nutch_noindex
CANCEL
/nutch_noindex

Radhamangalam Ramamurthi, MD

  • Radhamangalam J Ramamurthi

Specialties

Anesthesia

Work and Education

Professional Education

University of Madras, INDIA, 1988

Internship

Madras University Medicine, Madras, India, 1987

Residency

Basildon General Hospital, Basildon, UK, 1996

Walsgrave Hospitals, Coventry, United Kingdom, 2000

Board Certifications

Anesthesia, The Royal College of Anaesthetists

Services

Anesthesia

All Publications

Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network. Anesthesiology Walker, B. J., Long, J. B., Sathyamoorthy, M., Birstler, J., Wolf, C., Bosenberg, A. T., Flack, S. H., Krane, E. J., Sethna, N. F., Suresh, S., Taenzer, A. H., Polaner, D. M., Martin, L., Anderson, C., Sunder, R., Adams, T., Martin, L., Pankovich, M., Sawardekar, A., Birmingham, P., Marcelino, R., Ramarmurthi, R. J., Szmuk, P., Ungar, G. K., Lozano, S., Boretsky, K., Jain, R., Matuszczak, M., Petersen, T. R., Dillow, J., Power, R., Nguyen, K., Lee, B. H., Chan, L., Pineda, J., Hutchins, J., Mendoza, K., Spisak, K., Shah, A., DelPizzo, K., Dong, N., Yalamanchili, V., Venable, C., Williams, C. A., Chaudahari, R., Ohkawa, S., Usljebrka, H., Bhalla, T., Vanzillotta, P. P., Apiliogullari, S., Franklin, A. D., Ando, A., Pestieau, S. R., Wright, C., Rosenbloom, J., Anderson, T., Pediatric Regional Anesthesia Network Investigators 2018

Abstract

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.METHODS: This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.RESULTS: There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).CONCLUSIONS: The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.

View details for DOI 10.1097/ALN.0000000000002372

View details for PubMedID 30074928

Early experience with PECS 1 block for Port-a-Cath insertion or removal in children at a single institution. Journal of clinical anesthesia Munshey, F., Ramamurthi, R. J., Tsui, B. 2018; 49: 6364

View details for DOI 10.1016/j.jclinane.2018.06.010

View details for PubMedID 29894919

Bilateral continuous erector spinae plane blocks for sternotomy in a pediatric cardiac patient. Journal of clinical anesthesia Wong, J., Navaratnam, M., Boltz, G., Maeda, K., Ramamurthi, R. J., Tsui, B. C. 2018; 47: 8283

View details for DOI 10.1016/j.jclinane.2018.03.020

View details for PubMedID 29631111

Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy NEW ENGLAND JOURNAL OF MEDICINE Mercuri, E., Darras, B. T., Chiriboga, C. A., Day, J. W., Campbell, C., Connolly, A. M., Iannaccone, S. T., Kirschner, J., Kuntz, N. L., Saito, K., Shieh, P. B., Tulinius, M., Mazzone, E. S., Montes, J., Bishop, K. M., Yang, Q., Foster, R., Gheuens, S., Bennett, C. F., Farwell, W., Schneider, E., De Vivo, D. C., Finkel, R. S., CHERISH Study Grp 2018; 378 (7): 62535

Abstract

Nusinersen is an antisense oligonucleotide drug that modulates pre-messenger RNA splicing of the survival motor neuron 2 ( SMN2) gene. It has been developed for the treatment of spinal muscular atrophy (SMA).We conducted a multicenter, double-blind, sham-controlled, phase 3 trial of nusinersen in 126 children with SMA who had symptom onset after 6 months of age. The children were randomly assigned, in a 2:1 ratio, to undergo intrathecal administration of nusinersen at a dose of 12 mg (nusinersen group) or a sham procedure (control group) on days 1, 29, 85, and 274. The primary end point was the least-squares mean change from baseline in the Hammersmith Functional Motor Scale-Expanded (HFMSE) score at 15 months of treatment; HFMSE scores range from 0 to 66, with higher scores indicating better motor function. Secondary end points included the percentage of children with a clinically meaningful increase from baseline in the HFMSE score (3 points), an outcome that indicates improvement in at least two motor skills.In the prespecified interim analysis, there was a least-squares mean increase from baseline to month 15 in the HFMSE score in the nusinersen group (by 4.0 points) and a least-squares mean decrease in the control group (by -1.9 points), with a significant between-group difference favoring nusinersen (least-squares mean difference in change, 5.9 points; 95% confidence interval, 3.7 to 8.1; P<0.001). This result prompted early termination of the trial. Results of the final analysis were consistent with results of the interim analysis. In the final analysis, 57% of the children in the nusinersen group as compared with 26% in the control group had an increase from baseline to month 15 in the HFMSE score of at least 3 points (P<0.001), and the overall incidence of adverse events was similar in the nusinersen group and the control group (93% and 100%, respectively).Among children with later-onset SMA, those who received nusinersen had significant and clinically meaningful improvement in motor function as compared with those in the control group. (Funded by Biogen and Ionis Pharmaceuticals; CHERISH ClinicalTrials.gov number, NCT02292537 .).

View details for DOI 10.1056/NEJMoa1710504

View details for Web of Science ID 000425000000008

View details for PubMedID 29443664

Anaesthesia for Intestinal Obstruction in children http://www.anaesthesiauk.com/article.aspx?articleid=101005 Ramamurthi R J, Wilson C M
Nusinersen versus Sham Control in Infantile-Onset Spinal Muscular Atrophy. The New England journal of medicine Finkel, R. S., Mercuri, E., Darras, B. T., Connolly, A. M., Kuntz, N. L., Kirschner, J., Chiriboga, C. A., Saito, K., Servais, L., Tizzano, E., Topaloglu, H., Tulinius, M., Montes, J., Glanzman, A. M., Bishop, K., Zhong, Z. J., Gheuens, S., Bennett, C. F., Schneider, E., Farwell, W., De Vivo, D. C. 2017; 377 (18): 172332

Abstract

Spinal muscular atrophy is an autosomal recessive neuromuscular disorder that is caused by an insufficient level of survival motor neuron (SMN) protein. Nusinersen is an antisense oligonucleotide drug that modifies pre-messenger RNA splicing of the SMN2 gene and thus promotes increased production of full-length SMN protein.We conducted a randomized, double-blind, sham-controlled, phase 3 efficacy and safety trial of nusinersen in infants with spinal muscular atrophy. The primary end points were a motor-milestone response (defined according to results on the Hammersmith Infant Neurological Examination) and event-free survival (time to death or the use of permanent assisted ventilation). Secondary end points included overall survival and subgroup analyses of event-free survival according to disease duration at screening. Only the first primary end point was tested in a prespecified interim analysis. To control the overall type I error rate at 0.05, a hierarchical testing strategy was used for the second primary end point and the secondary end points in the final analysis.In the interim analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (21 of 51 infants [41%] vs. 0 of 27 [0%], P<0.001), and this result prompted early termination of the trial. In the final analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (37 of 73 infants [51%] vs. 0 of 37 [0%]), and the likelihood of event-free survival was higher in the nusinersen group than in the control group (hazard ratio for death or the use of permanent assisted ventilation, 0.53; P=0.005). The likelihood of overall survival was higher in the nusinersen group than in the control group (hazard ratio for death, 0.37; P=0.004), and infants with a shorter disease duration at screening were more likely than those with a longer disease duration to benefit from nusinersen. The incidence and severity of adverse events were similar in the two groups.Among infants with spinal muscular atrophy, those who received nusinersen were more likely to be alive and have improvements in motor function than those in the control group. Early treatment may be necessary to maximize the benefit of the drug. (Funded by Biogen and Ionis Pharmaceuticals; ENDEAR ClinicalTrials.gov number, NCT02193074 .).

View details for DOI 10.1056/NEJMoa1702752

View details for PubMedID 29091570

The Role of Sugammadex in Symptomatic Transient Neonatal Myasthenia Gravis: A Case Report. A & A case reports Rubin, J. E., Ramamurthi, R. J. 2017; 9 (9): 27173

Abstract

We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis.

View details for DOI 10.1213/XAA.0000000000000590

View details for PubMedID 28691986

Improving prediction of surgery duration using operational and temporal factors. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Kayis, E., Wang, H., Patel, M., Gonzalez, T., Jain, S., Ramamurthi, R. J., Santos, C., Singhal, S., Suermondt, J., Sylvester, K. 2012; 2012: 456-462

Abstract

Inherent uncertainties in surgery durations impact many critical metrics about the performance of an operating room (OR) environment. OR schedules that are robust to natural variability in surgery durations require surgery duration estimates that are unbiased, with high accuracy, and with few cases with large absolute errors. Earlier studies have shown that factors such as patient severity, personnel, and procedure type greatly affect the accuracy of such estimations. In this paper we investigate whether operational and temporal factors can be used to improve these estimates further. We present an adjustment method based on a combination of these operational and temporal factors. We validate our method with two years of detailed operational data from an electronic medical record. We conclude that while improving estimates of surgery durations is possible, the inherent variability in such estimates remains high, necessitating caution in their use when optimizing OR schedules.

View details for PubMedID 23304316

View details for PubMedCentralID PMC3540440

Improving electrical safety for patients with Epidermolysis bullosa PEDIATRIC ANESTHESIA Edler, A. A., Ramamurthi, R. J., Valenzuela, G. A. 2008; 18 (11): 1107-1109
The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction PEDIATRIC ANESTHESIA Seybold, J. L., Ramamurthi, R. J., Hammer, G. B. 2007; 17 (12): 1212-1214

Abstract

We report the use of dexmedetomidine for laryngoscopy, rigid bronchoscopy, and tracheal extubation in the operating room in two children who had undergone tracheal reconstruction 1 week previously. Dexmedetomidine in combination with propofol provided appropriately deep anesthesia during these brief but stimulating procedures without cardiovascular or respiratory depression.

View details for DOI 10.1111/j.1460-9592.2007.02346.x

View details for Web of Science ID 000250648300014

View details for PubMedID 17986042

Local anesthetic pharmacology in pediatric anesthesia Techniques in Regional Anesthesia and Pain Management R J Ramamurthi, Elliot J Krane 2007; 11 (4): 229-234
Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile PEDIATRIC ANESTHESIA Malviya, S., Voepel-Lewis, T., Ramamurthi, R. J., Burke, C., Tait, A. R. 2006; 16 (5): 554-559

Abstract

Emergence agitation (EA) is a common postoperative problem in young children who have received sevoflurane and isoflurane for general anesthesia. This randomized, double-blinded study evaluated the efficacy of intraoperative clonidine in reducing EA, and describes its recovery profile.With Institutional Review Board approval and informed consent, children undergoing brief, minimally painful procedures were studied. All children received preemptive analgesia with acetaminophen and ketorolac, sevoflurane for induction, and isoflurane for maintenance of anesthesia. Children received either 2 microg.kg(-1) clonidine or placebo intravenously (i.v.) following induction of anesthesia. Children were observed postoperatively for behavior and side effects, and their parents were telephoned the next day to determine postdischarge recovery characteristics.One hundred and twenty children were included in this study: 59 of whom received clonidine, and 61 placebo; 41% of those in the placebo group exhibited moderate-severe EA compared with only 22% of those in the clonidine group (P < 0.03). Compared with those who received placebo, children who received clonidine awakened more slowly (22 min vs 14 min), had a longer postanesthesia care unit stay (57 min vs 46 min), and experienced sleepiness more frequently after discharge (75% vs 39%; all comparisons significant at P < 0.03). There were no adverse cardiorespiratory events in either group.Findings demonstrate that i.v. clonidine administered after induction of anesthesia significantly reduces the incidence of EA in young children, but is associated with sleepiness postoperatively.

View details for DOI 10.1111/j.1460-9592.2006.01818

View details for Web of Science ID 000236769600009

View details for PubMedID 16677266

Acute gastric distension: a lesson from the classics HOSPITAL MEDICINE Ramamurthi, R. J., Tatman, A. 2001; 62 (3): 187-187

View details for Web of Science ID 000167622000019

View details for PubMedID 11291475