Sohan Lal Solanki
@tmc.gov.in
Professor
Tata Memorial Hospital, Mumbai
Scopus Publications
Scopus Publications
Reshma Ambulkar, Satya Kumar Moharana, Sohan Lal Solanki, Bindiya G Salunke, and Vandana Agarwal
SAGE Publications
Background: Patients undergoing major gastrointestinal (GI) surgery including hepato-pancreato-biliary (HPB) surgeries have large incisions, which cause severe acute postoperative pain that, if untreated, is associated with a higher incidence of postoperative morbidity and delayed recovery. Methodology: Our study included all patients who underwent elective major upper GI and HPB surgeries from 1 January 2018 to 31 December 2018. The patients were divided into two groups: the epidural and the non-epidural group. The average and worst pain scores at rest and movement were compared between both groups. We also studied the effect of pain relief in the two groups and associated postoperative outcomes, resumption of feeding, ambulation, hospital stay and intensive care unit stay. Results: A total of 566 patients were included in the study, out of which 490 received epidurals, and the rest, 76, belonged to the non-epidural group (transversus abdominis plane, rectus sheath block or no regional analgesia technique). The median average pain score at rest and movement was 2.0 and 3.0, respectively, in the epidural and non-epidural groups. The postoperative outcomes showed no statistical difference. Conclusion: The epidural group and the non-epidural group had similar pain scores, and the postoperative outcomes were also comparable.
Shruti Gairola, Sohan Lal Solanki, Shraddha Patkar, and Mahesh Goel
Springer Science and Business Media LLC
Sohan Lal Solanki, Arya Kannancheeri, Mufaddal Kazi, and Avanish Saklani
Jaypee Brothers Medical Publishing
Reshma Ambulkar, Vignesh Baskar, Shraddha Patkar, Aditya Kunte, Vandana Agarwal, Sohan Lal Solanki, and Jigeeshu V Divatia
Medknow
Background and Aims: The International Normalised Ratio (INR), which assesses the loss of procoagulant factors in the extrinsic pathway, fails to evaluate the coagulation abnormalities comprehensively after a major liver resection, which often leads to reduced synthesis of procoagulant and anticoagulant-factors. This study was conducted with an aim to study the trend and compare the results of routine coagulation tests and thromboelastography (TEG) during the perioperative period in patients undergoing major liver resections (≥3 segments). Methods: Twenty-five patients who underwent a major liver resection were enrolled. This prospective, single-arm, interventional study was performed with the primary objective of determining the serial changes in conventional coagulation tests and TEG during the perioperative period in patients undergoing major liver resections, at the preincision period, intraoperative period, postoperatively, at 48 h and on the fifth postoperative day. Transfusion requirements of blood components were also assessed with a TEG-guided replacement strategy. Spearman rank-order correlation was used to study the relationships of coagulation tests (both TEG and conventional tests) at each time point. Results: The prothrombin time (PT)-INR was elevated in 14 patients (56%) at the intraoperative, immediate postoperative and 48-h time points in contrast to the TEG parameters, which remained normal in all patients. Blood component transfusion was avoided in 4, 11 and 10 patients at the intraoperative, immediate postoperative and 48-h time points, respectively. Conclusion: International Normalised Ratio overestimates the coagulopathy in patients undergoing major liver resection, and a thromboelastography-guided transfusion strategy reduces overall transfusion requirements.
Sohan Lal Solanki, Indubala Maurya, and Jyoti Sharma
Medknow
Background and Aims: Cytoreduction surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive surgery associated with significant fluid shift and blood loss. The haemodynamic management and fluid therapy protocol may impact postoperative outcomes. This systematic review was conducted to find the effect of haemodynamic monitoring and perioperative fluid therapy in CRS-HIPEC on postoperative outcomes. Methods: We searched PubMed, Scopus and Google Scholar. All studies published between 2010 and 2022 involving CRS-HIPEC surgeries that compared the effect of fluid therapy and haemodynamic monitoring on postoperative outcomes were included. Keywords for database searches included a combination of Medical Subject Headings terms and plain text related to the CRS-HIPEC procedure. The risk of bias and the certainty assessment were done by Risk of Bias-2 and the methodological index for non-randomised studies. Results: The review included 16 published studies out of 388 articles. The studies were heterogeneous concerning the design type and parameter measures. The studies with goal-directed fluid therapy protocol had a duration of intensive care unit (ICU) stay that varied from 1 to 20 days, while mortality varied from 0% to 9.5%. The choice of fluid, crystalloid versus colloid, remains inconclusive. The studies that compared crystalloids and colloids for perioperative fluid management did not show a difference in clinical outcomes. Conclusion: The interpretation of the available literature is challenging because the definitions of various fluid regimens and haemodynamic goals are not uniform among studies. An individualised approach to perioperative fluid therapy and a justified dynamic index cut-off for haemodynamic monitoring seem reasonable for CRS-HIPEC procedures.
Aditya R. Kunte, Aamir M. Parray, Manish S. Bhandare, and Sohan Lal Solanki
Walter de Gruyter GmbH
Abstract The role of prophylactic hyperthermic intraperitoneal chemotherapy (p-HIPEC) in serosa invasive gastric cancers without gross or microscopic peritoneal disease, to reduce the rate of peritoneal relapse is an area of ongoing research. Although p-HIPEC is effective in reducing the rate of peritoneal relapse and improving disease free and overall survival with or without adjuvant chemotherapy, when added to curative surgery in locally advanced, non-metastatic gastric cancers, the available literature is at best, heterogeneous, centre-specific and skewed. Apart from that, variations in the systemic therapy used, and the presence of the associated nodal disease further complicate this picture. To evaluate the role of p-HIPEC the PubMed, Cochrane central register of clinical trials, and the American Society of Clinical Oncology (ASCO) meeting library were searched with the search terms, “gastric”, “cancer”, “hyperthermic”, “intraperitoneal”, “chemotherapy”, prophylactic”, “HIPEC” in various combinations, and a critical review of the available evidence was done. Although p-HIPEC is a promising therapy in the management of locally advanced gastric cancers, the current evidence is insufficient to recommend its inclusion into routine clinical practice. Future research should be directed towards identification of the appropriate patient subset and towards redefining its role with current peri-operative systemic therapies.
SohanLal Solanki, GauriR Gangakhedkar, and JigeeshuV Divatia
Medknow
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex surgical procedure with significant complications. These complications stem from extremes of haemodynamics, biochemical abnormalities and thermal fluctuations that the patient is subjected to, with morbidity and mortality rates going up to 20%–40% and 3%, respectively.[1,2] Cardiac output monitoring is being used during CRS-HIPEC in many centres, for patients with high-volume disease.[2] Goal-directed therapy in CRS-HIPEC has been shown to lower morbidity. The HemoSphere advanced monitoring platform along with the Acumen sensor (Edwards Lifesciences, Irvine, CA), is equipped with additional parameters to allow clinicians to pre-emptively recognise and treat impending hypotension.[3] The Hypotension Prediction Index (HPI), is based on arterial waveform features and predicts the occurrence of hypotension (defined as mean arterial pressure (MAP) less than 65 mmHg for at least 1 minute).[4] HPI is displayed as a unit less number from 0-100, with higher values being inversely proportional to the time to impending hypotension. An HPI of 85 implies that there is an 85% probability of a hypotensive event in the next 15 minutes.[4] A high HPI value increases the certainty of hypotension (MAP <65 mmHg). Other derived parameters such as dP/dtmax, which is the maximal change in the left ventricular pressure over time, and dynamic arterial elastance (Eadyn), which is the ratio of pulse pressure variation (PPV) and stroke volume variation (SVV), which help determine fluid responsiveness, myocardial contractility and determine whether fluid bolus will increase the MAP.[3]
SohanLal Solanki, MihikaJ Divatia, Kunal Gala, and JigeeshuV Divatia
Medknow
Sohan Lal Solanki and Ketan Kataria
Scientific Scholar
Cognitive changes and psychomotor recovery affecting patients, following anesthesia and surgery, have been recog-nized for more than 100 years. Various studies have been conducted pertaining to this, demonstrating con fl icting results with few showing propofol having better pro fi le, while few skewing in for inhalational being better for postoperative psychomotor recovery. 1 Surprisingly, no study till date has compared the effect of propofol, sevo fl urane, and des fl urane agents on recovery of cognitive and psychomotor functions simultaneously after daycare surgeries. In this study “ Comparison of recovery pro fi les of patients undergoing endoscopic lumbar discectomy under des fl urane, propofol or sevo fl urane anesthesia. A randomized, prospective, clinical, comparative study, ” 2 the authors documented that the patientsin thethree groups had similar psychomotor and cognitive functional impairments with comparable recovery time periods postoperatively. They also noted that the emergence and early recovery were faster in the des fl urane group. This is a single-center prospective randomized trial wherein 75 patients were analyzed out of 79 being enrolled with 25 patients in each group. Seventy- fi ve adult American Society of Anaesthesiologists (ASA) I and II patients being operated for endoscopic lumbar discectomy under different anesthetic regimens, that is, des fl urane (D), propofol (P), and sevo fl urane(S), were enrolled and were subjected to Treiger Dot Test (TDT), Digit Symbol Substitution Test (DSST), and Mini Mental State Examination (MMSE) preoperatively and at speci
Jeson R. Doctor, , Sohan Lal Solanki, Arihant Ravi Jain, Vijaya P. Patil, , , and
AVES Publishing Co.
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-established multimodal treatment in patients with peritoneal surface malignancies in adults. Children younger than 3 years rarely undergo such extensive surgeries with heated chemotherapy infusion intraoperatively. Only one such case is reported in the literature for CRS-HIPEC for an abdominopelvic rhabdomyosarcoma in a child of 2 years or less. We present the case of a 2-year-old child with abdominopelvic rhabdomyosarcoma undergoing CRS-HIPEC and discuss the perioperative concerns and challenges.
Reshma Ambulkar, Unnathi Manampadi, Shilpushp Bhosale, Meenal Rana, Vandana Agarwal, and Sohan Lal Solanki
Springer Science and Business Media LLC
Anjana S Wajekar, Sohan L Solanki, and Jigeeshu V Divatia
Springer Science and Business Media LLC
Gauri R. Gangakhedkar, Sohan L. Solanki, and Jigeeshu V. Divatia
Ovid Technologies (Wolters Kluwer Health)
Sohan Lal Solanki, MD, PDCC, MAMS, Raghu S. Thota, MD, MAMS, Jeson Rajan Doctor, MD, DNB,et al.
Weston Medical Publishing
Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thoracic, abdominal, pelvic, and lower limb surgeries and use of regional nerve blocks/catheter in head neck, neuro, and upper limb onco-surgeries, wherever possible along with nonopioids analgesics, are suggested. Short-acting opioids in small aliquots may be allowed to control breakthrough pain for expedient control of pain. The purpose of this consensus practice guideline is to provide the practicing anesthesiologists with best practice evidence and consensus recommendations by the expert committee of the Society of Onco-Anesthesia and Perioperative Care for safe opioid use in onco-surgeries.
Geetu Bhandoria, Sohan Lal Solanki, Mrugank Bhavsar, Kalpana Balakrishnan, Cherukuri Bapuji, Nitin Bhorkar, Prashant Bhandarkar, Sameer Bhosale, Jigeeshu V. Divatia, Anik Ghosh,et al.
Walter de Gruyter GmbH
Abstract Objectives Enhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians’ practice about ERAS in patients undergoing CRS-HIPEC. Methods An online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists. Results The response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76–95%), preoperative (50–94%), and intraoperative (55–90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated. Conclusions Most respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.
Sohan Lal Solanki, Saneya Pandrowala, Abhirup Nayak, Manish Bhandare, Reshma P Ambulkar, and Shailesh V Shrikhande
Baishideng Publishing Group Inc.
Artificial intelligence (AI) demonstrated by machines is based on reinforcement learning and revolves around the usage of algorithms. The purpose of this review was to summarize concepts, the scope, applications, and limitations in major gastrointestinal surgery. This is a narrative review of the available literature on the key capabilities of AI to help anesthesiologists, surgeons, and other physicians to understand and critically evaluate ongoing and new AI applications in perioperative management. AI uses available databases called “big data” to formulate an algorithm. Analysis of other data based on these algorithms can help in early diagnosis, accurate risk assessment, intraoperative management, automated drug delivery, predicting anesthesia and surgical complications and postoperative outcomes and can thus lead to effective perioperative management as well as to reduce the cost of treatment. Perioperative physicians, anesthesiologists, and surgeons are well-positioned to help integrate AI into modern surgical practice. We all need to partner and collaborate with data scientists to collect and analyze data across all phases of perioperative care to provide clinical scenarios and context. Careful implementation and use of AI along with real-time human interpretation will revolutionize perioperative care, and is the way forward in future perioperative management of major surgery.
Sohan Lal Solanki, Jasmeen Kaur, Amit M. Gupta, Shraddha Patkar, Riddhi Joshi, Reshma P. Ambulkar, Akshay Patil, and Mahesh Goel
Elsevier BV
Sohan L. SOLANKI
Edizioni Minerva Medica
SohanL Solanki and JesonR Doctor
Medknow
238 Saudi Journal of Anesthesia / Volume 15 / Issue 2 / April-June 2021 endoscopes to remove items.[2] In this particular case, the property of iron to attract and capture magnets could also have been utilized for gastrointestinal foreign bodies. The use of a metallic capturing device such as metallic biopsy forceps or magnetic retrievers could also have prevented possible advancement in the duodenum as had happened in this case. To conclude, metal objects are ideal for dragging foreign magnetic bodies and vice versa.
Sohan Lal Solanki, Mrida AK Jhingan, and Avanish P Saklani
Springer Science and Business Media LLC
Vivekanand Sharma, Sohan Lal Solanki, and Avanish P Saklani
Jaypee Brothers Medical Publishing
Abstract Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for peritoneal surface malignancies. A variety of metabolic derangements have been reported in the perioperative period in these patients, most of which are a result of the complex interaction of peritoneal denudation, chemotherapy bath, and fluid imbalance. We report three cases of hyperammonemia-related neurological dysfunction seen in HIPEC patients. To the best of our knowledge, this is the first report of this presentation. Timely recognition of this condition needs a high degree of suspicion, and unless aggressively treated, is likely to be associated with poor outcome. How to cite this article: Sharma V, Solanki SL, Saklani AP. Hyperammonemia after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Report of Three Cases with Unusual Presentation. Indian J Crit Care Med 2021;25(5):590–593.
Sohan Lal Solanki, Mrida A. K. Jhingan, and Avanish P. Saklani
Walter de Gruyter GmbH
AbstractObjectivesCytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) for peritoneal malignancies are complex surgeries marked with hemodynamic perturbations, temperature fluctuations, blood loss and metabolic disturbances in the intra-operative and post-operative period. In this report, we highlighted perioperative factors which may have led to cardiac arrest in immediate postoperative period and subsequent successful resuscitation in two patients with high volume peritoneal cancers who underwent CRS-HIPEC.Case presentationBoth patients had a similar clinical course, characterized by massive blood and fluid loss, metabolic derangement, hemodynamic instability, long duration of surgery, post HIPEC rebound hypothermia and hypokalemia which need to be anticipated.ConclusionsWe reviewed the literature related to postoperative hypothermia and other major complications after CRS-HIPEC and correlated the available literature with our findings.
Divya Srivastava, SohanLal Solanki, and Abhilash Chandra
Medknow
To the Editor, World Health Organization on March 11, 2020, declared the current spread of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection as coronavirus disease (COVID‐19) pandemic. The virus is known to be a highly contagious one, spreading by aerosols, fomites, and fecal–oral transmission.[1] The first case was detected in India on January 30, 2020, and the disease started spreading gradually. The government of India adopted a policy of “complete lockdown” on March 25, 2020, which led to cessation of all elective surgeries including elective solid‐organ transplantations.
SohanLal Solanki, JEdward Johnson, and Aloka Samantaray
Medknow
© 2020 Indian Journal of Anaesthesia | Published by Wolters Kluwer Medknow Supraglottic airway devices (SADs) are now an indispensable instrument in the operating room as well as in non-operative room anaesthesia practice. They have evolved greatly from Archie Brain’s laryngeal mask airway (LMA).[1] Use of SADs has expanded over the time from short surgical procedures initially, to all types of surgeries including laparoscopic/robotic and obstetrics. SADs have also been used in oral, cervical tracheal, prone position surgeries[2,3] and during cardiopulmonary resuscitation.[4] From the first-generation LMA classic to the most advanced third-generation Baska mask, there is much progress in the field of SADs. Despite their improved utility, SADs do have disadvantages like not providing 100% protection from pulmonary aspiration of gastric material like a cuffed tracheal tube (TT).[5]
SohanLal Solanki, RaghuS Thota, Rakesh Garg, and JigeeshuV Divatia
Medknow