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Kamaladevi RK, Mishra SK, Rudingwa P, Mohapatra DP, Badhe AS, Senthilnathan M. Comparison of preformed microcuff and preformed uncuffed endotracheal tubes in pediatric cleft palate surgery-A randomized controlled trial. Paediatr Anaesth 2024; 34:340-346. [PMID: 38189558 DOI: 10.1111/pan.14837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND AIMS Airway management in children with oral cleft surgery carries unique challenges, concerning the proximity of the surgical site and the tracheal tube. We hypothesized that using a Microcuff oral RAE tube would reduce tube exchange and migration rate. We aimed to compare the performance of Microsoft and uncuffed oral performed tracheal tubes in children undergoing cleft palate surgeries regarding the rate of tracheal tube exchange, endobronchial intubation, and ventilatory parameters. METHODS One hundred children scheduled for cleft palate surgery were randomized into two groups. In the uncuffed group (n = 50), the tracheal tube was selected using the Modified Coles formula, and in the Microcuff (n = 50) group, the manufacturer's recommendations were followed. Intraoperatively, we compared the primary outcome of tube exchange using the chi-square test. The leak pressure and ventilatory parameters after head extension and mouth gag application were measured in both groups. RESULTS The tracheal tube exchange rate was significantly lower in the Microcuff group (0/50) than in uncuffed (19/50) preformed tubes (0 vs. 38% respectively; p <.001). The uncuffed and Microcuff tracheal tube were comparable concerning ventilation parameters and leak pressure of finally placed tubes (17.78 ± 3.95 vs. 19.26 ± 3.81 cm H2 O respectively, with a mean difference (95% CI) of -1.48 (-0.01-2.98); p-value =0.059. Cuff pressure did not vary significantly during the initial hour, and the incidence of postoperative airway morbidity between uncuffed and Microcuff tube was comparable, 5/50 (10%) versus 7/50 (14%) with risk ratio (95% CI) of 0.71(0.24-2.1), p value .49. CONCLUSION Microcuff oral preformed tubes performed better than uncuffed tubes regarding tube exchange during cleft palate surgery.
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Affiliation(s)
- Rithu Krishna Kamaladevi
- Department of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Kumar Mishra
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Priya Rudingwa
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Devi Prasad Mohapatra
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ashok Shankar Badhe
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kundra P, Senthilnathan M. Amalgamation of artificial intelligence and simulation in anaesthesia training: Much-needed future endeavour. Indian J Anaesth 2024; 68:8-10. [PMID: 38406343 PMCID: PMC10893798 DOI: 10.4103/ija.ija_1264_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/27/2024] Open
Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Borah K, Ramamoorthy L, Senthilnathan M, Murugesan R, Lalthanthuami HT, Subramaniyan R. Effect of fourth hourly oropharyngeal suctioning on ventilator-associated events in patients requiring mechanical ventilation in intensive care units of a tertiary care center in South India: a randomized controlled trial. Acute Crit Care 2023; 38:460-468. [PMID: 38052511 DOI: 10.4266/acc.2022.01501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Mechanical ventilation (MV) is a necessary life-saving measure for critically ill patients. Ventilator-associated events (VAEs) are potentially avoidable complications associated with MV that can double the rate of death. Oral care and oropharyngeal suctioning, although neglected procedures, play a vital role in the prevention of VAE. METHODS A randomized controlled trial was conducted in the intensive care units to compare the effect of fourth hourly oropharyngeal suctioning with the standard oral care protocol on VAE among patients on MV. One hundred twenty mechanically ventilated patients who were freshly intubated and expected to be on ventilator support for the next 72 hours were randomly allocated to the control or intervention groups. The intervention was fourth hourly oropharyngeal suctioning along with the standard oral care procedure. The control group received standard oral care (i.e., thrice a day) and on-demand oral suctioning. On the 3rd and 7th days following the intervention, endotracheal aspirates were sent to rule out ventilator-associated pneumonia. RESULTS Both groups were homogenous at baseline with respect to their clinical characteristics. The intervention group had fewer VAEs (56.7%) than the control group (78.3%) which was significant at P<0.01. A significant reduction in the status of "positive culture" on ET aspirate also been observed following the 3rd day of the intervention (P<0.001). CONCLUSIONS One of the most basic preventive strategies is providing oral care. Oropharyngeal suctioning is also an important component of oral care that prevents microaspiration. Hence, fourth-hourly oropharyngeal suctioning with standard oral care significantly reduces the incidence of VAE.
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Affiliation(s)
- Khanjana Borah
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Lakshmi Ramamoorthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Rajeswari Murugesan
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Hmar Thiak Lalthanthuami
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Rani Subramaniyan
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Rakhi Krishna CM, Mishra SK, Jha AK, Senthilnathan M, Parida S. Ultrasound-Guided Radial Arterial Catheterization in Patients With Regurgitant and Stenotic Left-Sided Cardiac Valvular Lesions. Semin Cardiothorac Vasc Anesth 2023; 27:153-161. [PMID: 37269115 DOI: 10.1177/10892532231181481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Background. The pulse characteristics of arterial circulation might affect radial artery catheterization's success rate. Therefore, we hypothesized that the success rate of radial artery catheterization would be lower in the left-sided severe stenotic valvular lesion group than severe regurgitant valvular lesion group. Methods. This prospective study was conducted among patients with left-sided cardiac valvular lesions undergoing cardiac and non-cardiac surgery. The patients with left-sided severe valvular stenosis and left-sided severe valvular regurgitation were included in the study. Radial artery cannulation was performed using an ultrasound-guided out-of-plane short-axis approach. The outcome measures were success rate, number of attempts, and cannulation time. Result. One hundred fifty-two patients were recruited for the study, and all were eligible for final analysis. The first attempt success rate was non-significantly higher in the stenotic valvular lesion group than the regurgitant group (69.7% vs 56.6%; P = .09). Furthermore, the number of attempts (median; 95% CI) was significantly higher in the regurgitant group (1; 1.2-1.43 vs 1; 1.38-1.67; P = .04). However, it may not be of clinical relevance. Moreover, the cannulation time and the number of redirections of the cannula were comparable. Heart rate was significantly higher in the regurgitant group (91.8 ± 13.9 vs 82.26 ± 15.92 beats/min; P = .00), while the incidence of atrial fibrillation was significantly higher in the stenotic lesion (P = .00). No failure was reported, and the incidence of periarterial hematoma was comparable. Conclusion. The success rate of ultrasound-guided radial arterial catheterization is comparable in left-sided stenotic valvular and regurgitant lesion groups.
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Affiliation(s)
- C M Rakhi Krishna
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Satyen Parida
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Parida S, Senthilnathan M. Administration of paediatric intranasal sedation: Need for appropriate formulation & equipment for dispensation. Indian J Med Res 2023; 157:96-99. [PMID: 37040234 DOI: 10.4103/ijmr.ijmr_847_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Affiliation(s)
- Satyen Parida
- Department of Anaesthesiology & Critical Care, Jawarlal Institute of Postgraduate Medical Education and Research, Puducherry 605 006, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology & Critical Care, Jawarlal Institute of Postgraduate Medical Education and Research, Puducherry 605 006, India
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Purushothaman S, Kundra P, Senthilnathan M, Sistla SC, Kumar S. Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery-a randomized clinical trial. J Anesth 2023; 37:387-393. [PMID: 36809505 DOI: 10.1007/s00540-023-03173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE AND OBJECTIVES Phantom limb pain (PLP) is a major cause of physical limitation and disability accounting for about 85% of amputated patients. Mirror therapy is used as a therapeutic modality for patients with phantom limb pain. Primary objective was to study the incidence of PLP at 6 months following below-knee amputation between the mirror therapy group and control group. METHODS Patients posted for below-knee amputation surgery were randomized into two groups. Patients allocated to group M received mirror therapy in post-operative period. Two sessions of therapy were given per day for 7 days and each session lasted for 20 min. Patients who developed pain from the missing portion of the amputated limb were considered to have PLP. All patients were followed up for six months and the time of occurrence of PLP and intensity of the pain were recorded among other demographic factors. RESULTS A total of 120 patients completed the study after recruitment. The demographic parameters were comparable between the two groups. Overall incidence of phantom limb pain was significantly higher in the control group (Group C) when compared to the mirror therapy (Group M) group [Group M = 7 (11.7%) vs Group C = 17 (28.3%); p = 0.022]. Intensity of PLP measured on the Numerical Rating Scale (NRS) was significantly lower at 3 months in Group M compared to Group C among patients who developed PLP [NRS - median (Inter quartile range): Group M 5 (4,5) vs Group C 6 (5,6); p 0.001]. CONCLUSION Mirror therapy reduced the incidence of phantom limb pain when administered pre-emptively in patients undergoing amputation surgeries. The severity of the pain was also found to be lower at 3 months in patients who received pre-emptive mirror therapy. TRIAL REGISTRATION This prospective study was registered in the clinical trial registry of India. TRIAL REGISTRATION NUMBER CTRI/2020/07/026488.
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Affiliation(s)
- Samatharman Purushothaman
- Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India
| | - Sarath Chandra Sistla
- Department of Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Shathish Kumar
- Department of Anaesthesiology, Manipal Hospital Whitefield, Bangalore, Karnataka, India
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Senthilnathan M, Chatterjee P, Tenzing E. Response to comments on 'Hypertension and tachycardia following high spinal anaesthesia during LSCS: An unusual presentation'. Indian J Anaesth 2023; 67:319-320. [DOI: 10.4103/ija.ija_134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/17/2023] Open
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Chatterjee P, Senthilnathan M, Tenzing E. Hypertension and tachycardia following high spinal anaesthesia during lower segment caesarean section: An unusual presentation. Indian J Anaesth 2022; 66:741-742. [PMID: 36437978 PMCID: PMC9698289 DOI: 10.4103/ija.ija_644_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Protiti Chatterjee
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India,Address for correspondence: Dr. Muthapillai Senthilnathan, Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India. E-mail:
| | - Emayah Tenzing
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Senthilnathan M, Ravi R, Suganya S, Kumar Sivakumar R. Manual vs. Mechanical Ventilation in patients with Advanced Airway during CPR. Indian Heart J 2022; 74:428-429. [PMID: 35926586 DOI: 10.1016/j.ihj.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Early chest compressions and rapid defibrillation are important components of cardiopulmonary resuscitation (CPR). American heart association (AHA) recommends two breaths to be delivered for every 30 compressions for an adult cardiac arrest victim. Patient with an advanced airway like endotracheal tube (ETT) should be given one breath every 6 seconds without interruptions in chest compression (10 breaths per minute). All of the modern mechanical ventilators have option to generate spontaneous breaths by the patient if the patient has spontaneous respiratory efforts. During CPR, the mechanical ventilator is fallaciously sensing the chest compressions as patient's spontaneous trigger and thereby it delivers higher respiratory rates. Avoiding excessive ventilation is one of the components of high quality CPR as excessive ventilation decreases venous return thereby decreasing the cardiac output and also it affects intra-thoracic pressure thereby adversely affects intra-arterial pressure. As modern ventilators have trigger for spontaneous breaths and they will be erroneously triggered by chest compressions, it would be prudent to use volume marked resuscitation bags or manual breathing devices (manual self-inflating resuscitation bag, Bain's circuit) for delivering breaths which can be synchronised with compression phase of CPR at RR of 10.min -1 with advanced airway in place. If any patient who is on mechanical ventilation develops cardiac arrest, patient should be disconnected from the mechanical ventilator and should be ventilated manually. Manual ventilation with aforementioned breathing devices should be used in a patient without and with advanced airway devices during CPR.
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Affiliation(s)
- Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - Ramya Ravi
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Srinivasan Suganya
- Department of Anaesthesiology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, India
| | - Ranjith Kumar Sivakumar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Senthilnathan M, Ravi R, Sivakumar R, Suganya S. Pre-injection technique to identify neural elements in the costoclavicular space for brachial plexus block: Where and what to inject? Indian J Anaesth 2022; 66:166-167. [PMID: 35359476 PMCID: PMC8963226 DOI: 10.4103/ija.ija_398_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/08/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022] Open
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Ravi R, Srinivasan S, Sivakumar RK, Senthilnathan M. Surgical anaesthesia for scapular surgery in a patient with ipsilateral thoracic injury. Indian J Anaesth 2021; 65:630-632. [PMID: 34584290 PMCID: PMC8445207 DOI: 10.4103/ija.ija_1552_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/03/2021] [Accepted: 01/31/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ramya Ravi
- Department of Anaesthesia, Ng Teng Fong General Hospital, National University Health Services, Singapore
| | - Suganya Srinivasan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ranjith Kumar Sivakumar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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12
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Senthilnathan M, Ravi R, Sivakumar RK, Majella MG, Chidambaram V. Aspirin Use, Mechanical Ventilation, and Inhospital Mortality in Coronavirus Disease 2019: Are We Missing Something? Anesth Analg 2021; 133:e31-e33. [PMID: 34257214 DOI: 10.1213/ane.0000000000005621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramya Ravi
- Department of Anaesthesia, Ng Teng Fong General Hospital, Singapore,
| | - Ranjith Kumar Sivakumar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | | | - Vignesh Chidambaram
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
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Cherian A, Jha AK, Padala SRAN, Senthilnathan M. Unusual complications of spontaneous pneumomediastinum and subcutaneous emphysema in patients with SARS-CoV-2 infection: A case report. Indian J Anaesth 2021; 65:483-486. [PMID: 34248193 PMCID: PMC8252999 DOI: 10.4103/ija.ija_192_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anusha Cherian
- Department of Anaesthesiology and Critical Care Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Srinivasan S, Senthilnathan M, Sivakumar RK, Mishra SK. A novel manoeuvre in succeeding rail-roading of tracheostomy tube. Indian J Anaesth 2021; 65:174-176. [PMID: 33776102 PMCID: PMC7983812 DOI: 10.4103/ija.ija_886_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Suganya Srinivasan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ranjith Kumar Sivakumar
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ravi R, Senthilnathan M, Sivakumar RK, Suganthapriya C. Positive end-expiratory pressure as a novel method to thwart CO 2 leakage from capnothorax in robotic-assisted thoracoscopic surgery. Indian J Anaesth 2020; 64:145-147. [PMID: 32139934 PMCID: PMC7017661 DOI: 10.4103/ija.ija_627_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/03/2019] [Accepted: 10/23/2019] [Indexed: 11/04/2022] Open
Abstract
Capnography and end tidal CO2 (EtCO2) aids the anaesthesiologist in diagnosing problems during all phases of general anaesthesia. Negative arterial to end-tidal carbon-dioxide gradient during anaesthesia has been reported in various conditions including pregnancy, infants and inadvertent exogenous addition of carbon dioxide (CO2) to the expired gas in case of thoracoscopic procedures with iatrogenic injury to lung parenchyma/bronchial tree. Thus, airway injury or intentional opening of airway as a part of surgical step can be diagnosed using a negative arterial and end tidal CO2 gradient. Higher optimal PEEP can be used as a splint across the bronchial cuff in one-lung ventilation which prevents leak from capnothorax and decrease inadvertent entry of CO2 in to the expired gases which erroneously increase arteriolar to end tidal CO2 gradient.
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Affiliation(s)
- Ramya Ravi
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
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16
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Rudingwa P, Senthilnathan M, Suganya S, Panneerselvam S. Intraoperative acute hematuria: Sole clue to mismatch transfusion. Asian J Transfus Sci 2019; 13:63-65. [PMID: 31360015 PMCID: PMC6580825 DOI: 10.4103/ajts.ajts_153_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemolytic transfusion reactions (HTRs) remain one of the dreaded complications of transfusion-related morbidity and mortality. Here, we describe the diagnosis and management of acute HTR following transfusion of ABO-incompatible packed red blood cell under general anesthesia which manifested solely as acute intraoperative hematuria. A 65-year-old, diabetic male was scheduled for emergency re-explorative laparotomy in view of suspected anastomotic leak following subtotal gastrectomy. One unit of packed cell was transfused intraoperatively. Toward the end of surgery, hematuria was noted by the attending anesthesiologist, and the accidental bladder injury was ruled out by the surgeon. Transfusion of ABO-incompatible blood was spotted; direct Coombs test became positive. To mitigate the impact of incompatible blood, 1 L of 0.9% normal saline was administered. Mannitol 0.5 g/kg and furosemide 20 mg were administered every 8th hourly, and 1 ml/kg/h of urine output was targeted. Sodium bicarbonate (7.5%) 20 meq was administered intravenously to alkalinize the urine.
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Affiliation(s)
- Priya Rudingwa
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Srinivasan Suganya
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sakthirajan Panneerselvam
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Ramachandran S, Mishra SK, Balachander H, Bidkar PU, Velayudhan S, Parida S, Senthilnathan M. Microcuff Pediatric Endotracheal Tubes: Evaluation of Cuff Sealing Pressure, Fiber-optic Assessment of Tube Tip, and Cuff Position by Ultrasonography. Anesth Essays Res 2019; 13:596-600. [PMID: 31602084 PMCID: PMC6775848 DOI: 10.4103/aer.aer_97_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Use of uncuffed tubes causes lots of morbidity, and there is a surge in the use of microcuff pediatric endotracheal tubes. These tubes are not evaluated in the Indian population. Aims: The study aimed to evaluate the pediatric microcuff endotracheal tubes in terms of cuff sealing pressure, fiber-optic assessment of tube tip, and cuff position to assess postextubation airway morbidity. Settings and Design: Study design involves follow-up analytical study. Subjects and Methods: Thirty-four children in the age group of 2–12 years were studied. Patients with leak pressure >20 cm H2O were exchanged with smaller size tube and excluded. Cuff pressure, fiber-optic assessment of tube tip to carina distance in neutral and flexion, ultrasound assessment of cuff position, and postextubation airway morbidity were assessed. Statistical Analysis Used: Parameters expressed as the median with the interquartile range. Nonparametric data were analyzed using the Wilcoxon signed-rank test. Results: The tracheal leak pressure was <20 cm H2O (median 14.5 cm H2O) in 30 children. Tube exchange was required in four patients. A complete seal was achieved in 30 patients with cuff pressures ranging from 6 to 8.25 cm of H2O (median 8 cm of H2O). The median caudal displacement is 0.8 cm (0.47–1.22 cm) with flexion. There was no airway-related morbidity in any of these patients. Conclusions: The microcuff pediatric endotracheal tubes when used according to the age-based formula had a higher tube exchange rate in our study population. However, in children in whom the tube size was appropriate, the tubes provided good sealing without increasing airway morbidity. Further studies with a larger sample size might be required to confirm the findings.
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Affiliation(s)
- Srinivasan Ramachandran
- Department of Anesthesiology and Critical Care, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Sandeep Kumar Mishra
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hemavathi Balachander
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prasanna Udupi Bidkar
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Savitri Velayudhan
- Department of Anesthesiology and Critical Care, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Satyen Parida
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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18
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Mishra SK, Chandrasekaran A, Parida S, Senthilnathan M, Bidkar PU, Gupta SL. Time course of psychomotor recovery after intravenous dexmedetomidine infusion as a part of balanced anaesthetic technique: A randomised, double-blind study. Indian J Anaesth 2019; 63:623-628. [PMID: 31462807 PMCID: PMC6691630 DOI: 10.4103/ija.ija_192_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Dexmedetomidine is a drug that is being widely used as an adjuvant to anaesthesia because of its unique pharmacodynamic and pharmacokinetic properties. We aimed to assess the recovery of psychomotor function from balanced anaesthesia including intravenous dexmedetomidine infusion as adjunct. Methods: Ninety American Society of Anesthesiologists I and II patients were randomised to group D (n = 45), to receive 1 μg/kg of dexmedetomidine loading dose over 10 min, with maintenance infusion of 0.5 μg/kg/h, and group S (n = 45), to receive an equal volume of 0.9% normal saline. Objective parameters were recovery of psychomotor function assessed by Trieger dot test (TDT), digit symbol substitution test (DSST) and intraoperative opioid requirement. the total fentanyl used intraoperatively in the two groups. Statistical analysis was performed using unpaired Student's t-test, Chi-squareor Fisher's exact test. Results: Psychomotor recovery assessed by TDT showed statistically significant early recovery in group D compared with group S. This was seen in the maximum distance of dots missed at 30 min, 60 min, 90 min and 120 min as well as in the average distance of dots missed at identical time points. Similarly, DSST revealed early recovery at 30 min (12.4 ± 5.3 vs. 10.4 ± 3.9 P = 0.04) postoperative interval but not at other time intervals. There was significant decrease in the intraoperative opioid requirement in group D compared with group S. Conclusion: The addition of dexmedetomidine to balanced anaesthetic technique significantly hastened the psychomotor recovery compared with placebo.
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Affiliation(s)
- Sandeep Kumar Mishra
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ayyappan Chandrasekaran
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Satyen Parida
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Prasanna Udupi Bidkar
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Suman Lata Gupta
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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19
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Ravi R, Swaminathan S, Senthilnathan M, Rajendran VP. Bilateral diaphragmatic palsy in a parturient for emergency Caesarean delivery - What are our concerns? Indian J Anaesth 2019; 63:417-418. [PMID: 31142893 PMCID: PMC6530287 DOI: 10.4103/ija.ija_840_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ramya Ravi
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
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20
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Manjari P, Hyder I, Kapoor S, Senthilnathan M, Dang AK. Exploring the concentration‐dependent actions of interferon‐τ on bovine neutrophils to understand the process of implantation. J Cell Biochem 2018; 119:10087-10094. [DOI: 10.1002/jcb.27345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Affiliation(s)
- P. Manjari
- Veterinary Science Krishi Vigyan Kendra Pandirimamidi India
| | - Iqbal Hyder
- Department of Veterinary Physiology NTR CVSc Gannavaram India
| | - Suresh Kapoor
- Division of Animal Physiology ICAR‐NDRI Karnal India
| | | | - A. K. Dang
- Division of Animal Physiology ICAR‐NDRI Karnal India
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21
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Chinnasamy C, Tamilselvam P, Karthick B, Sidharth B, Senthilnathan M. Green Synthesis, Characterization and Optimization Studies of Zinc Oxide Nano Particles Using Costusigneus Leaf Extract. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.matpr.2017.11.331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Senthilnathan M, Kundra P, Mishra SK, Velayudhan S, Pillai AA. Competence of Intensivists in Focused Transthoracic Echocardiography in Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2018; 22:340-345. [PMID: 29910544 PMCID: PMC5971643 DOI: 10.4103/ijccm.ijccm_401_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: Focused transthoracic echocardiography (fTTE) in critical care can be used to assess patient's volume status, ventricular contractility, right ventricle chamber size, and valvular abnormalities. The objective of the study was to assess the competency of intensivists in performing fTTE in Intensive Care Unit (ICU) patients after a brief training course by cardiologist using a specific ECHO protocol. Methods: One hundred and four patients in ICU were recruited for this prospective observational study over a period of 12 months. Intensivists were trained for 60 h (2 h/day for 30 days). Intensivists performed fTTE in 82 ICU patients using a specific ECHO protocol developed in consensus with cardiologists. Each patient was assessed by an intensivist and two blinded cardiologists. At the end of the study period, the competency of intensivists was compared with two cardiologists and analyzed using intraclass correlation coefficient (ICC). Results: There were excellent agreement between intensivists and cardiologists in terms of measuring ejection fraction (ICC estimate was 0.973–0.987), valvular function (ICC estimate for mitral valve was 0.940–0.972; ICC estimate for aortic valve was 0.872–0.940), and ICC estimate for pulmonary hypertension was 0.929–0.967. Good reliability has been found for the assessment of volume status with inferior vena cava diameter (ICC estimate for assessing hypovolemia was 0.790–0.902). Conclusion: Intensivists with requisite training in TTE were able to perform focused echocardiography with comparable accuracy to that of cardiologists. Further studies are required to elucidate the therapeutic implications of fTTE performed by the intensivists.
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Affiliation(s)
- Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Savitri Velayudhan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Senthilnathan M, Cherian A, Balachander H, Maroju NK. Role of Methylene Blue in the Maintenance of Postinduction Hemodynamic Status in Patients with Perforation Peritonitis: A Pilot Study. Anesth Essays Res 2017; 11:665-669. [PMID: 28928568 PMCID: PMC5594787 DOI: 10.4103/0259-1162.206854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Context: Methylene blue is an inhibitor of guanylate cyclase and hence prevents vasoplegia mediated by nitric oxide in patients with sepsis. Aims: This study aimed to analyze the effect of methylene blue on blood pressure maintenance following induction of anesthesia in patients presenting with peritonitis. Subjects and Methods: Thirty patients diagnosed to have perforation peritonitis were randomized into two groups (Group MB, Group NS). Patients in Group MB were given injection methylene blue 2 mg/kg over 20 min and patients in Group NS were given 50 ml of normal saline over 20 min, before induction. Heart rate, mean arterial pressure (MAP), cardiac output, and systemic vascular resistance (SVR) were recorded every 5 min for 1 h after infusion. Statistical Analysis: Hemodynamic parameters were analyzed using repeated-measures analysis of variance with Bonferroni's test. Blood gas analysis was analyzed using independent Student's t-test, and P < 0.05 was considered statistically significant. Results: MAP was lower at all-time points in Group NS than Group MB; however, it was statistically significant immediately, and 5 min the following induction. MAP fell from 94.8 ± 11.8 mmHg to 89.2 ± 16.0 mmHg immediate postinduction in Group MB and from 92.1 ± 9.8 mmHg to 74.1 ± 12.6 mmHg in Group NS. MAP and SVR were significantly higher in Group MB, 5 min following induction. No adverse events attributable to methylene blue were noted. Conclusions: Methylene blue contributes to the maintenance of postinduction hemodynamic stability in patients with perforation peritonitis.
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Affiliation(s)
- Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Anusha Cherian
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Hemavathi Balachander
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nanda Kishore Maroju
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Senthilnathan M, Velayudhan S, Cherian A, Kundra P. Anaesthetic management of a pregnant woman with preeclampsia and Eisenmenger's syndrome: Role of advanced haemodynamic monitoring. Indian J Anaesth 2017; 61:359-360. [PMID: 28515531 PMCID: PMC5416733 DOI: 10.4103/0019-5049.204244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Savitri Velayudhan
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
| | - Anusha Cherian
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
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Abstract
The Morse-Smale complex is a useful topological data structure for the analysis and visualization of scalar data. This paper describes an algorithm that processes all mesh elements of the domain in parallel to compute the Morse-Smale complex of large 2D datasets at interactive speeds. We employ a reformulation of the Morse-Smale complex using Forman’s Discrete Morse Theory and achieve scalability by computing the discrete gradient using local accesses only. We also introduce a novel approach to merge gradient paths that ensures accurate geometry of the computed complex. We demonstrate that our algorithm performs well on both multicore environments and on massively parallel architectures such as the GPU.
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Affiliation(s)
- Nithin Shivashankar
- Department of Computer Science and Automation, Indian Institute of Science, Karnataka, Bangalore 560012, India.
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