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Author(s): Upender Gowd [1]; Sukhminder Jit Singh Bajwa (corresponding author) [2]; Madhuri Kurdi [3]; Gaurav Sindwani [4] A call for anaesthesia from the gastrointestinal (GI) endoscopy suite always stirs up [...]

Objective: To compare intraoperative hemodynamic parameters, blood loss, renal function, and duration of surgery with and without temporary portocaval shunt (TPCS) in live donor liver transplantation (LT) recipients. Secondary objectives were postoperative early graft dysfunction, morbidity, mortality, total intensive care unit, and hospital stay. Background: Blood loss during recipient hepatectomy for LT remains a major concern. Routine use of TPCS during LT is not yet elucidated. Methods: This study is a single-center, open-label, randomized control trial. The sample size was calculated based on intraoperative blood loss. After exclusion, a total of 60 patients, 30 in each arm (TPCS vs no TPCS) were recruited in the trial. Results: The baseline recipient and donor characteristics were comparable between the groups. The median intraoperative blood loss (P = 0.004) and blood product transfusions (P < 0.05) were significantly less in the TPCS group. The TPCS group had significantly improved intraoperative hemodynamics in the anhepatic phase as compared with the no TPCS group (P < 0.0001), requiring significantly less vasopressor support. This led to significantly better renal function as evidenced by higher intraoperative urine output in the TPCS group (P = 0.002). Because of technical simplicity, the TPCS group had significantly fewer inferior vena cava injuries (3.3 vs 26.7%, P = 0.026) and substantially shorter hepatectomy time and total duration of surgery (529.4 ± 35.54 vs 606.83 ± 48.13 min, P < 0.0001). The time taken for normalization of lactate in the immediate postoperative period was significantly shorter in the TPCS group (median, 6 vs 13 h; P = 0.04). Although postoperative endotoxemia, major morbidity, 90-day mortality, total intensive care unit, and hospital stay were comparable between both groups, tolerance to enteral feed was earlier in the TPCS group. Conclusions: In live donor LT, TPCS is a simple and effective technique that provides superior intraoperative hemodynamics and reduces blood loss and duration of surgery. [ABSTRACT FROM AUTHOR]

Byline: Megha. Kohli, Neha. Garg, Gaurav. Sindwani, Deepak. Tempe, Viniyendra. Pamecha, Samba. Pasupuleti Background and Aims: Fluid administration during liver transplant (LT) surgery is controversial. Although adverse outcomes following positive [...]

Byline: Shankey. Garg, Gaurav. Sindwani, Neha. Garg, Mahesh. Arora, Viniyendra. Pamecha, Deepak. Tempe Background and Aims: Coagulation dynamics after donor hepatectomy are complex. Having complete knowledge of the actual changes [...]

Byline: Gaurav. Sindwani, Mahesh. Arora, Achal. Dhir, Viniyendra. Pamecha Sir, Liver transplantation is a definitive treatment for end-stage liver disease patients.[1] These patients can have cardiomyopathy, coronary artery disease, hepato-pulmonary [...]

Byline: Gaurav. Sindwani, Sandeep. Sahu, Aditi. Suri, Sanjoy. Sureka, Manu. Thomas Background and Aims: Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new [...]

Byline: Gaurav. Sindwani, Aditi. Suri, Sandeep. Sahu Sir, We thank the readers for their critical comments.[1],[2] In response to the first question, quadratus lumborum block (QLB) can be given in [...]

Byline: Gaurav. Sindwani, Aditi. Suri, Rafat. Shamim Sir, Upper gastrointestinal (GI) endoscopy is both a diagnostic and therapeutic procedure. Some of these procedures are usually done under deep sedation with [...]

Byline: Rafat. Shamim, Gaurav. Sindwani, Vansh. Priya, Aditi. Suri Sir, The endotracheal tube (ETT) stylet is commonly used in difficult airway management. Although its use can increase the success rate [...]

Introduction: The duration of perioperative antibiotic prophylaxis following live liver donor hepatectomy (LDH) is not known. Methods: This is a double‐blind equivalence trial. All consecutive LDH were randomized into: group A (three doses) and group B (nine doses) of perioperative antibiotics (piperacillin + tazobactam − 4.5 g intravenous) at fixed 8 hourly intervals. Primary end point was incidence of infective complications as per CDC (Centers for Disease Control and Prevention) criteria. Secondary end points were liver function tests, total leukocyte count, international normalized ratio, hospital stay, morbidity, and cost analysis. Results: One hundred and twenty‐six LDHs were enrolled. A total of 19.8% (n = 25) experienced postoperative complications, 11 (17.7%) in group A and 14 (21.9%) in group B (P =.561). Infective complications were seen in 11 donors (8.1%), five in group A and six in group B (P =.79). A total of 8.1% of donors required continuation/up‐gradation of antibiotics in group A and 9.4% in group B. Return to soft diet was delayed in group B (P =.039). Median hospital stay and cost were similar. Conclusion: Three doses of perioperative antibiotic are equally effective in preventing infective complications. [ABSTRACT FROM AUTHOR]

Byline: Aditi. Suri, Gaurav. Sindwani, Sandeep. Sahu, Sanjoy. Sureka Sir, Quadratus lumborum block (QLB) is a type of abdominal wall block which has shown promising results in managing the post-operative [...]

Byline: Gaurav. Sindwani, Aditi. Suri, Ruchi. Verma Sir, A 52-year-old post-menopausal female belonging to American Society of Anesthesiologists Physical Status Class 1, weighing 50 kg, diagnosed with renal cell carcinoma, [...]