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  1. Article ; Online: Anaesthesia of a parturient with uncorrected pentalogy of Fallot undergoing caesarean section and postpartum sterilisation.

    Leong, Rachel Wei-Li / Chen, Jinghui / Mathews, Abey Matthew Varughese / Kothandan, Harikrishnan

    BMJ case reports

    2023  Volume 16, Issue 10

    Abstract: Pentalogy of Fallot is a rare congenital cyanotic heart disease; few patients with uncorrected disease survive to childbearing age. Cardiovascular changes during pregnancy and delivery can lead to haemodynamic instability, while anaesthesia can cause ... ...

    Abstract Pentalogy of Fallot is a rare congenital cyanotic heart disease; few patients with uncorrected disease survive to childbearing age. Cardiovascular changes during pregnancy and delivery can lead to haemodynamic instability, while anaesthesia can cause right-to-left shunting and worsen hypoxaemia.We present the learning points from the anaesthetic management of an obstetric patient with uncorrected pentalogy of Fallot. We describe the successful application of general anaesthesia, choice of transoesophageal echocardiography for real-time haemodynamic monitoring and management, and the comprehensive multidisciplinary care of this high cardiovascular risk obstetric patient perioperatively. We also review the literature and discuss the anaesthetic management of patients with pentalogy of Fallot going for caesarean section.
    MeSH term(s) Pregnancy ; Humans ; Female ; Cesarean Section ; Tetralogy of Fallot/complications ; Tetralogy of Fallot/surgery ; Heart Defects, Congenital ; Anesthetics ; Anesthesia, Obstetrical ; Postpartum Period
    Chemical Substances Anesthetics
    Language English
    Publishing date 2023-10-06
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2022-251598
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Anaesthetic management of a patient with complex, cyanotic congenitally corrected transposition of great arteries for electrophysiological study and thermoablation.

    Chen, Jinghui / Tan, Shi Hui / Chee, Sheryl Wei Lin / Kothandan, Harikrishnan

    BMJ case reports

    2022  Volume 15, Issue 4

    Abstract: Congenitally corrected transposition of great arteries (ccTGA) is a rare congenital heart disease, and little literature is available that describes its anaesthetic management. We present the perioperative management of a patient with complex, cyanotic ... ...

    Abstract Congenitally corrected transposition of great arteries (ccTGA) is a rare congenital heart disease, and little literature is available that describes its anaesthetic management. We present the perioperative management of a patient with complex, cyanotic ccTGA who underwent electrophysiological study with catheter ablation under general anaesthesia. Good understanding of the patient's complex cardiac anatomy and physiology and multidisciplinary communication are vital to facilitate the successful care of the patient.
    MeSH term(s) Anesthetics ; Arteries ; Congenitally Corrected Transposition of the Great Arteries ; Heart Defects, Congenital ; Humans ; Transposition of Great Vessels/complications ; Transposition of Great Vessels/surgery
    Chemical Substances Anesthetics
    Language English
    Publishing date 2022-04-15
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-247265
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  3. Article: Is hypotensive anaesthesia guided by invasive intraarterial monitoring required for orthognathic surgery? - A retrospective review of anaesthetic practice and intraoperative blood loss in orthognathic surgery in a tertiary hospital.

    Lee, Yi Lin / Thangavelautham, Suhitharan / Harikrishnan, Sudha / Karthekeyan, Ranjith / Kothandan, Harikrishnan

    Indian journal of anaesthesia

    2021  Volume 65, Issue 7, Page(s) 525–532

    Abstract: Background and aims: Orthognathic surgeries for maxillofacial deformities are commonly performed globally and are associated with significant blood loss. This can distort the surgical field and necessitate blood transfusion with its concomitant risks. ... ...

    Abstract Background and aims: Orthognathic surgeries for maxillofacial deformities are commonly performed globally and are associated with significant blood loss. This can distort the surgical field and necessitate blood transfusion with its concomitant risks. We aimed to review if invasive intraarterial (IA) line monitoring and/or hypotensive anaesthesia is required for orthognathic surgeries, and their effects on intraoperative blood loss and transfusion requirements.
    Methods: This was a retrospective observational study conducted in patients admitted for orthognathic surgeries in a public tertiary hospital. Anaesthetic techniques and intraoperative haemodynamics were studied for their effects on intraoperative blood loss.
    Results: The data from 269 patients who underwent orthognathic-bimaxillary surgeries was analysed. Inhalational anaesthetic combined with remifentanil was administered for 86.6%, total intravenous anesthesia to 11.2% patients, while the rest received inhalational anaesthesia. Hypotensive anaesthesia was achieved in 48 subjects (17.8%) and associated with shorter duration of surgery (349 vs 378 min,
    Conclusion: Invasive blood pressure monitoring is as effective as noninvasive methods to achieve hypotensive anaesthesia. It does not aid in achieving lower target blood pressure. There is a lack of association between a reduction in blood loss and higher blood transfusion during hypotensive anaesthesiaand thiswill require further evaluation.
    Language English
    Publishing date 2021-07-23
    Publishing country India
    Document type Journal Article
    ZDB-ID 412570-8
    ISSN 0019-5049
    ISSN 0019-5049
    DOI 10.4103/ija.IJA_201_21
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  4. Article ; Online: Anaesthetic management of a patient with Fontan physiology for electrophysiology study and catheter ablation.

    Lim, Denise Yan Yin / Suhitharan, Thangavelautham / Kothandan, Harikrishnan

    BMJ case reports

    2019  Volume 12, Issue 3

    Abstract: The success of the Fontan procedure for congenital single ventricle anatomy has resulted in adult patients with Fontan physiology requiring anaesthesia for cardiac and non-cardiac procedures. We present the perioperative management of a patient with ... ...

    Abstract The success of the Fontan procedure for congenital single ventricle anatomy has resulted in adult patients with Fontan physiology requiring anaesthesia for cardiac and non-cardiac procedures. We present the perioperative management of a patient with Fontan physiology who underwent electrophysiological study with radiofrequency ablation for atrial tachycardia under general anaesthesia. Good communication between the multidisciplinary teams, a detailed understanding of the patient's complex cardiac anatomy and physiology, as well as the ability to recognise and manage perioperative complications all play a vital role for a successful outcome.
    MeSH term(s) Adult ; Anesthesia, General/methods ; Anesthetics/administration & dosage ; Electrophysiology ; Fontan Procedure/methods ; Heart Atria/physiopathology ; Heart Atria/surgery ; Heart Defects, Congenital/surgery ; Humans ; Interdisciplinary Communication ; Male ; Perioperative Care/methods ; Radiofrequency Ablation ; Tachycardia/surgery ; Treatment Outcome
    Chemical Substances Anesthetics
    Language English
    Publishing date 2019-03-31
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2018-228520
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: In Response.

    Thiruvenkatarajan, Venkatesan / Wong, David T / Kothandan, Harikrishnan / Sekhar, Vimal / Adhikary, Sanjib Das / Currie, John / Van Wijk, Roelof

    Anesthesia and analgesia

    2021  Volume 132, Issue 3, Page(s) e43–e44

    MeSH term(s) Adult ; Airway Management ; COVID-19 ; Humans ; Operating Rooms ; SARS-CoV-2
    Language English
    Publishing date 2021-02-16
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000005338
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  6. Article: Anesthetic Implications for Cesarean Section in a Parturient with Complex Congenital Cyanotic Heart Disease.

    Lim, Huili / Yeoh, Chuen Jye / Tan, Jerry / Kothandan, Harikrishnan / Mok, May U S

    Case reports in anesthesiology

    2018  Volume 2018, Page(s) 2616390

    Abstract: The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving ... ...

    Abstract The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving peripartum morbidity and mortality. Designing the most appropriate anesthetic care will require a concerted effort, with inputs from the obstetricians, obstetric and cardiac anesthesiologists, cardiologists, neonatologists, and cardiothoracic surgeons. We report the multidisciplinary peripartum care and anesthetic management for cesarean section (CS) of a 28-year-old primigravida who has partially corrected transposition of the great arteries, atrial and ventricular septal defect, dextrocardia, right ventricle hypoplasia, and tricuspid atresia.
    Language English
    Publishing date 2018-03-29
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2659087-6
    ISSN 2090-6390 ; 2090-6382
    ISSN (online) 2090-6390
    ISSN 2090-6382
    DOI 10.1155/2018/2616390
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  7. Article ; Online: Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients: A Practical Review.

    Thiruvenkatarajan, Venkatesan / Wong, David T / Kothandan, Harikrishnan / Sekhar, Vimal / Adhikary, Sanjib Das / Currie, John / Van Wijk, Roelof M

    Anesthesia and analgesia

    2020  Volume 131, Issue 3, Page(s) 677–689

    Abstract: Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 ... ...

    Abstract Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.
    MeSH term(s) Adult ; Airway Extubation/methods ; Airway Extubation/standards ; Airway Management/methods ; Airway Management/standards ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Coronavirus Infections/therapy ; Humans ; Infection Control/methods ; Infection Control/standards ; Intubation, Intratracheal/methods ; Intubation, Intratracheal/standards ; Operating Rooms/methods ; Operating Rooms/standards ; Pandemics/prevention & control ; Personal Protective Equipment ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/therapy ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-06-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000005043
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  8. Article ; Online: Anaesthesia for goitre surgery

    Patrick Wong / Geoffrey Haw Chieh Liew / Harikrishnan Kothandan

    Proceedings of Singapore Healthcare, Vol

    A review

    2015  Volume 24

    Abstract: Goitres are relatively common and, in extreme cases, present unique challenges (particularly in airway management) for the anaesthetist. There are no specific guidelines from the Difficult Airway Society (United Kingdom) or the American Society of ... ...

    Abstract Goitres are relatively common and, in extreme cases, present unique challenges (particularly in airway management) for the anaesthetist. There are no specific guidelines from the Difficult Airway Society (United Kingdom) or the American Society of Anesthesiologists for the management of the obstructed airway. We therefore present the principles governing the provision of safe anaesthesia for goitre surgery including formulating a plan ABC for patients with a stable airway and for those presenting with acute airway obstruction.
    Keywords Medicine ; R
    Language English
    Publishing date 2015-09-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
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  9. Article: Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery.

    Liew, Geoffrey Haw Chieh / Yu, Esther Dawen / Shah, Shitalkumar Sharad / Kothandan, Harikrishnan

    Singapore medical journal

    2016  Volume 57, Issue 8, Page(s) 432–437

    Abstract: Introduction: The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.: Methods: 150 ... ...

    Abstract Introduction: The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.
    Methods: 150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety.
    Results: Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel.
    Conclusion: The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia, General ; Deglutition Disorders/complications ; Elective Surgical Procedures ; Equipment Design ; Female ; Humans ; Laryngeal Masks ; Male ; Middle Aged ; Oropharynx ; Pharyngitis ; Postoperative Period ; Pressure ; Respiration, Artificial ; Young Adult
    Language English
    Publishing date 2016-08
    Publishing country Singapore
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2016133
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  10. Article ; Online: Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients

    Thiruvenkatarajan, Venkatesan / Wong, David T. / Kothandan, Harikrishnan / Sekhar, Vimal / Adhikary, Sanjib Das / Currie, John / Van Wijk, Roelof M.

    Anesthesia & Analgesia

    A Practical Review

    2020  Volume 131, Issue 3, Page(s) 677–689

    Keywords Anesthesiology and Pain Medicine ; covid19
    Language English
    Publisher Ovid Technologies (Wolters Kluwer Health)
    Publishing country us
    Document type Article ; Online
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ane.0000000000005043
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