflammatory Response to Cardiac Surgery and Strategies to Overcome it.
    (2004-07-11) Kapoor, Mukul Chandra; Ramachandran, T R
    A general activation of the immune system is observed during any operative procedure as a physiological response to the surgical trauma. Cardiopulmonary bypass may directly activate the inflammatory response by three distinct mechanisms: direct 'contact activation' of the immune system following exposure of blood to the foreign surfaces, ischaemia-reperfusion injury to vital organs and systemic endotoxaemia resulting from gut translocation of endotoxin. The inflammatory response depends upon recruitment and activation of inflammatory cells. The cellular immune response, in particular polymorphonuclear cell-endothelial adhesion, leads to widespread endothelial damage and dysfunction. Increased oxygen derived free radical activity represents a risk for myocardial and pulmonary complications. The clinical consequences of the stress response vary from a mild generalised transient response, termed the 'systemic inflammatory response syndrome,' to life threatening organ dysfunction. The introduction of the 'off-pump' coronary artery bypass graft surgery has now made it possible to differentiate the influence of cardiopulmonary bypass and surgical access on different modalities of the immune response. 'Off-pump' cardiac surgery has been found to trigger inflammatory response, lesser than 'on-pump' cardiac surgery. Researches are directed towards understanding this complex interplay of humoral and cellular mediators and develop strategies to limit the resultant organ dysfunction. Current literature on the various mediators of this inflammatory response, the role of surgical stress, the pathogenesis of the organ damage and strategies to limit / overcome this response are reviewed.
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    Invited Commentary.
    (2013-04) Kapoor, Mukul Chandra
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    Percutaneous transvenous mitral commissurotomy - a life saving option in severe mitral stenosis with cardiogenic shock.
    (2004-07-11) Kapoor, Mukul Chandra; Dugal, Jaskaran Singh; Sharma, Suveer; Singh, Sujan
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    Phenylephrine in cardiac surgery: Will it have a place.
    (2014-07) Kapoor, Mukul Chandra
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    A randomized double-blind study to evaluate asurgeon-based technique to reduce post-operative pain in minimal gynecological surgery
    (Medip Academy, 2023-06) Mustafa, Asif; Khemani, Manju; Verma, Deepika; Kapoor, Mukul Chandra; Makhija, Bela; Bhandari, Ruchi
    Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale.Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I & II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group.Results: Mean pain scores were significantly lower (p<0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group.Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery.
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    Stellate ganglion block in cardiac surgery.
    (2013-10) Kapoor, Mukul Chandra; Khanna, Gautam
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    Surgical retrieval of embolised atrial septal occluder device from pulmonary artery: pathophysiology and role of the intraoperative transoesophageal echocardiography.
    (2009-01-13) Gadhinglajkar, Shrinivas; Unnikrishnan, K P; Sreedhar, Rupa; Kapoor, Mukul Chandra; Neema, Praveen Kumar
    Atrial septal defect is usually closed in the cardiac catheterisation laboratory using atrial septal occluder (ASO) device. One of the complications associated with the procedure is embolisation of the device into the pulmonary artery. We are reporting two cases wherein the pulmonary embolisation of ASO device occurred during the procedure in one patient and in the early post-procedure period in another; both were retrieved surgically. We are also describing the haemodynamic consequences of this complication and the role of intraoperative transoesophageal echocardiography during surgical retrieval of the device.