Anaesthesiology

At an age when most people prefer a quiet and retired life, 76-year-old Prashant (name changed) had a passion that defied conventions—riding heavy motorcycles. He had spent decades on the road, covering thousands of kilometers across the country on his Royal Enfield and Harley-Davidson. His passion for biking was more than a hobby; it was a way of life.

However, one unfortunate accident threatened to take away not just his passion but also his ability to walk. What followed was a challenging medical journey that tested his resilience and showcased the power of advanced orthopedic care at Kauvery Hospital, Marathahalli.

The Injury: A Life-Altering Accident

Prashant’s accident occurred during one of his usual long-distance rides. The impact was severe, leaving his knee in a state of complete instability. Unlike common knee injuries that involve damage to one ligament, his case was far more complex—three out of the four major ligaments in his knee were completely torn. This kind of multi-ligament injury is rare, especially in elderly individuals, and requires specialized surgical intervention.

The severity of the injury meant that walking was impossible. Prashant was completely wheelchair-bound for two weeks, struggling with the emotional toll of losing his independence. At his age, multi-ligament surgeries are not commonly performed due to concerns about poor tissue quality, longer healing times, and lower success rates. Many doctors advised conservative management, suggesting that surgery might not yield favorable results.

Determined to regain his mobility and continue his biking journey, Prashant sought expert help at Kauvery Hospital, where he met Dr. Raghu Nagaraj, Director of Orthopaedics, Sports Medicine, and Robotic Joint Replacement.

The Challenges: Age, Injury Complexity & Uncertain Outcomes

1. Age and Tissue Quality:
   Performing a multi-ligament reconstruction on a 76-year-old patient is highly challenging. The natural aging process leads to weaker ligaments, reduced healing capacity, and a greater risk of complications. The success rates of such surgeries are lower in older individuals, making it a rare and complex case.
2. Multi-Ligament Tear Complexity:
   Prashant’s injury wasn’t limited to just one ligament. Three out of four major knee ligaments were completely torn, making his knee highly unstable. Walking or even standing was impossible without external support. Traditional single-ligament repair methods wouldn’t be effective in such a case.
3. Need for Multiple Grafts:
   To reconstruct his knee, surgeons had to harvest grafts from three different parts of his body—the knee, ankle, and another lower limb region. This approach required extensive surgical expertise and careful planning to ensure the grafts would be strong enough to restore knee stability.
4. Risk of Post-Surgical Recovery Issues:
   At this age, post-operative complications like poor wound healing, joint stiffness, and muscle atrophy are major concerns. Rehabilitation can be slow, and long-term success is not always guaranteed.

Despite these challenges, Dr. Raghu and his team decided that surgery was the best option to restore Prashant’s mobility. Given his passion for biking and strong determination, they believed he could overcome the odds with the right medical care and rehabilitation.

The Surgical Approach: Multi-Ligament Arthroscopic Reconstruction

Prashant underwent a complex arthroscopic multi-ligament reconstruction surgery at Kauvery Hospital, Marathahalli. This minimally invasive approach allowed the team to reconstruct the damaged ligaments using grafts from different parts of his body.

Key Highlights of the Surgery:

✔️ Grafts were taken from three different sites (knee, ankle, and lower leg) to replace the torn ligaments.
✔️ Advanced arthroscopic techniques ensured precision in reconstruction.
✔️ Despite the patient’s age, the surgery was successfully completed without complications.
✔️ Minimally invasive techniques led to reduced post-surgery pain and faster recovery.

Post-surgery, Prashant was placed on an intensive rehabilitation protocol to help regain strength and mobility. His commitment to recovery was remarkable. He followed every physiotherapy session diligently, ensuring that his knee regained full function.

The Road to Recovery: From Wheelchair to Riding Again

The first two weeks after surgery were crucial. Prashant was initially dependent on assistive devices but showed significant improvement within the first month. He adhered to a structured physiotherapy and rehabilitation plan that focused on:

✔️ Strengthening exercises for knee stability

✔️ Range of motion (ROM) training to regain flexibility

✔️ Balance training to prevent falls

✔️ Gradual weight-bearing exercises

By the third month, he was able to walk independently and started light exercises to rebuild strength. His ultimate goal was clear—getting back on his bike.

At just four months post-surgery, Prashant made an inspiring comeback—he was back to riding his heavy motorcycles, something that even younger patients struggle to achieve after such an extensive procedure. His passion for biking, combined with his unwavering determination and Dr. Raghu’s expert surgical intervention, had given him a second chance at life.

Key Takeaways from the Case

✅ Age Is Just a Number: Despite being 76 years old, Prashant proved that determination and expert medical care can overcome physical limitations. His successful outcome challenges the notion that elderly patients cannot undergo complex knee surgeries.

✅ Arthroscopic Multi-Ligament Surgery Can Restore Mobility: This case highlights the effectiveness of multi-ligament reconstruction in restoring function, even in highly unstable knee injuries.

✅ Rehabilitation Is Key to Successful Recovery: Prashant’s commitment to physiotherapy played a crucial role in regaining full mobility. His adherence to post-surgical rehabilitation protocols ensured he could get back to his passion.

✅ Personalized Treatment Matters: Every patient is unique, and treatment approaches should be tailored to individual needs. In Prashant’s case, a multi-ligament reconstruction was the best choice, considering his lifestyle and passion.

Conclusion: A Story of Passion, Resilience & Medical Excellence

Prashant’s journey from being wheelchair-bound to riding his motorcycle again is a testament to the advancements in orthopedic surgery and the importance of perseverance.

His case stands as an inspiration for others who believe age limits their ability to recover from injuries. It also showcases Kauvery Hospital’s expertise in handling complex orthopedic cases, providing personalized care, and helping patients regain their independence.

"This is one of the most complex surgeries we have performed. Given his age and the severity of the injury, success was uncertain. But Prashant’s passion and determination made all the difference. This case proves that with the right medical care, even the most challenging conditions can be overcome." — Dr. Raghu Nagaraj

With his knees fully functional, Prashant is back on the road, riding with the same enthusiasm he had decades ago—proving that passion knows no age limits.

At just 16 years old, Usha’s world was disrupted by a devastating knee injury. A simple accident led to multiple ligament tears, failed surgeries, and an ongoing struggle with instability. Unable to walk without a brace, she endured immense physical and emotional challenges, including losing a year of college. However, her journey took a transformative turn when she sought expert care at Kauvery Hospital, Bengaluru, under the guidance of Dr. Mohan & Team. Today, she stands as a testament to the power of advanced medical intervention and perseverance.

The Initial Struggle: Failed Surgeries and Persistent Instability

A year ago, Usha suffered an injury to her right knee, tearing multiple ligaments. She underwent her first surgery at a nearby hospital, but within a month, her knee felt unstable. A second surgery was performed, followed by four months of physiotherapy and bracing. Yet, despite these interventions, her knee remained weak, preventing her from walking without assistance.

Determined to find a solution, her family sought further medical advice. Six months after her initial injury, Usha arrived at Kauvery Hospital, Bengaluru. Dr. Mohan & Team conducted a detailed examination and confirmed severe knee instability due to multiple ligament injuries that had not healed properly.

“She had torn at least four ligaments, all of which were lax, leading to significant instability,” explains Dr. Mohan. “She couldn’t walk without a brace, and every step made her knee pop out, making even basic activities a struggle.”

The Challenges of a Complex Reconstruction Surgery

Given the complexity of her case, undergoing a third surgery was a daunting decision for Usha and her family. “Performing a revision surgery, especially in such a young patient, comes with considerable risks,” says Dr. Mohan. “We had to explain the prognosis, potential complications, and surgical challenges in detail to ensure they were fully prepared.”

One of the biggest challenges was the need for four ligament reconstructions. In standard cases involving one or two ligaments, tissues are taken from the same knee. However, given Usha’s extensive injuries, grafts had to be harvested from her uninjured knee as well—a significant step requiring careful planning.

The Surgical Approach: LaPrade Technique for Multi-Ligament Reconstruction

The surgical team opted for the LaPrade technique, a highly specialized approach for reconstructing multiple ligaments in an anatomically precise manner. The major ligaments addressed included:

• Anterior Cruciate Ligament (ACL) – Reconstructed using an arthroscopic technique.
• Posterior Cruciate Ligament (PCL) – Repaired to restore posterior knee stability.
• Posterolateral Corner (PLC) Complex – Reconstructed to restore lateral stability, involving:

○ Lateral Collateral Ligament (LCL)

○ Popliteofibular Ligament

○ Popliteus Tendon

“Most surgeons reconstruct only two ligaments because addressing all three in the posterolateral corner makes the procedure much more complex,” says Dr. Mohan. “However, by using the LaPrade technique, we ensured precise anatomical reconstruction, giving her the best chance at a full recovery.”

Recovery: A Step-by-Step Rehabilitation Process

The surgery was successful, but the journey to recovery required patience and structured rehabilitation. For the first three weeks, Usha’s knee was completely immobilized, and she was instructed not to bear weight on it. Given the delicate nature of her reconstruction, her rehabilitation was closely monitored, and physiotherapy was arranged at home to ensure every movement was carefully executed.

By the 10-week follow-up, her progress was remarkable. “She is pain-free, walking without a brace, and has regained full range of motion,” shares Dr. Mohan. “Given the severity of her condition, achieving this outcome was truly significant.”

Overcoming the Odds: A New Beginning

Reflecting on her journey, Usha recalls, "Every day, I feared I might never stand on my own again. The pain, the uncertainty—it felt endless. But today, I walk without hesitation. The care I received at Kauvery Hospital gave me back more than just mobility; it gave me confidence. I'm ready to step forward into my future with strength and gratitude."

From being unable to walk independently to regaining full mobility, Usha’s journey is one of resilience and expert medical care. Today, she is preparing to return to college, reclaiming the life she had put on hold due to her injury.

“This case highlights the importance of specialized surgical expertise and a multidisciplinary approach to rehabilitation,” says Dr. Mohan. “With the right treatment and a dedicated team, even the most challenging cases can achieve successful outcomes.”

Her story serves as an inspiration, proving that timely medical intervention, advanced surgical techniques, and a structured rehabilitation plan can help individuals overcome severe injuries and regain their active lives. Usha’s determination, combined with the unwavering support of her family and the medical team, made all the difference in her incredible journey to recovery.

A Landmark Achievement in Pediatric Trauma Surgery at Kauvery Hospital

In a remarkable feat of surgical expertise, Kauvery Hospital successfully performed a laparoscopic repair of a diaphragmatic injury in an 11-year-old girl who sustained severe polytrauma following a road traffic accident. This case underscores the advancements in minimally invasive surgery (MIS) and pediatric trauma care, setting a benchmark for future trauma management.

The Accident That Changed Everything

Sony (name changed), an 11-year-old girl, was rushed to the emergency department after suffering multiple injuries in a road accident. The extent of her trauma was critical, including:

• Degloving injury to the right lower abdomen and thigh.
• Fractures in the right pubic rami and sacral ala.
• Multiple rib fractures and hemopneumothorax (air and blood accumulation in the chest cavity).
• Severe kidney injury with internal bleeding in the abdominal cavity.

Given the complexity of her injuries, the medical team at Kauvery Hospital acted swiftly. The immediate interventions included chest tube insertion to treat the lung injury and ventilatory support to stabilize her condition. Additionally, she underwent wound debridement, split-thickness skin grafting (SSG), and vacuum-assisted closure (VAC) dressing for her lower limb injury. She was then closely monitored in the intensive care unit (ICU).

A Hidden Threat – The Diaphragmatic Tear

Despite initial stabilization, further evaluation through a CT scan uncovered a posterior diaphragmatic tear, causing the stomach fundus to herniate into the chest cavity. This rare and often missed injury posed a significant risk of respiratory distress and gastrointestinal complications.

Recognizing the urgency of the situation, the surgical team opted for a minimally invasive laparoscopic approach to repair the crushed crus of the diaphragm. This decision was driven by the need to minimize surgical trauma and expedite recovery.

Executing a High-Risk Laparoscopic Surgery

The surgical team, led by Dr. Ganesh Shenoy, employed five laparoscopic ports to access and repair the damaged diaphragm. The intricate procedure involved:

• Exposing the diaphragmatic hiatus by carefully dividing the blood vessels supplying the stomach’s greater curvature.
• Identifying the full extent of the injury, which included blood accumulation behind the spleen and a severely crushed left diaphragmatic crus.
• Repositioning the herniated stomach back into the abdominal cavity.
• Performing a cruroplasty, suturing the damaged left crus to the opposite side using non-absorbable sutures in a tension-free manner.
• Gastropexy, securing the stomach to the anterior abdominal wall to prevent future migration into the chest.

The entire high-risk procedure was completed laparoscopically, demonstrating the hospital’s expertise in complex pediatric trauma surgery.

Swift Recovery and a New Lease on Life

Post-surgery, Sony was closely monitored in the ICU. Remarkably, she was able to tolerate oral feeds within 24 hours, and by the second day, she was successfully extubated. Her steady recovery enabled an early discharge, with stable vitals and an optimistic prognosis.

Dr. Ganesh Shenoy reflected on this milestone, stating, “Laparoscopic repair in a severely injured child is an enormous challenge. The presence of multiple injuries heightened the risk, but our team’s precision and expertise ensured the best possible outcome. Her rapid recovery is a testament to the advantages of minimally invasive surgery.”

Overcoming Surgical Challenges

This pioneering laparoscopic approach was not without its challenges:

• Polytrauma complications: Managing multiple injuries, including pelvic fractures and soft tissue damage, required careful intraoperative planning.
• Lung injury and chest tube presence: Persistent air leakage limited the operative field.
• Hidden diaphragmatic injury: The posterior location of the tear required a high index of suspicion and meticulous exploration.
• Restricted movement due to concurrent injuries: The thigh and abdominal trauma made laparoscopic instrument maneuverability more complex.

A Defining Moment in Pediatric Trauma Care

This case redefines the role of laparoscopy in pediatric trauma, proving that minimally invasive techniques can be safely applied even in severely injured young patients.

Dr. Ganesh Shenoy highlighted the significance of this achievement: “This was more than just saving a life; it was about preserving the patient’s future. The laparoscopic approach significantly reduced post-surgical pain, minimized scarring, and accelerated recovery, ensuring she could return to normal life much sooner.”

With continuous advancements in trauma surgery, cases like Sony’s pave the way for safer, faster, and more effective treatment options, offering young trauma victims a brighter and healthier future.

Conclusion

The successful laparoscopic repair of this 11-year-old polytrauma patient represents a turning point in pediatric trauma care. Kauvery Hospital’s commitment to cutting-edge surgical techniques and expert decision-making reinforces its position as a leader in life-saving innovations.

With such breakthroughs, the future of minimally invasive surgery in pediatric trauma cases looks promising, offering young patients not just survival, but a quality life post-recovery.

In a remarkable feat of medical expertise and coordinated critical care, doctors at Kauvery Hospital, Marathahalli, successfully saved the life of a 28-year-old woman who was battling severe bisoprolol toxicity—a condition that pushed her into multi-organ failure and cardiogenic shock. The young woman, who had intentionally overdosed on the beta-blocker bisoprolol, had already endured five days of intensive treatment at another hospital, but her condition continued to deteriorate despite high-dose insulin therapy, ventilator support, and dialysis.

Faced with a grim prognosis, her family approached Dr Harish Mallapura Maheshwarappa (Director Institute of Critical Care Medicine, Kauvery Hospitals, Bengaluru) and made a desperate decision—to shift her to Kauvery Hospital, Marathahalli, a leading center for ECMO and critical care. The transfer was a high-risk endeavor, but what followed was nothing short of a medical miracle.

A Race Against Time

By the time she reached Kauvery Hospital, the patient was in severe shock, dependent on triple inotropic support, struggling with 100% oxygen dependency, and experiencing severe metabolic acidosis due to acute pulmonary edema and acute kidney injury (AKI). She had already undergone SLED dialysis twice at the referring hospital, but her kidney function had not improved.

Recognizing the urgency of the situation, Dr. Harish and ECMO critical care team (Dr Abbas, Dr Gururaj, Dr Shridhar, Dr Goura and Dr Ashwini) along with the ER, CTVS, and nephrology teams, immediately sprang into action. Within minutes of her arrival, the patient was initiated on Veno-Arterial (V-A) ECMO support via femoro-femoral cannulation.

“Given the severity of her condition, this was her only chance. We knew the risks, but we had to act fast,” said Dr. Harish M.M.

Managing Complications: The Battle for Survival

While ECMO stabilized her hemodynamics, it was far from smooth sailing. The patient developed Harlequin Syndrome (North-South Syndrome)—a dangerous ECMO complication where oxygenated and deoxygenated blood mix, leading to differential hypoxia in the body. In most cases, this necessitates a switch to Veno-Arterial-Venous (V-AV) ECMO, but the team at Kauvery Hospital took a calculated risk.

Instead of transitioning to a hybrid ECMO setup, they aggressively managed fluid removal, tolerated higher PEEP (positive end-expiratory pressure) and peak airway pressures, and carefully monitored her oxygenation levels. The approach paid off—her oxygenation improved rapidly, and she avoided hybrid ECMO altogether.

The Turning Point: Beating the Odds

Once her lung function stabilized, the medical team focused on weaning her off ECMO. After five days, she was successfully decannulated, and by day seven, she was extubated—a remarkable recovery given the initial prognosis.

However, new challenges emerged. The patient developed sepsis (Klebsiella pneumonia, Staphylococcal bacteremia) and experienced severe coagulopathy, thrombocytopenia, and massive bleeding from her gastrointestinal tract, oral cavity, and cannula sites. The CTVS team had to perform bedside surgical re-exploration and hematoma evacuation, while massive blood transfusions were administered to correct her coagulation abnormalities.

Despite these complications, her body gradually fought back. With continuous dialysis for three days, her kidney function recovered, and her multi-organ dysfunction started reversing.

The Road to Recovery

After three weeks in the hospital, the young woman walked out of Kauvery Hospital, ready to resume her normal life. Though she developed critical illness myopathy, physiotherapy and rehabilitation ensured that she regained her strength.

“Her recovery is a testament to the power of advanced critical care and ECMO expertise. Cases like this highlight the importance of early intervention, a multidisciplinary approach, and precise clinical judgment,” said Dr. Harish, reflecting on the case.

A Testament to Excellence in ECMO Care

The successful management of this case underscores Kauvery Hospital’s leadership in advanced ECMO and critical care. The hospital’s ECMO program, led by Dr. Harish M.M with Dr. Mohammad Abbas, Dr Rajesh, Dr. Chiran, Dr Vikas, Dr Mahendra was instrumental in ensuring the patient’s survival. The ER team (Dr. Surendar), CTVS team (Dr. Rajesh, Dr. Vikas), perfusionist team (Mr Tejas), and nephrology team (Dr. Ravindra and Dr. Nishchay) played a crucial role in her round-the-clock care.

Beyond the technical excellence, the case demonstrated Kauvery Hospital’s commitment to holistic patient care—where advanced technology meets expert clinical decision-making and compassionate care.

Today, the 28-year-old survivor is back on her feet, expected to return to work in the coming weeks. From the brink of death to a new lease on life, her journey is a story of resilience, teamwork, and medical brilliance—a reminder that even in the darkest hours, hope prevails.

A 32-year-old gentleman who is an IT professional was leading a normal life until he noticed an unusual swelling on his scalp. Concerned, he underwent a routine scan to investigate the swelling, only to discover a far more serious issue—a 3x3cm size brain tumor.

Incidental Finding of a Brain Tumor

Although the swelling turned out to be a benign external condition, the scan revealed a tumor in the left frontal region of his brain. What made this case particularly challenging was the tumor’s deep-seated location, which was close to the area controlling his speech. The location of the tumor close to the speech area posed a significant risk during surgery, which, in traditional surgical methods, could impair his ability to speak.

Recognizing the complexity of the case, he sought treatment at Kauvery Hospital, Electronic City, Bangalore, where he was evaluated by our neurosurgical team led by Dr. Sumana Pallegar, Dr. Ganesh Veerabhadraiah, Dr. Manjunath H G and Dr Vivek(Anesthesiologist).

A High-Risk Decision: Awake Craniotomy with Speech Mapping

Given the tumor’s location, the doctors recommended an Awake Craniotomy, a brain tumor surgery with Real-Time Speech Mapping, a novel procedure designed to ensure the patient's speech function remained intact at the end of surgery.

Dr. Sumana, Senior Consultant, Neurosurgery (Brain & Spine), Kauvery Hospital, Electronic City, explained:
"When a tumor is located close to the brain’s speech center, performing surgery under general anesthesia carries the risk of causing permanent speech impairment. By keeping the patient awake, we can actively monitor and test his speech function in real time, ensuring we remove the tumor maximally while preserving his speech function."

The Complexity of Awake Brain Surgery

Awake craniotomy is a highly specialized brain tumor medical procedure that requires not only expert surgical skills but also a highly cooperative patient. Since brain tissue itself does not have pain receptors, the surgery is performed under local anesthesia, numbing only the scalp and skull. The patient remains awake and responsive throughout the surgery.

Dr. Sumana elaborated:
"For an awake craniotomy, mental preparation is crucial. The patient needs to be psychologically ready to remain conscious and co-operative while we are opening his skull and removing the tumor. In this case, he was incredibly cooperative, engaging with us throughout the procedure—even making jokes!"

Advanced Surgical Techniques Used

The team at Kauvery Hospital employed multiple advanced neurosurgical techniques to ensure precision and safety:

1. Real-Time Speech Mapping – Helped in maximal tumor resection while completely preserving his speech including his comprehension, articulation, fluency and speech production.
2. Intraoperative Neuro-Navigation – A GPS-like system to accurately localize the location of the tumor and to differentiate tumor tissue from normal brain tissue.
3. Fluorescein-Guided Tumor Resection – The use of special dyes that highlight tumor cells under blue light of the microscope, ensuring precise and maximal tumor removal.
4. Continuous Motor mapping – Allowed real-time assessment of the patient's movements of the limbs during tumor excision.

A Remarkable Recovery

Despite the complexity of the procedure, the patient remained awake and alert during surgery. The team meticulously removed the tumor while continuously testing his speech.

"Throughout the procedure, he was actively conversing with us. We were able to remove the tumor from the deeper portion also, without damaging his speech areas," added Dr. Sumana.

Astonishingly, during the surgery, he was cracking jokes & singing along with the hospital staff. He walked out of the Operating room to the ICU without assistance, much to the disbelief of his family.

Final Diagnosis and Next Steps

The pathology report confirmed the tumor was predominantly Grade 2 with focal Grade 3 features, meaning he would require further radiation therapy and brain tumor medication as part of his treatment plan. However, thanks to the extensive tumor removal achieved through awake craniotomy, his prognosis has significantly improved.

"The best treatment for such cases is to remove as much of the tumor as safely possible. Because we performed the surgery while he was awake, we were able to ensure maximal tumor resection without impairing his neurological functions," explained Dr. Sumana.

Conclusion: A Life Transformed

The expertise of the neurosurgical team at Kauvery Hospital, coupled with cutting-edge technology, enabled this young man to return to his normal life with preserved speech, mobility, and cognitive function. His journey serves as a testament to the life-changing impact of modern neurosurgery and patient-centered care at Kauvery Hospital, a leading brain hospital in Bangalore.

He left the hospital grateful, pain-free, and optimistic about his future, proving that even the most challenging brain tumors can be successfully treated with the right approach.