Clinical Focus

  • Anesthesia

Academic Appointments

Professional Education

  • Residency:All India Institute of Medical Science (2006) India
  • Fellowship, University of Washington, WA (2012)
  • Fellowship:Northwestern McGaw (2011) IL
  • Internship:Bangalore Medical College (2001) India
  • Medical Education:Bangalore Medical College (2001) India


Journal Articles

  • Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation does not worsen neurologic outcome. Anesthesia and analgesia Bebawy, J. F., Zeeni, C., Sharma, S., Kim, E. S., Dewood, M. S., Hemmer, L. B., Ramaiah, V. K., Bendok, B. R., Koht, A., Gupta, D. K. 2013; 117 (5): 1205-1210


    When temporary arterial occlusion of the parent artery is difficult for anatomical reasons, or when inadvertent aneurysmal rupture occurs during surgical dissection, adenosine administration can be used to produce flow arrest and brief, profound systemic hypotension that can facilitate intracranial aneurysm clip ligation. There is a concern, however, that the flow arrest and profound hypotension produced by adenosine, although brief, may cause cerebral ischemia and therefore worsen neurologic outcome compared with other techniques to facilitate aneurysm clip ligation. Therefore, we performed a retrospective, case-control study to determine whether adenosine-induced flow arrest had negative effects on the neurologic outcome of our patients.We reviewed the perioperative records of all patients in our intracranial aneurysm surgery outcomes database between August 1, 2006, and June 15, 2012. The primary outcome was the presence or absence of a poor neurologic outcome 48 hours after surgery, with a modified Rankin scale score >2 being defined as a poor neurologic outcome. The neurologic outcome at the time of hospital discharge was a secondary outcome. Secondary outcomes related to cardiac morbidity included atrial or ventricular arrhythmia requiring treatment and elevated cardiac biomarkers consistent with ischemia (i.e., Troponin-I).During the study period, adenosine-induced flow arrest was used in 72 of the 413 patients (17.4%) who underwent intracranial aneurysm clip ligation. The difference in the incidence of poor neurological outcome, with or without the use of adenosine, was no larger than 15.7% at 48 hours after surgery (P =0.524) or -12.7% at discharge (P = 0.741). In addition, the difference in the incidence of cardiac morbidity was no larger than -16.0% for persistent arrhythmia (P = 0.155) or -9.4% for biomarkers of myocardial ischemia (P = 0.898) in the initial 48 hours after surgery.When used to facilitate intracranial aneurysm clip ligation, adenosine-induced flow arrest was associated with no more than a 15.7% increase or a 12.7% decrease in the incidence of a poor neurologic outcome at either 48 hours or at the time of hospital discharge. In addition, adenosine use was not associated with cardiac morbidity in the perioperative period (i.e., persistent arrhythmia or biomarkers of cardiac ischemia).

    View details for DOI 10.1213/ANE.0b013e3182a6d31b

    View details for PubMedID 24108260

  • Prevention of perioperative and anesthesia-related complications in facial cosmetic surgery. Facial plastic surgery clinics of North America Nekhendzy, V., Ramaiah, V. K. 2013; 21 (4): 559-577


    Although office-based anesthesia for facial cosmetic surgery remains remarkably safe, no anesthesia or sedation performed outside the operating room should be considered minor. Proper organization, preparation, and patient selection, close collaboration with the surgeon, and expert and effective anesthesia care will increase patient safety and improve perioperative outcomes and patient satisfaction. This article presents a comprehensive overview of anesthesia in terms of facial plastic surgery procedures, beginning with a broad review of essentials and pitfalls of anesthesia, followed by details of specific anesthetic agents, their administration, mechanism of action, and complications.

    View details for DOI 10.1016/j.fsc.2013.07.011

    View details for PubMedID 24200375

  • Admission oxygenation and ventilation parameters associated with discharge survival in severe pediatric traumatic brain injury CHILDS NERVOUS SYSTEM Ramaiah, V. K., Sharma, D., Ma, L., Prathep, S., Hoffman, N. G., Vavilala, M. S. 2013; 29 (4): 629-634


    Current Brain Trauma Foundation guidelines recommend avoiding hypoxemia after severe pediatric traumatic brain injury (TBI). Yet, recent studies on optimum admission oxygenation and ventilation parameters associated with discharge survival in pediatric TBI are lacking.After IRB approval, a retrospective study involving pediatric patients ages ≤14 years with severe TBI (head Abbreviated Injury Scale (AIS) score of ≥3, Glasgow Coma Scale score of ≤8 on admission) admitted to Harborview Medical Center (level 1 pediatric trauma center), Seattle, WA, during 2003 to 2007 was performed. Admission demographics, clinical data, and laboratory characteristics were abstracted. Hypoxemia was defined as PaO2 < 60 mmHg, hypocarbia was defined as PaCO2 ≤ 35 mmHg, and hypercarbia was defined as PaCO2 ≥ 46 mmHg.One hundred ninety-four patients met inclusion criteria of which 162 (83.5 %) patients survived. Admission hypoxemia occurred in nine (5.6 %) patients who survived and eight (25 %) patients who died (p < 0.001). Children with admission PaCO2 between 36 and 45 mmHg had greater discharge survival compared with those with both admission hypocarbia (PaCO2 ≤ 35 mmHg) and hypercarbia (PaCO2 ≥ 46 mmHg). Admission PaO2 301-500 mmHg (adjusted odds ratio (AOR), 8.02 (95 % confidence interval (CI), 1.73-37.10); p = 0.008) and admission PaCO2 = 36-45 mmHg (AOR, 5.47 (95 % CI, 1.30-23.07); p = 0.02) were independently associated with discharge survival.Discharge survival after severe pediatric TBI was associated with admission PaO2 301-500 mmHg and PaCO2 = 36-45 mmHg. Admission hypocarbia and hypercarbia were each associated with increased discharge mortality.

    View details for DOI 10.1007/s00381-012-1984-5

    View details for Web of Science ID 000316127800014

    View details for PubMedID 23207977

  • The Effect of Furosemide on Intravascular Volume Status and Electrolytes in Patients Receiving Mannitol: An Intraoperative Safety Analysis JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY Bebawy, J. F., Ramaiah, V. K., Zeeni, C., Hemmer, L. B., Koht, A., Gupta, D. K. 2013; 25 (1): 51-54


    Mannitol is often used during intracranial surgery to improve surgical exposure. Furosemide is often added to mannitol to augment this effect. The concern exists, however, that the augmented diuresis caused by the addition of furosemide to mannitol may cause hypovolemia and hypoperfusion, hypokalemia, and hyponatremia. We examined the intraoperative safety of low-dose furosemide (0.3 mg/kg) combined with mannitol (1 g/kg).We observed 23 patients in a double-blind, block randomized, placebo-controlled study to examine the effects of furosemide (0.3 mg/kg) when combined with mannitol (1 g/kg) on surgical brain relaxation for tumor surgery. Mannitol and the study drug (furosemide or placebo) were administered, and arterial blood gases with electrolytes (sodium, potassium, and lactic acid) and urine output volume were recorded every 30 minutes for 3 hours. Plasma sodium, potassium, and lactic acid concentrations, and interval urine outputs, were compared across time and between furosemide-placebo assignment groupings, with a P<0.01 considered significant.Although mannitol produced a large volume of diuresis (1533±335 mL), the addition of a low dose of furosemide substantially increased both the rate of production of urine for the first 90 minutes after administration and the total volume of urine produced (2561±611 mL, P<0.001, compared with placebo group). The addition of furosemide did not produce a serum potassium level below 3.8±0.7 mEq/L, a serum sodium level below 128.3±3.4 mEq/L, or a serum lactic acid level above 2.4±0.9 mmol/L. There were no differences in the plasma potassium concentration, sodium concentration, or lactic acid concentration between the drug groups at any time point.Despite an increase in urine output by as much as 67%, adding low-dose furosemide to mannitol does not seem to produce significant electrolyte derangements or hypovolemia compared with the administration of mannitol alone.

    View details for DOI 10.1097/ANA.0b013e318269c335

    View details for Web of Science ID 000312561800007

    View details for PubMedID 23237936

  • Anesthesia implications of waterpipe use JOURNAL OF CLINICAL ANESTHESIA Kesner, K. L., Ramaiah, V. K., Hemmer, L. B., Koht, A. 2012; 24 (2): 137-140


    The waterpipe is an ancient Middle Eastern tobacco delivery system, which is also known as hookah, shisha, or narghile, and it is gaining widespread use. Waterpipes are often perceived as less dangerous than cigarettes. The amount of smoke inhaled in a waterpipe session may equal that produced by more than 100 cigarettes with high nicotine, carbon monoxide, and carcinogen intake. A case of significantly elevated intraoperative carboxyhemoglobin level and decreased oxyhemoglobin saturation in a patient with recent waterpipe use is presented.

    View details for DOI 10.1016/j.jclinane.2011.05.005

    View details for Web of Science ID 000301894600011

    View details for PubMedID 22414706

  • Clinical pharmacology of insulin confounds stroke trials ANNALS OF NEUROLOGY Bebawy, J. F., Ramaiah, V. K., Hemmer, L. B., Gupta, D. K. 2012; 71 (1): 148-148

    View details for DOI 10.1002/ana.22377

    View details for Web of Science ID 000299412200021

    View details for PubMedID 21425188

  • Damaged guidewire by the introducer needle tip while inserting central venous catheter in subclavian vein by supraclavicular approach. Saudi journal of anaesthesia Garg, R., Ramaiah, V. K., Chouhan, R. S. 2010; 4 (3): 210-212

    View details for DOI 10.4103/1658-354X.71576

    View details for PubMedID 21189864

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