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Naveen Aggarwal
Anesthesiologist by profession . Nothing is more important than SAFE SURGERY SAFE ANESTHESIA AND SAFE PATIENT .
Location Dubai
Activity
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PLEASE CHECK THE INDUCTION DOSE OF KETAMINE
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Naveen Aggarwal made a comment
Agreed
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Naveen Aggarwal made a comment
1) Dexmedetomidine
2) Ketamine
3) Magnesium
4) Gabapentin -
Naveen Aggarwal made a comment
Can it be used in preoperative room in place of other anxiolyis like midazolam
How it prevents postop shivering and nausea ? Can it replace iv pethidine for shivering ? -
Naveen Aggarwal made a comment
Agreed but the benefits are more when prescriber have detailed and thorough knowledge of all the drugs or it might complicate the care
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All of the above indicators are not cumbersome to use ? If gere are so many variables affacting BIS , then the relisbility must be very poor
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Naveen Aggarwal made a comment
DOA is not cost effective in minor or moderate surgeries esp in developing world .
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Naveen Aggarwal made a comment
dexmedetomitidine
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Naveen Aggarwal made a comment
perfect
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Naveen Aggarwal made a comment
A nice combination of remifentnayl and propofol is enough for any surgery with provision of good postop analgesia
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Naveen Aggarwal made a comment
I like the concept of priming of intravenous line with propofol.
But i usually start combined tci of both remifentanyl and propofol- 2`3 mcg and ng / ml .The mentioned 1 mcg/ml is yvery less and time consuming in busy setup esp when surgeon is on your head -
Naveen Aggarwal made a comment
the
monitoring during TIVA is very important ethically as well as medico-legally -
Naveen Aggarwal made a comment
Its diificult to understand
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Naveen Aggarwal made a comment
Still not clear about KEO- If keo is small means long or delay in drugs effect ? SHOULD NOT BE OPPOSITE ?
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Naveen Aggarwal made a comment
Why there is no relationship betweem V2 , V3 To effect site . There is a equilibrium grdient between them and C1 too
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Naveen Aggarwal made a comment
Though i am using TIVA for long time but i didnt know the so amny advantages of using Propofol in cancer patients and thansk for that .
The only problrm is unavailabilty of other drugs like remifentanyl thats require with propofol for induction and also for maintenence . -
Naveen Aggarwal made a comment
There is no problem when it coes to envirnment hazard with inhalational as there will be scavenging system and also provision of low flow anestheisa if you are using advanced inhalationls
I believe most of the good and safe anesthetits are always ready to embrace the changes if somehing is good for the patients .
i dont see much advantegs with TIVA except... -
Naveen Aggarwal made a comment
I am a big fan of TCI and TIVA but its not practising even in developed coutires coz-
1) Lack of TCI pumps and even drugs
2) Cost factors now in present time when there is lots of competition and everyone wants less medicine and less effort
3) Extra effort and expense on additional monitoring and fear of medicolegal issues if not using that monitors in the... -
Naveen Aggarwal made a comment
Most of the factors mentioned here are just superficial for the problem.
Main factor - in busy theatre , everyone wants the time tested technique thats can result in smooth OT funtioning without much increase in OT time and also less crowded in OT -
Naveen Aggarwal made a comment
exactly
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I dont agree with the poll . There is not a problem with the knowledge and experience nowadays when we have social media and knowledge around and this is problem only in very poor countries .
The only thing is lack of equipments and extra efforts required for thi -
Naveen Aggarwal made a comment
Good but I have never seen anyone making headup of 45 degree for ECG .Pt should be supine not headup .
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Good
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Naveen Aggarwal made a comment
Ketopropofol , esmeron and Fentanyl
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Icu only
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Naveen Aggarwal made a comment
Good
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Absolutely agreed .Just curious to know about your IVF protocol in sepsis pts with hypotension (MAP less than 60 )
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Very important point in Covid pts
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Naveen Aggarwal made a comment
I will do the same as mentioned
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Naveen Aggarwal made a comment
Sepsis 6 is a life saving measure
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Naveen Aggarwal made a comment
Difficult to understand the implications of new definitions right now as I’m from the old school of medicine and time will tell how practical is this new definition and score
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Naveen Aggarwal replied to Syed Ali Abbas Rahat
That’s called bacteremia or viremia
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Naveen Aggarwal made a comment
My most fav topic but the difficult one
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Naveen Aggarwal made a comment
Absolutely amazing learning experience
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Naveen Aggarwal made a comment
Good case
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Naveen Aggarwal made a comment
What’s the level of acidosis when pt needs RRT ? Can it be used for hyper apnea induced acidosis ( like in Covid pts nowadays )
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Naveen Aggarwal made a comment
Great learning .Have seen RRT in my ICU but never thought about the mechanisms .
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Naveen Aggarwal made a comment
Good .But ahem to start .
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Naveen Aggarwal made a comment
In ICU , if pt is on ventilator and there is increases in metabolic acidosis and rise in creatinine , RRT is the indication
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Naveen Aggarwal made a comment
Nowadays have seen many Centre’s giving albumin too inntrauma pts
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Naveen Aggarwal made a comment
The main goal is also maintaining MAP more than 65 to maintain adequate renal perfusion
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1) quick CT scan is nearly impossible or risky in such cases 2) Avoid vasopressors and crystalloids as they exaggerate more acidosis
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Naveen Aggarwal made a comment
We are managing the trauma pts like you mentioned but we don’t follow strict 1.1.1. Policy for BT but we generally give 1 FFP after 3-4 pint of PRBC .Rest same . Some cases we follow hypervolemic hemodilution Keeping in mind about coagulopathy
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Problem in developing countries ~
1) There is no warmer or blanket or Baer hugger to warm the patients
2) No source to warm the fluids .Fluids come directly from coLd storage or oT temperature
3) No emergency protocols
4) Less concern to prevent lethal triad @ ~~ they only concern for intubation, fluid resuscitation and emergency surgeries
4) No blood... -
Lethal Triad is an important factor to be taken care of in all trauma patients to improve the chances of survival and reduce long term morbidity
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Naveen Aggarwal made a comment
Perfect
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Naveen Aggarwal made a comment
If blood is available and no occult bleeding , blood transfusion is the best otherwise isotonic crystalloids like NS and ringer lactate
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Naveen Aggarwal made a comment
A good team leader and a proper delegation of tasks is the most important part of success of any emergency
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Naveen Aggarwal made a comment
Very well explained and good learning points . What about sedation if Pt is agitated and ketamine could worsen the situation
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Naveen Aggarwal made a comment
Thanks
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Naveen Aggarwal made a comment
Thanks
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Naveen Aggarwal made a comment
Important subject
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Naveen Aggarwal made a comment
Looking forward to it
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Naveen Aggarwal made a comment
Good learning esp HFNO and ECMO part .
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Naveen Aggarwal made a comment
Good explanation
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In COVID cases , ventilator settings is very critical and better to switch to ECMO rather than increasing PEEP beyond 18
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Absolutely the same treatment by us .
Main thing is avoidance of further lung injury and Spo2 between 90-94% will be good too .
Little head up (if possible ).
Maintain vitals -
Naveen Aggarwal made a comment
Definitely this is the time to think of fast and safe action .Pt is deteriorating and the best option is deloading of his respiratory system . Pt should be in ICU and planned for mechanical ventilation till respiratory parameters and biochemistries are in a good range
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Naveen Aggarwal replied to Ghadi albyali
Ice?
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What’s AIRVO ?
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Naveen Aggarwal made a comment
I have never used HFNO .I am just curious to know if it’s better than NIV ?
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Naveen Aggarwal made a comment
HFNO therapy is not available everywhere .What to do then ?
NRFacemask with reservoir bag or CPAP mask ?
I’ll prefer intubation if there is no HFNO -
Naveen Aggarwal made a comment
Need to manage in HDU with NIV and be ready for early intubation if condition deteriorates
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Naveen Aggarwal made a comment
Good learning
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Naveen Aggarwal made a comment
?Aspiration Pneumonia
?Covid-19 given the current climate
?Sepsis
?exacerbation of underlying lung pathology ?COPD ?bronchiectasis
Decompensated cardiac failure
As anesthetist and intensivist, i would prefer to keep this patient in ICU with close monitoring (if bed available ) and in isolatio(till we get the negative report for corona or CT lung shows... -
Naveen Aggarwal made a comment
Same in my hospital as in video .
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Naveen Aggarwal made a comment
HDU admission criterias are different in different institutions . Like in my hospital, labour analgesia or postop epidural analegesia to pts are not admitted in HDU ,but can be managed in the ward if there is no contraindication.
For us , HDU--
1)Those pts who requires more care than in the ward but less than ICU
2) Single organ support
3) Postoperative... -
Absolutely same in my Faciilty .
We believe in MDT as it increases the confidence in treating any patient, build relationship and improve quality of any ICU -
@MaxwellTwum-Boateng Anesthetists are the one who were managing ICU till few years ago and then intensivits came into view. Anesthetits are the one who are trained and best in all the medical fields and working with MDT , are the best for ICU care
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Highly specialised area in any healthcare facility that requires dedicated doctors and staff and vigilant monitoring of patient's vitals ( Conscious/ unconscious, ventilated/ non-ventilated ,etc). Could be of different types and requires specialized skiils for all of these diiferent types of critical care unit--medical unit/ surgical/ neuro/ etc . A well...
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Naveen Aggarwal made a comment
I am Consultant Anesthetist in India and a constant learner
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Don’t understand binary system .
One one preventive aspect has been mentioned and I think that can be done by other measures and really don’t understand the value of AI in prevention and cure . -
Lots of things can be done -
1) Physician vitals and patient’s satisfaction sick physician gives less care to patients
2) Preopn patients comorbid conditions and postoperative outcome
3) Patients lifestyle over few years and tendency for dementia
4) Measurement of unnoticed stress level during the whole day
5) Warning of unnoticed anxiety and... -
Do we have control over the information like cortex in our brain?
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Have to learn
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Naveen Aggarwal made a comment
I am Anesthesiologist and as OT is getting advanced , i want to learn how AI can help us in this highly risky and challenging area of healthcare facility and improve the quality .
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Naveen Aggarwal made a comment
Actually the discussion is beyond my level and difficult to understand . I am Anesthetist and using so many monitors with alarms and other electronic devices everywhere for the safety of patients but i dont know if we will call it AI as its just a preprogrammed data and it cant take any decision or advice .
Waiting for the day when-
1) AI will tell if... -
Naveen Aggarwal made a comment
I’m Medicos and these terms are difficult to understand and analyzed but trying and hoping to understand as the time passes
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Naveen Aggarwal made a comment
I think everything has been changed in the last few months coz of COVID. My perspective last year was totally different what i have now. I was expecting AI in healthcare few years in future but it seems that now its in HORIZON and will be there in healthcare especially soon. No healthcare will survive without telemedicine , teleconsultation and telediagnosis...
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Naveen Aggarwal made a comment
We have digitisation of patients records for the last 4 years and we are working nearly paperless.
But everything will change due to covid and its the high time to embed AI in all the areas of Medicine , like Teleconsultation, teleprescription , teleconference and so on .
Its going to be AI driven world soon. -
Naveen Aggarwal made a comment
Looking forwardd to it
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Naveen Aggarwal made a comment
I am novice in this field but as per my understanding , AI is to help all of us and we cant depend on it totally . Like in operation theatre , it can creates alarm if something go outside the normal limits and thus help all of us. But i am doubtful if it can take safe decisions too depending on the data available .
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Naveen Aggarwal made a comment
I need to learn how AI could be useful in anesthesia and operation theatre and how could it increase the patients satisfaction .This AI area is totally RAW for me .
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Naveen Aggarwal made a comment
I am Anesthesiologist and i want to learn about usage of AI in healthcare . I have no experience in this field . I believe that the world is going to change completely and AI will play a major role in healthcare but how ? I have to learn from here
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I am workholic and attention seeker but now on unpaid leaves as hospitals dont need anesthetists now for COVID .Its a very stressful time siting at done and its a mental deprivation of well being .
I have involved in -
1) Household activities
2) Siiting alone sometimes in the balcony
3) Reading Anesthesia amd hospital management resources
4) Photography... -
I am in UAE and Gov is doing excellent job and taking care of all the precautions and safety .
Everything is same like all other countries are following -
Lockdown
isolation
Public education ( online ) -hand hygiene , etc
Treatment of covid pts in hospitals
Utmost care of everyone -residents or expats -
Naveen Aggarwal made a comment
Looking forward to learn more
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@UshaDevkota Conditions are totally diffrent as i expected . Wealhier countires have spent less on basic needs of healthcare and they r the who r suffering most with maximum death in USA
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Naveen Aggarwal made a comment
1)Virtual consultation if possible
2) Proper hand washing and yse of PPE ( nOT WASTAGE )
3) Social Distance
4) Hydrated
5) Meditation
6) Time with relatives( virtual) and family
7) Positive talk amd many more -
Naveen Aggarwal made a comment
1) Appropriate use of PPE -no cant use PPE for everything -conserve PPE TOO
2) Hand hygiene is very important
3) If you are sick yourself, dont care for any patient in the hospital till u r ok
4) Practice tele consultation if possible-this is going to be a routine soon in the future -
What about diferent types of waste ? Infected or non infected ?
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Naveen Aggarwal made a comment
Room should have negative pressure too to contain the infection in the isolation room only.
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Naveen Aggarwal made a comment
PPE is the most important part in healthcare settings , not only for staff protection but also protection to society
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Naveen Aggarwal made a comment
Effective demonstartion
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Naveen Aggarwal made a comment
gOOD SUBJECT
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This is following everywhere now and its a safe practice. I belive that this practice should cultivate in our medical specialties after this COVID CRISIS get over
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Naveen Aggarwal made a comment
Great written-up. I have a doubt-if we have to see any patient in OPD for any Semielective surgery in few days and the hospital is full of admitted COVID patients , what should we do ? The pt for surgery is asymptomatic and sure no COIVD tests will be there .
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Naveen Aggarwal made a comment
We are using video consultation first time and i believe this is going to be a game changer after this covid crisis is over . It will be good for those patients who just want to come for follow up and for their chronic medications . This things can be discussed on video conferencing and prescriptions can be send online . This will save a lot of time , lwill...
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Naveen Aggarwal made a comment
Remote consultation might cause more errors than help
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Naveen Aggarwal made a comment
Thanks
