CURRICULUM VITAE

 

 

NAME                                                   PRASANNA KUMAR MISHRA

BIRTH DATE                                        27TH OCTOBER 1951

ADDRESS                                             PLOT NO. 10, ANNAPURNA HOUSING COMPLEX, SHERTER CHHAK, TULSIPUR.                                                       CUTTACK - 753008    ODISHA

                                                                TEL NO. 0671-2363323, MOB:  9437026526 

 EMAIL:  pkm51@yahoo.com, pkmishra1951@gmail.com

Presently Working as                          Consultant Anaesthesia and Critical Care Ashwini Hospital, Cuttack

Educational Qualification

                                1, MBBS                 M K C G Medical College, BERHAMPUR, Odisha                            1975

                                2.  M D ( Anaesthesiology ) SCB Medical College, CUTTACK                                        1979

Fellowship :        Interventional Pain Management, Daradia Pain Institute, Kolkatta

Visiting Fellow:  Napean Institute of Critical Care , Sydney Australia

 

Work & experience

                1.             Resident Post Graduate SCB Medical College                                                1977- 1979

                2,             Lecturer/ Tutor  Anaesthesiology     VSs Medical College                           Sept 1981-  Jun1991

                3.             -  do -                                                      SCB Medical College                           Jun 1991- Jan 1997

                4.             Assst Prof Anaesthesiology,              MKCG Medical College                      Jan 1997-   Sept 1999

                5.                    - do -                                                SCB Medical College                          Sept 1999- Jun .2002

                6              Associate prof Anaesthesiology        SCB Medical College                          Jun 2002- Jun 2006

                7.             Professor of Anaesthgesiology          SCB Medical College                           Jun 2006-  Dec2009

                8.                 -do  -                                                   VSS Medical College                            Dec 2009 - Oct 2011

                9                   -  do -                                                 K I M S, Bhubaneswar                         July 2012 - Feb- 2015

                10            Prof Anaesthesiology                          Apollo Hospital, Bhubaneswar          Mar 2015- Mar 2019  

              11.          Consultant Anaesthesia and Critical Care , Ashwini Hospital

                                Accredited teacher IDCCM,IDCCN, Ashwini Hospital, Cuttack                    March 2019  cont

                12.         Prof & HOD Emergency Medicine , Ashwini Hospital, Cuttack                        2022........... Cont.

 

Specialised experience::

                                 Cardiac surgery ( Open Heart ), Interventional pain management , Critical care

Nature of Job

                a. Specialised patient care Anaesthesia in all kinds of surgery including Neuro surgery, Cardiac surgery under CPB, Thoracic surgery & Laparoscopic surgery

                b. General Teaching to Undergraduate and post graduate students

                c. Guide to post Graduate Students in thesis & research work  d. Examiner to Post graduate students in Anaesthesia to various Universities

                d. Teaching to students of IDCCM, IDCCN,  Em MEdicine

               

TEACHER :

o    Member editorial Board  Ind J Anaesthesia  2009-2010 - 2 years

o    Peer Reviewer Ind J Critical Care Medicine: 10 article

 

                 Publications .. and presentations

PUBLICATIONS

1.             Respiratory embrassment and delay in recovery following General Anaesthesia in a patient of   Congenital Rubella syndrome - A Case report _ Ind J Anaesthsia  2001 ;45 ( 4 ):p-298

                2.             Letter to Editor: Anaesthesia for congenital Rubella Syndrome

                                                                Ind J Anaesthesia  2002; 46( 1) : 64

                                                                Ind J Anaesthesia  2002 46 ( 3 ) p-:226

                3,             Efficacies and Inefficiencies in Different Anaesthesia MAchine

                                                                Ind J Anaesthesia 2002  46 ( 5 )

4.             Letter to Editor : Accidental injection of Large doses of Neostigmine methyle sulphate      intrathecally:    Ind J Anaesthesia  2004   48 (1 )  p-64

                5.             Homonymus Hemianopia- A coincidene following short General Anaesthesia - A case report

                                                                Ind j Anaesthesia  2004   48 ( 3 ) p-228

                6.             Letter to Editor : Can N2O Cylinder be overe filled

                                                                Ind J Anaesthesia  2005  49 ( 5) p 437

                7.             Effect of Oral Gabapentine on post operative epidural Analgesia. Rath S. Mishra PK

                                                                Ind J of Pain 2009 ; 23 ( 2 ) 308-312

                8.             Letter to Editor:  Euthanesia an ethical risk,  Mishra PK

                                                                Ind J of Medical Ethics  Dec 2011 Vol 8 ( 4 )  261-262

9	Burn from DC Defibrillator  a small price to pay- A case report  Pattanaik, NK , Mishra PKMishra PK
		J Evolution of Med Dent Sci. 2016 ; 5(83) ;6226-6227
		Pattnaik NK, Mishra PK. 7, DOI: 10.14260/jemds/2016/1406
10	Atypical location of a Right Atrial Myxoma- A case report
		Intnl J of Med Res and Pharmaceutical Sci:  Vol 3, Issue12 Dec 2016 :p 1-6
		ISSN : 2349-5340	Impact factor ( PIF):3.109

          11.              Deep vein thrombosis: Review and update. Review Article  ,  Pattnaik,N K, Mishra, PK ( 2016)  J. Evolution Med. Dent Sci.Vol 5;Issue 103   Dec26,2016:P7605

                                eISSN- 2278-4802, pISSN- 2278-4748

        12              INTUBE STUDY: An International Multi centre study:

 COLLABERATING AUTHOR, Dr Prasanna Mishra, Dr Sampat Dash., Ashwini Hospital, Cuttack. Published JAMA 2018                                                                Original Investigation | ,Intubation Practices and Adverse Peri-intubation Events in critically Ill Patients From 29 Countries

     13  A prospective observational study of prevalence, incidence, and prognostic implications

 of right-sided heart failure in acute respiratory distress syndrome patients. ( 2023 )

Sahu, C. Rao K. S. Mishra P. Panda R. Int J Res Med Sci. 2023 Dec;11(12):4324-4328

     14.    Supraclavicular brachial plexus block with and without dexamethasone as an adjuvan  t to local anesthetics- an observational study. ( 2023)

Sahu C, Rao KS, Mishra PK, Panda R. Student’s Journal of Health Research Africa, Vol 4 No.9( 2023)

 PRESENTATIONS IN CONFERENCES

                1.             AN UN USUAL FOREIGNBODY IN TRACHEA

                2.             LMA - WHATS NEW ? EAST ZONE CONFERENCE

                3.             DID I MAKE A MISTAKE ? Annual National Conf ISA, Bhubaneswar 2003

                4.             UNFAITHFUL SLAVE VALVE - POSTER PRESENTATION

                5.             ACUTE LUNG INJURY: REPORT OF 5 CASES: CRITICARE CONGRESS NEWDELHI

                5.             ACID BASE BALANCE; MANAGEMENT OF RESP ACIDOSIS, Annual Conf ISA Chennai

                6.             VOLATILE ANAESTHETIC AGENTS  YESTERDAY TODAY & TOMORROW

                                                Annual National conf ISA, Cochine

                7.             TURP SYNDROME IN NON TURP CASES -POSTER PRESENTATION

                8.             NEWER MODALITIES OF MANAGEMENT OF ACUTE PAIN .: Annual National Conf ISA

                                                                              Guwahati :2013

                9.             ANAESTHETIC IMPLICATION OF PRONE POSITION IN ELDERLY: Annual Conf ISA LUDHIANA 2016

10            ANAESTHESIA FOR INFERTILITY TREATMENT: Annual Conf ISA Kolkatta-2017

                11.  .       ANALYSIS OF LIFE AFTER DEATH: NDE SYNDROME. Annual Conf ISA, AGRA 2018

                12            Prof S Parmanik Oration : East Zone Annual Conference PURI – 28 Sept 2016

                                “ PAINS AND PLEASURES IN ANAESTHESIA “

 

LIFE MEMBER   I M A , ( Indian Medical Association)

I S A ( INDIAN SOCIETY OF ANAESTHESIOLOGIST),

ISCCM ( Indian Society of Critical Care Medicine )

ISSP  ( Indian Society for  study of pain )

     Member Face Book group   GIVE   ( Global Anaesthesia            

My Blog posts: https://www.blogger.com/blogger.g?blogID=8433572811259396978#allposts

 

 Headache for Anaesthtists:

PDPH is sometimes severe and disabling, WHEN THE HEAD ACHE CONTINUES BEYOND nearly 2 weeks, it makes the heache for Anaesthetist as well.

The patient still blames the anaesthetist for her brain problem, May be she was right . Here is the analysis.

CASE REPORT AND ANALYSIS:

A 40 yr old Lady, ASA-I ,with no co morbidity was posted for Vaginal Hysterectomy under Spinal Anaesthesia. Her Hb,DC,TLC,Platalate,Urea Creatinine, Na, K were all in normal limit.

After an IV line established 500ml NS given Her BP was 134/88 HR 90/min SpO2 99% and a sitting spinal was done successsfully in a single attempt with a 25G needle when CSF was clear and normal pressure, Bupivivaine heavy 2.8 ml was adminstered, After positioning Blood pressure dropped to 92/66 and an Injection Ephedrine 5 mg 2 doses was given IV and the BP rose to 140/86. Rest of intra op was uneventful

She developed headache about 24 hrs later, which was positional and diagnosed as PDPH, She was reassured by Nursing staff that it happens sometimes after Spinal injection and will disappear in 2-3 days, along with Paracetamol 1gm BD ,advised to lie down more as it was positional. It improved in next 3-4 days and she was discharged.

About 5 days later at home she again she developed headache the intensity increased , It was disabling with disturbed sleep and other activity , there was more pain in nape of neck, and some rigidity. She was readmitted to the hospital which was exclusively an obst and Gyn Hospital. The Anaesthetist was consulted

O/E it was found she was in distress, had some fever for 3-4 days, The head ache was disabling and no more positional There was neck rigidity, TLC count 14000.A differential diagnosis of re appearnce of PDPH, Meningigm, Meningitis, SAH was suspected.

When she was asked for a repeat spinal puncture and CSF analysis for presence of blood and/or cell count, she vehemently refused. So she was referred to a nearby Neuro center for a CT scan which confirmed the diagnosis of SAH. ( PIC -1 ). The neuro surgeon further advised a CT angio which confirmed an Anneurism in MCA ( middle cerebral artery ) area, ( PIC-II) which was clipped next day and the patients head ache decreased and in 7 days she was back to normal.

ANALYSIS: Major Neurologic complecations following Spinal anaesthesia is not common, but headache,Septic and aseptic meningitis,Arachnoiditis, Myelitis, Chordaequina syndrome are known since long , reported as early as 1946 ( JAMA 1946 ;132 (12) 679-685)

Risk factor for PDPH: (1) younger age, (2) pregnancy, (3) use of largebore needle. Theory for PDPH is Bimodal, a) Low Spinal fluid volume b) relative vasodilation in response to stretching intracrannial anchoring structure.

General Anaesthesia is advocated in Anneurism with control of mean arterial pressure, airway protection and Oxygenation.

There are plenty of case reports of Anneurism rupture after Spinal Anaesthesia.

Anaesthetists from Basil, successfully manages a known case of Giant Aneurism with Epidural Anaesthesia with out any complication .

They have explained that the Aneurism is at danger of rupture if the differential pressure of ( Transmural aneurism pressure) ( MAP) – Intra cranial Preessure( ICP ) increase by either raise in MAP or fall in ICP after fall in CSF pressure that raises Intramural pressure.

So a fluctuation of BP resulting in high intramural pressure against a low intracrannial pressure following Spinal Anaesthesia and csf leak could have resulted the rupture of Annurysm.

View in Group

My first Anaesthesia as a Professional

My first Anaesthesia

MY FIRST ANAESTHESIA AND PRIVATE PRACTICE 

During my PG study at SCB Medical College,way back in eighties, I was staying in hostel but used to come home often at 4,Gautam Nagar, Bhubaneswar, that was my fathers official residence.

During that time Dr S N Mohanty who was 2 years senior to us but finished MBBS and internship along with us had started a nursing home, Sunder Nursing Home  probably the 1st Nursing home of Capital city , Bhubaneswar. A very small one compared to many at present with just 6-7 cabins, a reception, an OT, two doctors chamber.

 Prof A M Naik FRCS, a renouned surgeon of that time used to operate in the nursing home. We being friendly during undergraduate Medical college, used to visit the nursing home occasionally.

 One-day he asked me, “Prasanna, why do not you give anaesthesia here”, by that time I had  finished  my Post Graduation in Anaesthesia theory exam and about to appear my , oral and practical examination.

“OK, what is the case, ?”

“ A 12 year old boy with cystic hygroma in neck”. “Sir will do it tomorrow evening” He added.

“I am sure you can do it”.

 I agreed. During that time Ether, rather open ether Anaesthesia was widely practised. Boyle’s Anaesthesia machine was available only in Medical colleges. Practising Anaesthesiologists at Cuttack used an Air ether apparatus. A simple device with provision of air flowing in one direction only with an exhalation valve. I did not had one. 

“Open ether will be Ok with Sir “ I asked. 

“No problem with sir, as you decide”, he replied.

 Nextday while returning from SCB Medical college, I purchased a tea strainer from Ranihat, a bottle of ether. Reached Nursing home, much before time. Saw the boy and checked if he has any cough and cold. Saw a medium size swelling in the neck right side. Auscultated his heart and lungs. No ECG, No evaluation and clearance by cardiologist. We have our own tests to evaluate a normal cardiac status. I do not remember what kind of blood tests were done. But surely a stool and urine test. Probably a DC and Hb was enough.

 Everything looked normal. The parents were more anxious than the boy. Prof Naik was supposed to reach around 5.30 pm. 30 mins before I gave an injection of atropine 1 amp ingluteus muscle in his room. When Prof Naik arrived in his car  the boy was called into OT room. I do not remember if We had started an IV drip or not.

 Hesitantly he came into the room. With a little coaxing he was made to sit on the table eagerly looking all around. All new faces and covered with a white mask. He was made to sleep on the table with a little force. By that time I had cut the plastic handle of the tea strainer , it became a rounded mask and I covered it with 4 layers of gaudge piece. When I brought in the face mask towards the face the pungent odour made him move his head away. I had to fix his head as well as put ether drops on the mask at a rate of approximately 100 drops / min.There were 2-3 assistants who restrained his legs and hands.It was not a easy job. He held his breath for some time then cried out. Initially one needs high concentration. He cried and pleaded to leave him, the more he cried more ether vapour he inhaled. I could feel the strong ether vapour coming out during his expiration. I continued my act like an expert knowing my job fully well.Within a minute the boy was motionless and breathing spontaneously without any fight. An I.V line was placed on his forarm and a bottle of Glucose saline was started. There was no venous cannula during that time. Glucose saline flowed drop by drop through a needle that was fixed into the vein. Some one was assigned to hold that hand , probably tied to the table.

 I poured more ether drops to continue and reach a surgical stage, that was known from the pattern of respiration. There was no ECG monitor or SpO2 probe. In between we checked the radial pulse or near the head superficial temporal artery pulsation. 

 Prof Naik who was ready by that time with Surgeons glove and dress came to table applied antiseptic on the part and covered the site with sterile clothes.In those times the clothes were autoclaved but the instrument is were boiled in water for 30-40 mins. That was a little discomfort as we shared the head end of the patient to work. Before he put incision he looked at me, I had added more ether to suppress the reaction to incision. I nodded my head in positive,though I was a bit anxious as well. The incision was painless and there was no movement, I silently breathed heavily.

 Ether is a volatile anaesthetic, it quickly evaporates at room temperature. From the face mask the patient breathes in this vapour and anaesthetised. While exhaling the same vapors fill the room air but gets diluted and does not ffect us unless one puts his head close the the face mask. Many a times ice is formed in between the layers of gauze , as the moisture from expired gas becomes wet and ice forms and obstructs the flow of air. Like an expert I knew when to change these layers and put new ones.

 In between I had to check his pulse and look at his pupil to estimate the depth of Anaesthesia along with type of respiration, that guides us when to stop or add more of ether drops on to the mask to maintain optimum anaesthesia state for the surgery. More importantly there is a trick to hold the mask so that he breaths easily, as in an unconscious patient the tongue falls and one can not breath properly. That also strains my left hand. I do not remember  applying an airway ,( a metallic curved device placed in side mouth that prevents fall of tongue, we use these days often a plastic one)

 Luckily for me this patient needed lesser depth than a surgery in Abdomen. This adminstartion of ether vapour is a continuous process that needs balance , and this one lasted for about 30 mins. Prof Naik was a great surgeon no doubt.He did his job precisely and removed the liquid filled tumour along with its walls from the neck,He was assisted by only one nurse.The bleeding vessels were tied with cat gut almost obsolete these days. Also application hot tetra ( 4 layers of gauge stitchedtogether,size of a handkerchief) .Finally the skin which was cut for about 4 to 5  fingers long was closed with skin stitch with simple cotton thread sterilised by puting it in boiled water for 10-15 mins.

 Towards the end of stitch before applying  a skin ointment and surgical dressing, I stopped and removed the mask from his face and felt his breath clearly as as lifted this chin and head  a bit for unobstructed breathing. About 15 mins later his breathing pattern also changed slightly, When I pinched his ear lobule he responded with movement of hands after a while the boy cried a kind of soft moan. In another 5 mins he cried. Thats when I gave a sigh of relief. My patient is OK, and I remembered the age old dictum, “Patient cries ,Anaesthetist Laughs” .

Prof Naik who by that time had removed his OT dress and gloves, came in looked at the patient then looked up at me, said with his style of a smile “That was a good going, very good”. He felt his pulse , “How long it will be for recovery?”. 

“May be 15-20 mins, we will shift him to his room”, I responded. “OK then”, he said

 I asked the patient to be shifted to the cabin, Parents were happy to see their boy but still a little gloomy as the boy was still sleeping .We put him to  one side (lateral position), to have a better breathing as well as prevent  any aspiration if there is vomiting. Vomiting is very common after ether Anaesthesia. We also told the parents and watching sister that this happens during recovery of Anaesthesia. The parents had a lot of querries in their eyes, when the surgeon came in. He felt his radial pulse and checked his bandage. 

He declared, “The operation has gone well, There  is no bleeding, everything is fine”.

Wheather he addressed  to all medical staff or to the patients attendants difficult to say. The father bent to touch the feet of the surgeon. After Prof Naik left the father appeared to be satisfied.

I also confirmed,” Do not worry everything is fine”.

I advised, to give an injection of Pethidine  and Phenergan  intra muscular after complete recovery. IV fluids and Antibiotics were domain of surgeon. 

"He will sleep for next 6 hours with these", I told the parents.

 I left the room and came to doctors chamber along with Dr Mohanty. Soon a cup of  tea was served which I finished in two three gulps as it was nearly cold now. While chit chatting on some other things Dr Mohanty unlocked and opened his drawer , brought out a fifty rupees note as my professional fees. That was my first professional earning, which I put it in my pocket happily and carefully. I  thanked Dr Mohanty. 

Even though I had adminstered anaesth to patients being operated by many other professors in Medical College, at Cuttack , independently, that was a different experience for me, not because of the money I earned but administered anaesthesia to a patient operated by Prof Naik outside the Govt hospital. Prof Naik was a different and respected surgeon all over Odisha. Dr Morton the inventor of Anaesthesia must have felt like that in October 1846, a victory.

Note: Some names changed. Now I understand after a visit to USA hospital, sometimes an anaesthetist fees are more than the surgeons.

Analysis of Life after Deathg: NDE

                   


                         The topic is NDE- an analysis of LIFE after Death   

Dear Reader click on the link  and watch the VDO till end to learn about Life after death.
Please leave a comment .



                       

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Very large p wave ..in LEG monitor for diagnosis of correct cvp line placement

This ECG with extra large p wave can be seen only when you place your lead in the Right atrium.
Therefore when one inserts the CuP line from the sub clavian vein this is one of the good ways to know that the tip of the CVP is in RA. Very rarely the CVP tip may go upwards or to opposite side of sub clavian vein which can be detected only by an X-Ray chest later on.
Another way to know correct placement is by detection of an supra ventricular extra systole when the guide were is manipulated.
A third method is to connect the CVP to a pressure transducer and detect typical upward "abc" and downward "xy" waves.