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Articles by N Kumar
Total Records ( 2 ) for N Kumar
  R Singh , N Kumar and P. Singh
  Background

Various additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children.

Methods

A prospective, randomized, double-blind controlled study in 50 ASA I–II children (34 boys and 16 girls) aged 1–6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 µg kg–1 (MB) or clonidine 2 µg kg–1 (CB) in bupivacaine 0.2% (1.25 ml kg–1) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed.

Results

The mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P<0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P<0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P=0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects.

Conclusions

Caudal clonidine 2 µg kg–1 in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 µg kg–1 in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery.

  N Kumar , L Dahri , W Brown , N Duncan , S Singh , C Baker , I Malik , A Palmer , M Griffith , T Cairns and D. Taube
 

Background and objectives: Preemptive transplantation is ideal for patients with advanced chronic kidney disease (CKD). The practice has been to perform coronary angiography (CA) on all patients aged >50, all diabetics, and all patients with cardiac symptoms or disease with a view to revascularization before transplantation. Historically patients have delayed CA until established on renal replacement therapy due to concerns of precipitating the need for chronic dialysis. The objectives of this study were to establish the risk of contrast nephropathy in patients with advanced CKD who undergo screening CA, and to determine whether or not preemptive transplantation is achievable.

Design and setting: This retrospective analysis included 482 patients with stage IV/V CKD seen in West London predialysis clinics from 2004 to 2007. Seventy-six of 482 (15.8%) patients considered as potential transplant recipients met the authors' criteria for coronary angiography. Modification of Diet in Renal Disease (MDRD) GFR measurements were recorded for the 12 mo preceding and 12 mo following CA unless a defined endpoint was reached (transplantation, dialysis, or death).

Results: Mean MDRD GFR at CA was 12.51 ± 3.51 ml/min. The trend was not significantly different 6 mo pre- and postangiography. Cumulative dialysis-free survival was 89.1% 6 mo postangiography. Twenty-three of 76 (30.3%) patients had flow-limiting coronary artery disease. Twenty-five of 76 (32.9%) patients underwent transplantation with 22 of 25 (88.0%) transplants being performed preemptively.

Conclusions: The data suggest CA screening does not accelerate the decline in renal function for patients with advanced CKD, facilitating a safe preemptive transplant program.

 
 
 
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