Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000818
M. Elhamamsy, Hoda Hafez Bahi Eldin, Yahia Mahmoud, M. Hamed, Rana Ahmed Abdel-Ghaffar
Background: Cardioplegia is the solution used to arrest and protect the heart during aortic cross-clamping. Crystalloid and blood cardioplegia are both widely used in clinical practice. Custodial-HTK solution is an intracellular cardioplegic solution containing histidine, tryptophan and ketoglutarate. Aim: we compared the myocardial protective effects of 3 types of cardioplegia solution: The histidine–tryptophan– ketoglutarate (HTK) solution, blood and St.Thomas cardioplegia in pediatric cardiac surgery. Settings and Design: This study design was a prospective randomized controlled double blinded clinical study. Patients and Methods: 60 children aged 3-10 yrs of either sex who underwent elective cardiac surgery for acyanotic heart diseases using cardiopulmonary bypass were randomly allocated to three groups each one 20 patients: Group A received HTK cardioplegia. Group B received blood cardioplegia. Group C received St, Thomas cardioplegia. Hemodynamic parameters, duration of CPB, aortic cross clamping and the whole surgical duration, mechanical ventilation duration and the length of ICU stay were measured. Venous blood samples were collected for measurement of cardiac marker proteins (CK-MB) and troponin (t). Uses of inotropic support were also recorded. Statistical Analysis Used: one-way ANOVA test and Chi-square test were used. Results: The main findings in our results were that troponin (t) levels were not statistically significant different among the study groups except that recorded 24 h, with the highest level was in the group (B) and the lowest one in the group (C). CK-MB levels also were not statistically significant different among the study groups except that recorded after 12 h the highest one in group (C) and the lowest one in group (B). Conclusion: Single dose of cold HTK cardioplegia in pediatric cardiac surgery is as effective as multiple doses of cold blood and crystalloid (St.Thomas) cardioplegia in protecting the myocardium.
{"title":"Comparative Study between Three Solutions for Cardioplegia in Pediatric Cardiac Surgery: Histidine-Tryptophan-Ketoglutarate (HTK) Solution, Blood Cardioplegia and Crystalloid (St. Thomas) Cardioplegia","authors":"M. Elhamamsy, Hoda Hafez Bahi Eldin, Yahia Mahmoud, M. Hamed, Rana Ahmed Abdel-Ghaffar","doi":"10.4172/2155-6148.1000818","DOIUrl":"https://doi.org/10.4172/2155-6148.1000818","url":null,"abstract":"Background: Cardioplegia is the solution used to arrest and protect the heart during aortic cross-clamping. Crystalloid and blood cardioplegia are both widely used in clinical practice. Custodial-HTK solution is an intracellular cardioplegic solution containing histidine, tryptophan and ketoglutarate. Aim: we compared the myocardial protective effects of 3 types of cardioplegia solution: The histidine–tryptophan– ketoglutarate (HTK) solution, blood and St.Thomas cardioplegia in pediatric cardiac surgery. Settings and Design: This study design was a prospective randomized controlled double blinded clinical study. Patients and Methods: 60 children aged 3-10 yrs of either sex who underwent elective cardiac surgery for acyanotic heart diseases using cardiopulmonary bypass were randomly allocated to three groups each one 20 patients: Group A received HTK cardioplegia. Group B received blood cardioplegia. Group C received St, Thomas cardioplegia. Hemodynamic parameters, duration of CPB, aortic cross clamping and the whole surgical duration, mechanical ventilation duration and the length of ICU stay were measured. Venous blood samples were collected for measurement of cardiac marker proteins (CK-MB) and troponin (t). Uses of inotropic support were also recorded. Statistical Analysis Used: one-way ANOVA test and Chi-square test were used. Results: The main findings in our results were that troponin (t) levels were not statistically significant different among the study groups except that recorded 24 h, with the highest level was in the group (B) and the lowest one in the group (C). CK-MB levels also were not statistically significant different among the study groups except that recorded after 12 h the highest one in group (C) and the lowest one in group (B). Conclusion: Single dose of cold HTK cardioplegia in pediatric cardiac surgery is as effective as multiple doses of cold blood and crystalloid (St.Thomas) cardioplegia in protecting the myocardium.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"3 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81618497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000808
Monika Dabgotra, J. Jacob, M. George, M. Mathew
Management of head injury requiring emergency craniotomy in a parturient is indeed challenging. Unexpectedly mild head injury can threaten the life of mother or fetus. A multidisciplinary approach to management which is individualized according to severity of injury and gestational age is appropriate. Neuroanaesthetic approach should strive to provide balance between therapy for mother and risks for fetus. Evidence based recommendations from randomized controlled trials to manage such cases is limited. We report a case of 27 year old woman in late 2nd trimester with extradural and subdural hematoma requiring urgent decompressive craniotomy. Post-operatively, she was managed for two days in the intensive care unit with regular monitoring of Fetal Heart Sound (FHS). Pregnancy continued till term with good outcome of mother and child.
{"title":"Anaesthetic Management of Traumatic Brain Injury in Pregnancy for Emergency Craniotomy","authors":"Monika Dabgotra, J. Jacob, M. George, M. Mathew","doi":"10.4172/2155-6148.1000808","DOIUrl":"https://doi.org/10.4172/2155-6148.1000808","url":null,"abstract":"Management of head injury requiring emergency craniotomy in a parturient is indeed challenging. Unexpectedly mild head injury can threaten the life of mother or fetus. A multidisciplinary approach to management which is individualized according to severity of injury and gestational age is appropriate. Neuroanaesthetic approach should strive to provide balance between therapy for mother and risks for fetus. Evidence based recommendations from randomized controlled trials to manage such cases is limited. We report a case of 27 year old woman in late 2nd trimester with extradural and subdural hematoma requiring urgent decompressive craniotomy. Post-operatively, she was managed for two days in the intensive care unit with regular monitoring of Fetal Heart Sound (FHS). Pregnancy continued till term with good outcome of mother and child.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"38 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83069201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000825
Gebremedhn Endale Gebreegziabher, H. Tawuye
Background: Airway management is a basic life-saving intervention which is used when the patient’s breathing effort is compromised due to various reasons. Postsurgical patients are at risk of developing airway problems due to co-morbidities, intraoperative complications, surgery and anaesthetic drug effects. The severity of illness, analgesic drugs like narcotics and postoperative standard of monitoring may impact on breathing process of the patients. We aimed to assess the magnitude of airway problems at the recovery room. Methods and material: Cross sectional study conducted at a referral hospital recovery room, 2014. Standardized checklist used for data collection. All patients with airway problem who admitted at the recovery room during the study period were included in the study. Descriptive statistics and Chi-square were used. Results: One hundred seventy seven patients developed airway problems over five months duration. Of these, 47.5%, 32.2%, and 20.3% patients developed mild, moderate and severe airway problems respectively. The major airway problems were desaturation (62.7%), respiratory arrest (14.7%), aspiration (18.1%), bronchospasm (3.4%) and laryngospasm (1.1%) respectively. Factors associated with severity of airway problems were ASA status (P=0.031), type of trauma (P=0.026), intraoperative analgesia (P=0.020) and type of patient (P=0.049). The interventions made were ETTI or LMA (35%) patients, nasopharyngeal airway insertion (21.5%), oral airway (14.1%), oxygen supplementation (10.2%), surgical airway (9.6%), recovery position (7.3%) and emergency airway manoeuvre (2.3%) respectively. Anaesthetists involved in airway management in 30.5% of patients. Conclusion: The magnitude of airway problem was high. We recommend the availability of well trained staff for airway management and fulfilment of basic equipments and drugs for patient monitoring and resuscitation. High airway problems are an alarm for the need for well-equipped recovery room with well trained staff, patient monitoring and resuscitation materials.
{"title":"Magnitude of Airway Problems at a University Teaching and Referral Hospital Recovery Room of Low Resource Setting-A Cross Sectional Study","authors":"Gebremedhn Endale Gebreegziabher, H. Tawuye","doi":"10.4172/2155-6148.1000825","DOIUrl":"https://doi.org/10.4172/2155-6148.1000825","url":null,"abstract":"Background: Airway management is a basic life-saving intervention which is used when the patient’s breathing effort is compromised due to various reasons. Postsurgical patients are at risk of developing airway problems due to co-morbidities, intraoperative complications, surgery and anaesthetic drug effects. The severity of illness, analgesic drugs like narcotics and postoperative standard of monitoring may impact on breathing process of the patients. We aimed to assess the magnitude of airway problems at the recovery room. Methods and material: Cross sectional study conducted at a referral hospital recovery room, 2014. Standardized checklist used for data collection. All patients with airway problem who admitted at the recovery room during the study period were included in the study. Descriptive statistics and Chi-square were used. Results: One hundred seventy seven patients developed airway problems over five months duration. Of these, 47.5%, 32.2%, and 20.3% patients developed mild, moderate and severe airway problems respectively. The major airway problems were desaturation (62.7%), respiratory arrest (14.7%), aspiration (18.1%), bronchospasm (3.4%) and laryngospasm (1.1%) respectively. Factors associated with severity of airway problems were ASA status (P=0.031), type of trauma (P=0.026), intraoperative analgesia (P=0.020) and type of patient (P=0.049). The interventions made were ETTI or LMA (35%) patients, nasopharyngeal airway insertion (21.5%), oral airway (14.1%), oxygen supplementation (10.2%), surgical airway (9.6%), recovery position (7.3%) and emergency airway manoeuvre (2.3%) respectively. Anaesthetists involved in airway management in 30.5% of patients. Conclusion: The magnitude of airway problem was high. We recommend the availability of well trained staff for airway management and fulfilment of basic equipments and drugs for patient monitoring and resuscitation. High airway problems are an alarm for the need for well-equipped recovery room with well trained staff, patient monitoring and resuscitation materials.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"74 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88981546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000860
Avinash Londhe, Madhu Chavan
Myasthenia gravis is a disease of great significance to the anesthesiologist, because it affects the neuromuscular junction. In this paper, we discuss the case of a 57 y. Old male patient with newly diagnosed myasthenia gravis who is scheduled for transsternal thymectomy. Anaesthesia for thymectomy in myasthenia is challenging. We have used a modern approach and have successfully done thymectomy under general anaesthesia avoiding need for intubation of trachea and most importantly avoiding use of muscle relaxant. We maintained adequate muscle relaxation with the use of inhalational agent (Sevoflurane) and anaesthetic dose of local anaesthetic through cervical epidural.
{"title":"Cervical Epidural Analgesia with Laryngeal Mask Airway Assisted Ventilation for Thymectomy in Myasthenia Gravis","authors":"Avinash Londhe, Madhu Chavan","doi":"10.4172/2155-6148.1000860","DOIUrl":"https://doi.org/10.4172/2155-6148.1000860","url":null,"abstract":"Myasthenia gravis is a disease of great significance to the anesthesiologist, because it affects the neuromuscular junction. In this paper, we discuss the case of a 57 y. Old male patient with newly diagnosed myasthenia gravis who is scheduled for transsternal thymectomy. Anaesthesia for thymectomy in myasthenia is challenging. We have used a modern approach and have successfully done thymectomy under general anaesthesia avoiding need for intubation of trachea and most importantly avoiding use of muscle relaxant. We maintained adequate muscle relaxation with the use of inhalational agent (Sevoflurane) and anaesthetic dose of local anaesthetic through cervical epidural.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91533563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000861
C. Fidkowski
Backgroundː Optimal analgesia post-cesarean delivery is essential to promote maternal recovery for the care of the newborn. Intravenous (IV) ketorolac is commonly administered as a part of multi-modal analgesia for cesarean delivery. Ketorolac pharmacokinetics is altered in pregnancy. The purpose of this study is to compare the efficacy of IV and intramuscular (IM) ketorolac for post-cesarean analgesia. Methodsː This study is a prospective, double blinded, randomized controlled trial to assess the efficacy of IV versus IM ketorolac administration on post-cesarean analgesia. Patients undergoing an elective cesarean delivery under spinal anesthesia were randomized to receive either 30 mg IV ketorolac (Group 30IV), 30 mg IM ketorolac (Group 30IM), or 60 mg IM ketorolac (Group 60IM). Primary outcomes include time to the first analgesic, total analgesic consumption, and pain scores. Secondary outcomes include patient satisfaction, opioid related side effects, and length of hospital stay. Resultsː The time to first break through pain was not statistically significant in the IM groups as compared to the IV group (Group 30IV 527 min, Group 30IM 578 min and Group 60IM 581 min). Pain scores and post-operative analgesic use did not differ significantly between groups. Secondary outcomes did not differ between groups. Conclusionsː IV and IM ketorolac are equally effective for post-cesarean analgesia.
{"title":"A Randomized Controlled Trial of Intravenous and Intramuscular Ketorolac for Post-Cesarean Analgesia","authors":"C. Fidkowski","doi":"10.4172/2155-6148.1000861","DOIUrl":"https://doi.org/10.4172/2155-6148.1000861","url":null,"abstract":"Backgroundː Optimal analgesia post-cesarean delivery is essential to promote maternal recovery for the care of the newborn. Intravenous (IV) ketorolac is commonly administered as a part of multi-modal analgesia for cesarean delivery. Ketorolac pharmacokinetics is altered in pregnancy. The purpose of this study is to compare the efficacy of IV and intramuscular (IM) ketorolac for post-cesarean analgesia. Methodsː This study is a prospective, double blinded, randomized controlled trial to assess the efficacy of IV versus IM ketorolac administration on post-cesarean analgesia. Patients undergoing an elective cesarean delivery under spinal anesthesia were randomized to receive either 30 mg IV ketorolac (Group 30IV), 30 mg IM ketorolac (Group 30IM), or 60 mg IM ketorolac (Group 60IM). Primary outcomes include time to the first analgesic, total analgesic consumption, and pain scores. Secondary outcomes include patient satisfaction, opioid related side effects, and length of hospital stay. Resultsː The time to first break through pain was not statistically significant in the IM groups as compared to the IV group (Group 30IV 527 min, Group 30IM 578 min and Group 60IM 581 min). Pain scores and post-operative analgesic use did not differ significantly between groups. Secondary outcomes did not differ between groups. Conclusionsː IV and IM ketorolac are equally effective for post-cesarean analgesia.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88027357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000871
A. Endo, Y. Kuwabara, K. Yamakawa, D. Sakamaki, A. Suzuki, I. Kondo, Y. Mio, S. Uezono
Backgrounds: Patients with obstructive sleep apnea (OSA) undergoing endoscopic sinus surgery (ESS) are considered at risk of postoperative respiratory complications because postoperative nasal packing often delays resumption of preoperative continuous positive airway pressure (CPAP) therapy. Our hospital implemented a policy in 2011 that all patients with OSA undergoing ESS be admitted to the intensive care unit (ICU) for at least 1 night for postoperative respiratory monitoring. We conducted the present study to evaluate the policy by examining the incidence of postoperative respiratory complications and to identify risk factors for postoperative respiratory complications in these patients. Methods: All patients with OSA scheduled for ESS from 2011 to 2015 were included in this retrospective chart review. Postoperative respiratory complication was defined as decrease of the percutaneous arterial oxygen saturation (SpO2) greater than 3% from each baseline or apnea for more than 20 seconds. We examined the incidence of respiratory complications and conducted multiple logistic regression analysis to determine risk factors for those of complications. Results: A total of 152 patients were analyzed. Postoperative respiratory complications were observed in 27 patients (17.8%) and the minimum value of SpO2 was 84%. None of these patients experienced severe sequelae. Multiple logistic regression analysis showed that preoperative CPAP use was an independent risk factor for postoperative respiratory complications (odds ratio=4.1; 95% CI=1.1–14.7). Conclusion: This retrospective study revealed a relatively high incidence of postoperative respiratory complications after ESS in patients with OSA. Our hospital policy of continuous respiratory monitoring in the ICU for at least 1 night postoperatively appears to be valid for these patients.
背景:阻塞性睡眠呼吸暂停(OSA)患者接受内窥镜鼻窦手术(ESS)被认为有术后呼吸并发症的风险，因为术后鼻腔填塞经常延迟术前持续气道正压(CPAP)治疗的恢复。我院于2011年实施了一项政策，即所有接受ESS治疗的OSA患者均需在重症监护病房(ICU)进行至少1晚的术后呼吸监测。我们进行了本研究，通过检查术后呼吸系统并发症的发生率来评估该政策，并确定这些患者术后呼吸系统并发症的危险因素。方法:回顾性分析2011 - 2015年所有计划进行ESS的OSA患者。术后呼吸并发症定义为经皮动脉血氧饱和度(SpO2)比每次基线下降大于3%或呼吸暂停超过20秒。我们检查了呼吸系统并发症的发生率，并进行了多元logistic回归分析，以确定并发症的危险因素。结果:共分析152例患者。术后出现呼吸系统并发症27例(17.8%)，SpO2最小值为84%。这些患者均未出现严重的后遗症。多元logistic回归分析显示术前使用CPAP是术后呼吸系统并发症的独立危险因素(优势比=4.1;95% CI = 1.1 - -14.7)。结论:本回顾性研究显示OSA患者ESS术后呼吸系统并发症发生率较高。我院术后在ICU持续呼吸监测至少1晚的政策似乎对这些患者有效。
{"title":"Preoperative Use of Continuous Positive Airway Pressure is related to Postoperative Respiratory Complications in Patients with Obstructive Sleep Apnea Undergoing Endoscopic Sinus Surgery","authors":"A. Endo, Y. Kuwabara, K. Yamakawa, D. Sakamaki, A. Suzuki, I. Kondo, Y. Mio, S. Uezono","doi":"10.4172/2155-6148.1000871","DOIUrl":"https://doi.org/10.4172/2155-6148.1000871","url":null,"abstract":"Backgrounds: Patients with obstructive sleep apnea (OSA) undergoing endoscopic sinus surgery (ESS) are considered at risk of postoperative respiratory complications because postoperative nasal packing often delays resumption of preoperative continuous positive airway pressure (CPAP) therapy. Our hospital implemented a policy in 2011 that all patients with OSA undergoing ESS be admitted to the intensive care unit (ICU) for at least 1 night for postoperative respiratory monitoring. We conducted the present study to evaluate the policy by examining the incidence of postoperative respiratory complications and to identify risk factors for postoperative respiratory complications in these patients. Methods: All patients with OSA scheduled for ESS from 2011 to 2015 were included in this retrospective chart review. Postoperative respiratory complication was defined as decrease of the percutaneous arterial oxygen saturation (SpO2) greater than 3% from each baseline or apnea for more than 20 seconds. We examined the incidence of respiratory complications and conducted multiple logistic regression analysis to determine risk factors for those of complications. Results: A total of 152 patients were analyzed. Postoperative respiratory complications were observed in 27 patients (17.8%) and the minimum value of SpO2 was 84%. None of these patients experienced severe sequelae. Multiple logistic regression analysis showed that preoperative CPAP use was an independent risk factor for postoperative respiratory complications (odds ratio=4.1; 95% CI=1.1–14.7). Conclusion: This retrospective study revealed a relatively high incidence of postoperative respiratory complications after ESS in patients with OSA. Our hospital policy of continuous respiratory monitoring in the ICU for at least 1 night postoperatively appears to be valid for these patients.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"19 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81610239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000833
M. Amin, D. Chin, Sima D. Amin, Anuradha Patel
Pulmonary agenesis is a rare congenital anomaly, which results in a complete absence in the development of lung tissue, bronchi, and pulmonary vessels. Pulmonary agenesis can occur on its own or it can often be found in conjunction with other congenital defects as part of VACTERL association. Anesthesia for patients with pulmonary agenesis can be challenging particularly when other defects or comorbidities exist. Here, we describe the successful anesthetic and ventilation management of a pediatric patient with right-sided unilateral pulmonary agenesis with VACTERL association.
{"title":"Anesthetic Challenges in a Child with Pulmonary Agenesis: A Case Report and Review of Literature","authors":"M. Amin, D. Chin, Sima D. Amin, Anuradha Patel","doi":"10.4172/2155-6148.1000833","DOIUrl":"https://doi.org/10.4172/2155-6148.1000833","url":null,"abstract":"Pulmonary agenesis is a rare congenital anomaly, which results in a complete absence in the development of lung tissue, bronchi, and pulmonary vessels. Pulmonary agenesis can occur on its own or it can often be found in conjunction with other congenital defects as part of VACTERL association. Anesthesia for patients with pulmonary agenesis can be challenging particularly when other defects or comorbidities exist. Here, we describe the successful anesthetic and ventilation management of a pediatric patient with right-sided unilateral pulmonary agenesis with VACTERL association.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"9 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90546219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000837
Wirinaree Kampitak, T. Werawatganon, K. Uerpairojkit, B. Songthamwat
Background: Multiple attempts at needle redirection for paramedian spinal anesthesia can lead to significant complications, particularly in elderly patients. We hypothesized that ultrasound guidance may reduce the need for redirection (s), the associated discomfort, and complications in conventional landmark-guided paramedian spinal anesthesia. Methods: A total of 70 patients >65 years of age, undergoing total knee or hip arthroplasty, were randomly assigned to pre-procedural ultrasound-guided paramedian (PP) or conventional surface landmark-guided paramedian (CP) approach groups. The paramedian approach was performed at L3-4 in the lateral decubitus position. Results: The median number of needle redirection attempts was significantly lower in group PP (2 (interquartile range (IQR) 1-2)) than in group CP (4 (IQR 2-8.5)) (P<0.001). The median number of needle insertion attempts was also significantly lower in group PP than in group CP (P=0.003). All patients in group PP underwent successful needle insertion at the 3-4 lumbar intrathecal space, while 7 in group CP required multiple interspinous space insertions for success (P=0.006). No patient in group PP experienced significant complications related to spinal anesthesia. However, 5 (13.9%), 1 (2.8%), and 7 patients (19.4%) in group CP experienced transient radicular pain, paresthesia, and traumatic puncture, respectively. Conclusion: Application of pre-procedural ultrasound guidance in paramedian spinal anesthesia in elderly patients resulted in a significant decrease in the number of needle redirection and insertion attempts, as well as a reduction in related complications compared with the conventional paramedian technique.
{"title":"Paramedian Spinal Anesthesia: Landmark vs. Ultrasound-guided Approaches","authors":"Wirinaree Kampitak, T. Werawatganon, K. Uerpairojkit, B. Songthamwat","doi":"10.4172/2155-6148.1000837","DOIUrl":"https://doi.org/10.4172/2155-6148.1000837","url":null,"abstract":"Background: Multiple attempts at needle redirection for paramedian spinal anesthesia can lead to significant complications, particularly in elderly patients. We hypothesized that ultrasound guidance may reduce the need for redirection (s), the associated discomfort, and complications in conventional landmark-guided paramedian spinal anesthesia. Methods: A total of 70 patients >65 years of age, undergoing total knee or hip arthroplasty, were randomly assigned to pre-procedural ultrasound-guided paramedian (PP) or conventional surface landmark-guided paramedian (CP) approach groups. The paramedian approach was performed at L3-4 in the lateral decubitus position. Results: The median number of needle redirection attempts was significantly lower in group PP (2 (interquartile range (IQR) 1-2)) than in group CP (4 (IQR 2-8.5)) (P<0.001). The median number of needle insertion attempts was also significantly lower in group PP than in group CP (P=0.003). All patients in group PP underwent successful needle insertion at the 3-4 lumbar intrathecal space, while 7 in group CP required multiple interspinous space insertions for success (P=0.006). No patient in group PP experienced significant complications related to spinal anesthesia. However, 5 (13.9%), 1 (2.8%), and 7 patients (19.4%) in group CP experienced transient radicular pain, paresthesia, and traumatic puncture, respectively. Conclusion: Application of pre-procedural ultrasound guidance in paramedian spinal anesthesia in elderly patients resulted in a significant decrease in the number of needle redirection and insertion attempts, as well as a reduction in related complications compared with the conventional paramedian technique.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"9 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86422209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000830
Halim Syahril, S. Gaus, Syafri K. Arif, Nur Surya Wirawan
Background: Cranioplasty restores the normal cranial architecture and protective functions of the skull and may play a role in normalizing cerebrospinal fluid dynamics in patients undergoing large craniectomies. It has a definitive impact on restoration of normal intracranial physiology and improvement of patient neurological condition. Anesthesia for awake neurosurgery procedure poses a unique challenge to anesthesiologists. Objective: To present cases of awake cranioplasty and describe the principles of anesthetic management during this procedure. Case description: 3 patients who have skull defect underwent cranioplasty procedure. Patients were managed with dexmedetomidine load of 1 mcg/kg over 10-15 min followed by infusion at rates of 0.2 mcg/kg/hr to 0.7 mcg/kg/hr and a local infiltration without airway instrumentation. Discussion: Awake cranioplasty offers great advantages with respect to patient outcome. In this type of procedure, the anesthesiologist’s goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake cranioplasty results. Dexmedetomidine is a highly specific α2 adrenoceptor agonist with sedative, analgesic, anesthetic sparing effect, awake if neither stimulated brain protection with no addiction effect nor suppress ventilation. Patients treated with dexmedetomidine will be sedated, comfortably but is easily aroused. Conclusion: Awake cranioplasty procedures were successfully performed with stable hemodynamic intraoperative and no complications during procedure. Dexmedetomidine has been shown to provide sedation and analgesia without significant respiratory depression and has been used successfully in these settings.
{"title":"Awake Cranioplasty: A Case Series","authors":"Halim Syahril, S. Gaus, Syafri K. Arif, Nur Surya Wirawan","doi":"10.4172/2155-6148.1000830","DOIUrl":"https://doi.org/10.4172/2155-6148.1000830","url":null,"abstract":"Background: Cranioplasty restores the normal cranial architecture and protective functions of the skull and may play a role in normalizing cerebrospinal fluid dynamics in patients undergoing large craniectomies. It has a definitive impact on restoration of normal intracranial physiology and improvement of patient neurological condition. Anesthesia for awake neurosurgery procedure poses a unique challenge to anesthesiologists. Objective: To present cases of awake cranioplasty and describe the principles of anesthetic management during this procedure. Case description: 3 patients who have skull defect underwent cranioplasty procedure. Patients were managed with dexmedetomidine load of 1 mcg/kg over 10-15 min followed by infusion at rates of 0.2 mcg/kg/hr to 0.7 mcg/kg/hr and a local infiltration without airway instrumentation. Discussion: Awake cranioplasty offers great advantages with respect to patient outcome. In this type of procedure, the anesthesiologist’s goal is to make the operation safe and effective and reduce the psychophysical distress of the patient. Personal experience, careful planning, and attention to detail are the basis for obtaining good awake cranioplasty results. Dexmedetomidine is a highly specific α2 adrenoceptor agonist with sedative, analgesic, anesthetic sparing effect, awake if neither stimulated brain protection with no addiction effect nor suppress ventilation. Patients treated with dexmedetomidine will be sedated, comfortably but is easily aroused. Conclusion: Awake cranioplasty procedures were successfully performed with stable hemodynamic intraoperative and no complications during procedure. Dexmedetomidine has been shown to provide sedation and analgesia without significant respiratory depression and has been used successfully in these settings.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"3 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78527763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.4172/2155-6148.1000857
C. Mateus, Marta Araujo, C. Mexêdo, H. Machado
Introduction: Renal autotransplantation (RAT) is an unusual but safe procedure that implies a combination of living nephrectomy and a standard renal transplantation in the same patient. Indications for surgery include treatment of vascular and urologic lesions, and less frequently nephrolithiasis or chronic flank pain. Objectives: Due to rarity of the procedure there are a few reports published and little is known about anesthetic management of these patients. The goal of this study is to describe all cases of renal autotransplantation, focusing on anesthetic management. Methods: A retrospective review of the records of all patients who underwent renal auto transplantation from 2002 to 2015 in Centro Hospitalar do Porto was performed. Demographic, anesthetic, surgical and postoperative data were collected. Results: A total of twenty-four patients underwent renal autotransplantation from 2002 to 2015, including two patients who underwent bilateral RAT. The most frequent indication for RAT was the presence of renal artery aneurysms and most patients underwent laparoscopic nephrectomy. High-grade complications according to ClavienDindo classification occurred in 16% of patients. Hypertension was the most frequent comorbidity among patients. Combined anesthetic techniques were used in 52% of cases. Median duration of anesthesia was 423 min. There were no anesthetic complications, apart from one patient with hypothermia at the end of the procedure. Conclusions: RAT is a reasonable option for selected patients. Others studies are needed in order to provide evidence if anesthetic management influences outcomes.
{"title":"Renal Autotransplantation and its Anesthetic Management: A Case Series in a Tertiary Hospital","authors":"C. Mateus, Marta Araujo, C. Mexêdo, H. Machado","doi":"10.4172/2155-6148.1000857","DOIUrl":"https://doi.org/10.4172/2155-6148.1000857","url":null,"abstract":"Introduction: Renal autotransplantation (RAT) is an unusual but safe procedure that implies a combination of living nephrectomy and a standard renal transplantation in the same patient. Indications for surgery include treatment of vascular and urologic lesions, and less frequently nephrolithiasis or chronic flank pain. Objectives: Due to rarity of the procedure there are a few reports published and little is known about anesthetic management of these patients. The goal of this study is to describe all cases of renal autotransplantation, focusing on anesthetic management. Methods: A retrospective review of the records of all patients who underwent renal auto transplantation from 2002 to 2015 in Centro Hospitalar do Porto was performed. Demographic, anesthetic, surgical and postoperative data were collected. Results: A total of twenty-four patients underwent renal autotransplantation from 2002 to 2015, including two patients who underwent bilateral RAT. The most frequent indication for RAT was the presence of renal artery aneurysms and most patients underwent laparoscopic nephrectomy. High-grade complications according to ClavienDindo classification occurred in 16% of patients. Hypertension was the most frequent comorbidity among patients. Combined anesthetic techniques were used in 52% of cases. Median duration of anesthesia was 423 min. There were no anesthetic complications, apart from one patient with hypothermia at the end of the procedure. Conclusions: RAT is a reasonable option for selected patients. Others studies are needed in order to provide evidence if anesthetic management influences outcomes.","PeriodicalId":15000,"journal":{"name":"Journal of Anesthesia and Clinical Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81256879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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