Airway bleeding is an uncommon complication of pulmonary artery surgery. It can be caused by fragile bronchopulmonary collateral, vessel perforation, and reperfusion pulmonary edema. Early discovery of the breach and anesthetic management are very important for the prognosis of the patients. We present a case of 58-year-old female diagnosed with left pulmonary artery mass. After the resection of the mass, the surgeon injected saline into the pulmonary artery and the patient was ventilated manually. Air bubbles were found in the artery, indicating a breach between the airways and the pulmonary circulation. Fiberoptic bronchoscopy revealed the breach on the lateral wall of the left lower bronchus. We replaced the single lumen endotracheal tube with a 32 left-sided double-lumen endobronchial tube to prevent the contamination of the right lung. After a consultation with the thoracic department, left lower lung lobectomy was performed.
{"title":"Anesthetic Management of a Case of Airway Bleeding During Pulmonary Artery Mass Resection","authors":"","doi":"10.54289/jaad2300101","DOIUrl":"https://doi.org/10.54289/jaad2300101","url":null,"abstract":"Airway bleeding is an uncommon complication of pulmonary artery surgery. It can be caused by fragile bronchopulmonary collateral, vessel perforation, and reperfusion pulmonary edema. Early discovery of the breach and anesthetic management are very important for the prognosis of the patients. We present a case of 58-year-old female diagnosed with left pulmonary artery mass. After the resection of the mass, the surgeon injected saline into the pulmonary artery and the patient was ventilated manually. Air bubbles were found in the artery, indicating a breach between the airways and the pulmonary circulation. Fiberoptic bronchoscopy revealed the breach on the lateral wall of the left lower bronchus. We replaced the single lumen endotracheal tube with a 32 left-sided double-lumen endobronchial tube to prevent the contamination of the right lung. After a consultation with the thoracic department, left lower lung lobectomy was performed.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"409 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122900575","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}
Vanishing lung syndrome is a rare radiological syndrome in which the lungs appear to be disappearing on x- ray due to giant bulla. Anaesthetic considerations in a patient with bullous lung disease undergoing a non-thoracic surgery are to prevent enlargement and rupture of bulla causing pneumothorax and maintaining adequate oxygenation and ventilation. We present a case of 62-year-old female with vanishing lung syndrome posted for cholecystectomy for symptomatic gall bladder stones. We decided to proceed with open cholecystectomy instead of laparoscopic procedure in view of giant bulla and severely impaired lung functions. Our plan of anaesthesia for open cholecystectomy was combined spinal and epidural anaesthesia which allowed us to avoid positive pressure ventilation, nitrous oxide, high airway pressures, coughing at extubation and sore throat concerns.
{"title":"Anaesthetic Management of a Case of Vanishing Lung Syndrome Undergoing Cholecystectomy","authors":"","doi":"10.54289/jaad2200111","DOIUrl":"https://doi.org/10.54289/jaad2200111","url":null,"abstract":"Vanishing lung syndrome is a rare radiological syndrome in which the lungs appear to be disappearing on x- ray due to giant bulla. Anaesthetic considerations in a patient with bullous lung disease undergoing a non-thoracic surgery are to prevent enlargement and rupture of bulla causing pneumothorax and maintaining adequate oxygenation and ventilation. We present a case of 62-year-old female with vanishing lung syndrome posted for cholecystectomy for symptomatic gall bladder stones. We decided to proceed with open cholecystectomy instead of laparoscopic procedure in view of giant bulla and severely impaired lung functions. Our plan of anaesthesia for open cholecystectomy was combined spinal and epidural anaesthesia which allowed us to avoid positive pressure ventilation, nitrous oxide, high airway pressures, coughing at extubation and sore throat concerns.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122055556","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}
{"title":"Sedation-Related Adverse Events in Gastrointestinal Endoscopy","authors":"","doi":"10.54289/jaad2200110","DOIUrl":"https://doi.org/10.54289/jaad2200110","url":null,"abstract":"","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116510870","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}
Also known as: Reflex Sympathetic Dystrophy Syndrome (RSDS) or Causalgia Complex regional pain syndrome (CRPS) is an uncommon nerve disorder. It causes intense pain, usually in the arms, hands, legs or feet. It happens after an injury, either to a nerve or to tissue in the affected area. Rest and time may only make it worse. Doctors are not sure what causes it. Symptoms in the affected area are Dramatic changes in temperature and color Intense burning pain Extreme skin sensitivity The cause of CRPS is unknown, and there is no cure. It can get worse over time, and may spread to other parts of the body. Occasionally it goes away, either temporarily or for good. Treatment focuses on relieving the pain, and can include medicines, physical therapy and nerve blocks. The Academy is a nonprofit professional organization serving clinicians, representing a broad number of disciplines, who treat people with pain. The Patients tab includes a pain management specialist locator and links to other resources.
{"title":"Complex Regional Pain Syndrome - CRPS","authors":"","doi":"10.54289/jaad2200109","DOIUrl":"https://doi.org/10.54289/jaad2200109","url":null,"abstract":"Also known as: Reflex Sympathetic Dystrophy Syndrome (RSDS) or Causalgia Complex regional pain syndrome (CRPS) is an uncommon nerve disorder. It causes intense pain, usually in the arms, hands, legs or feet. It happens after an injury, either to a nerve or to tissue in the affected area. Rest and time may only make it worse. Doctors are not sure what causes it. Symptoms in the affected area are Dramatic changes in temperature and color Intense burning pain Extreme skin sensitivity The cause of CRPS is unknown, and there is no cure. It can get worse over time, and may spread to other parts of the body. Occasionally it goes away, either temporarily or for good. Treatment focuses on relieving the pain, and can include medicines, physical therapy and nerve blocks. The Academy is a nonprofit professional organization serving clinicians, representing a broad number of disciplines, who treat people with pain. The Patients tab includes a pain management specialist locator and links to other resources.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121236980","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}
Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain relief in knee pain due to knee osteoarthritis (KOA). Since adductor canal (AC) contains other sensory nerves innervating the medial part of knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of medial compartment (KOA-MC). Methods: We conducted a randomised prospective study in 60 patients with anteromedial knee pain due to KOA-MC. Patients in group A received PRF-SN and those in group B, PRF-AC. Primary objectives were, comparison of pain by visual analogue scale (VAS) score and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores (OKS). Secondary objectives were, comparison of analgesic requirements using Medicine Quantification Scale (MQS) scale and block related complications. Intra group comparison was done by Analysis of variance (ANOVA). Inter group normally distributed data was assessed by student's t-test, non-normally distributed and ordinal data by Mann-Whitney U-test and categorical data by Chi-square test. A p value of < 0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12 and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN however, duration of pain relief was not significantly different.
{"title":"Functional Outcome and Pain Relief After Pulsed Radiofrequency of Saphenous Nerve in Medial Compartment Knee Osteoarthritis: A Randomised Double-Blind Trial","authors":"Jadon Ashok","doi":"10.54289/jaad2200108","DOIUrl":"https://doi.org/10.54289/jaad2200108","url":null,"abstract":"Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain relief in knee pain due to knee osteoarthritis (KOA). Since adductor canal (AC) contains other sensory nerves innervating the medial part of knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of medial compartment (KOA-MC). Methods: We conducted a randomised prospective study in 60 patients with anteromedial knee pain due to KOA-MC. Patients in group A received PRF-SN and those in group B, PRF-AC. Primary objectives were, comparison of pain by visual analogue scale (VAS) score and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores (OKS). Secondary objectives were, comparison of analgesic requirements using Medicine Quantification Scale (MQS) scale and block related complications. Intra group comparison was done by Analysis of variance (ANOVA). Inter group normally distributed data was assessed by student's t-test, non-normally distributed and ordinal data by Mann-Whitney U-test and categorical data by Chi-square test. A p value of < 0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12 and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN however, duration of pain relief was not significantly different.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125166571","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}
Patients who present to the emergency department demonstrating clinical signs of circulatory shock constitute a medical emergency, often associated with significant mortality. Severe sepsis, characterized as infection with systemic manifestations and accompanying organ dysfunction or tissue hypoperfusion, can lead to septic shock. Septic shock is defined as severe sepsis plus sepsis-induced hypotension not reversed with adequate fluid resuscitation. Hypotension may be defined by a drop in systolic blood pressure (SBP) to < 90 mm Hg or by at least a 40-mm Hg from baseline. The inadequate perfusion of critical organs (heart, liver, and kidneys) may lead to significant morbidity and mortality.
{"title":"Septic Shock","authors":"Dalamagka Maria","doi":"10.54289/jaad2200107","DOIUrl":"https://doi.org/10.54289/jaad2200107","url":null,"abstract":"Patients who present to the emergency department demonstrating clinical signs of circulatory shock constitute a medical emergency, often associated with significant mortality. Severe sepsis, characterized as infection with systemic manifestations and accompanying organ dysfunction or tissue hypoperfusion, can lead to septic shock. Septic shock is defined as severe sepsis plus sepsis-induced hypotension not reversed with adequate fluid resuscitation. Hypotension may be defined by a drop in systolic blood pressure (SBP) to < 90 mm Hg or by at least a 40-mm Hg from baseline. The inadequate perfusion of critical organs (heart, liver, and kidneys) may lead to significant morbidity and mortality.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125698706","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}
Coronavirus disease (COVID)-19, especially the severe disease is associated with an increased risk and prevalence of venous thromboembolism [1]. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) binds to the angiotensin converting enzyme-2 (ACE-2) receptors on endothelial cells, especially within the kidneys, heart, lungs, etc. causing endothelial cell damage leading to thrombosis and thrombotic complications like deep vein thrombosis, pulmonary embolism, myocardial infarction, etc [2].We present here our experience of the anaesthetic management of a 40 year old male with post COVID-19 sinonasal mucormycosis and history of pulmonary embolism posted for bilateral functional endoscopic sinus surgery (FESS) and endoscopic debridement.
{"title":"Anaesthetic Management of a Case of Sinonasal Mucormycosis with Post Covid -19 Pulmonary Embolism for Endoscopic Debridement","authors":"Madhuri S Kurdi","doi":"10.54289/jaad2200106","DOIUrl":"https://doi.org/10.54289/jaad2200106","url":null,"abstract":"Coronavirus disease (COVID)-19, especially the severe disease is associated with an increased risk and prevalence of venous thromboembolism [1]. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) binds to the angiotensin converting enzyme-2 (ACE-2) receptors on endothelial cells, especially within the kidneys, heart, lungs, etc. causing endothelial cell damage leading to thrombosis and thrombotic complications like deep vein thrombosis, pulmonary embolism, myocardial infarction, etc [2].We present here our experience of the anaesthetic management of a 40 year old male with post COVID-19 sinonasal mucormycosis and history of pulmonary embolism posted for bilateral functional endoscopic sinus surgery (FESS) and endoscopic debridement.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"420 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129208387","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}
Objective: To describe the results of a self-administered anesthetic nasal spray developed to target the sphenopalatine ganglion (SPG) for the acute and preventive treatment of chronic migraine. Background: The SPG is a known migraine treatment target that may be anesthetized via minimally invasive in-office procedures. Historically, various noninvasive selfadministered intranasal anesthetic formulations have been developed for the treatment of migraine, with some studies suggesting implication of the SPG mechanism, however, this has needed further development and data on efficacy has been mixed and inconclusive. During COVID-19 pandemic clinic closures, we noticed a substantial need for improved at-home therapies for our university headache center patients with chronic migraine. Methods: We developed a compounded anesthetic nasal spray utilizing upward force and a supine delivery positioning with the aim of better targeting the SPG. Patients were instructed to use this treatment once per month as prevention and, additionally, up to four times per month as need acutely. Retrospective chart review was performed. Physician clinical judgment of patient reports was used to assign a dichotomous conclusion of the usefulness of such treatment for patients at an interval of 3 months (preventive effect) and acutely (acute effect). Adverse effects were also reviewed. Results differentiate treatment response in medication overuse headache (MOH) and peripartum subgroups as well. Results: 52 out of 66 (79%) patients reported improvement in overall headache frequency or intensity at 3 month follow up (preventive effect). 40 out of 53 (75%) patients who using the treatment acutely reported improvement in headache intensity (acute effect). Of the 6 patients also with MOH, 5 (83%) reported preventive effect and 4 (67%) reported acute effect. Of the 9 patients who were also peripartum, all 9 (100%) reported preventive effect and 8 (89%) reported acute effect. No significant adverse effects were reported. Conclusion: A self-administered nasal spray developed to target the SPG may be an effective and safe therapy for the acute and preventive treatment of chronic migraine. This delivery method suggests safe and potentially successful blockade of the SPG at home. Further developments in non-invasive intranasal techniques are warranted.
{"title":"Retrospective Chart Review: The Feasibility of a Self-Administered Nasal Spray Targeting the Sphenopalatine Ganglion (SPG) in Treatment of Chronic Migraine.","authors":"S. Bobker","doi":"10.54289/jaad2200105","DOIUrl":"https://doi.org/10.54289/jaad2200105","url":null,"abstract":"Objective: To describe the results of a self-administered anesthetic nasal spray developed to target the sphenopalatine ganglion (SPG) for the acute and preventive treatment of chronic migraine. Background: The SPG is a known migraine treatment target that may be anesthetized via minimally invasive in-office procedures. Historically, various noninvasive selfadministered intranasal anesthetic formulations have been developed for the treatment of migraine, with some studies suggesting implication of the SPG mechanism, however, this has needed further development and data on efficacy has been mixed and inconclusive. During COVID-19 pandemic clinic closures, we noticed a substantial need for improved at-home therapies for our university headache center patients with chronic migraine. Methods: We developed a compounded anesthetic nasal spray utilizing upward force and a supine delivery positioning with the aim of better targeting the SPG. Patients were instructed to use this treatment once per month as prevention and, additionally, up to four times per month as need acutely. Retrospective chart review was performed. Physician clinical judgment of patient reports was used to assign a dichotomous conclusion of the usefulness of such treatment for patients at an interval of 3 months (preventive effect) and acutely (acute effect). Adverse effects were also reviewed. Results differentiate treatment response in medication overuse headache (MOH) and peripartum subgroups as well. Results: 52 out of 66 (79%) patients reported improvement in overall headache frequency or intensity at 3 month follow up (preventive effect). 40 out of 53 (75%) patients who using the treatment acutely reported improvement in headache intensity (acute effect). Of the 6 patients also with MOH, 5 (83%) reported preventive effect and 4 (67%) reported acute effect. Of the 9 patients who were also peripartum, all 9 (100%) reported preventive effect and 8 (89%) reported acute effect. No significant adverse effects were reported. Conclusion: A self-administered nasal spray developed to target the SPG may be an effective and safe therapy for the acute and preventive treatment of chronic migraine. This delivery method suggests safe and potentially successful blockade of the SPG at home. Further developments in non-invasive intranasal techniques are warranted.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116278481","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}
Continuous alcohol monitoring devices are worn among offenders who have been referred by the court and are designed to keep track of alcohol consumption. Also, named transdermal alcohol sensors, these devices measure the concentration of alcohol in perspiration every 30 minutes and can give a continuous estimation of alcohol levels over time [1]. Notably, very little prospective data exists to guide the management of a patient with a monitoring device in a surgical case that necessitates the use of monopolar or bipolar electrocautery. We encountered a patient who had chosen to undergo an elective robotic hysterectomy, and it was not until the patient reached the operating room that the continuous alcohol monitoring system was discovered on her ankle. Prior to the surgery, several layers of gauze were packed between the device and the patient’s skin, and a grounding pad was placed on the contralateral buttock. No adverse outcomes were encountered during the operation and the patient was safely discharged.
{"title":"Peri-Operative Management of Patients with Continuous Alcohol Monitoring Devices: A Case Report and Review of Literature.","authors":"Nooli Nishank","doi":"10.54289/jaad2200104","DOIUrl":"https://doi.org/10.54289/jaad2200104","url":null,"abstract":"Continuous alcohol monitoring devices are worn among offenders who have been referred by the court and are designed to keep track of alcohol consumption. Also, named transdermal alcohol sensors, these devices measure the concentration of alcohol in perspiration every 30 minutes and can give a continuous estimation of alcohol levels over time [1]. Notably, very little prospective data exists to guide the management of a patient with a monitoring device in a surgical case that necessitates the use of monopolar or bipolar electrocautery. We encountered a patient who had chosen to undergo an elective robotic hysterectomy, and it was not until the patient reached the operating room that the continuous alcohol monitoring system was discovered on her ankle. Prior to the surgery, several layers of gauze were packed between the device and the patient’s skin, and a grounding pad was placed on the contralateral buttock. No adverse outcomes were encountered during the operation and the patient was safely discharged.","PeriodicalId":326444,"journal":{"name":"Journal of Anesthesia and Anesthetic Drugs","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127065785","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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