{"title":"Anaesthetists Seeing Through the Economic Crisis of Sri Lanka","authors":"N. Wijesuriya","doi":"10.4038/slja.v30i2.9105","DOIUrl":"https://doi.org/10.4038/slja.v30i2.9105","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44652641","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}
Complications associated with central venous catheters (CVC) can be early or delayed, and among them, hydrothorax is a rare one. Inappropriate initial positioning of the catheter, repeated changes in positioning and movement of the patient, and improper vigilance may be the causative factors. We describe a 47-year-old man with delayed right-sided hydrothorax after right-sided subclavian central line insertion. He was posted for anterior communicating artery aneurysmal clipping when the right-sided subclavian CVC was placed. His intraoperative and postoperative periods were uneventful. However, on postoperative day two, the patient developed labored breathing with desaturation to 76% of room air, with hypotension and tachycardia. An urgent chest x-ray was ordered and showed features suggestive of right-sided hydrothorax, which improved after right-sided intercostal drainage. This case report highlights the presentation of a rare complication of CVC and its recognition in patients with diminished consciousness. It also emphasizes the optimum site of positioning the CVC tip and the need for increased vigilance by healthcare providers in ordering routine chest x-rays, aspirating from all catheter ports prior to administering substances through them.
{"title":"Delayed Right-Sided Hydrothorax after Right-Sided Subclavian Central Line Insertion","authors":"Harsha S. Dhondu, Arjun Talapatra, Nita Varghese","doi":"10.4038/slja.v30i2.9020","DOIUrl":"https://doi.org/10.4038/slja.v30i2.9020","url":null,"abstract":"Complications associated with central venous catheters (CVC) can be early or delayed, and among them, hydrothorax is a rare one. Inappropriate initial positioning of the catheter, repeated changes in positioning and movement of the patient, and improper vigilance may be the causative factors. We describe a 47-year-old man with delayed right-sided hydrothorax after right-sided subclavian central line insertion. He was posted for anterior communicating artery aneurysmal clipping when the right-sided subclavian CVC was placed. His intraoperative and postoperative periods were uneventful. However, on postoperative day two, the patient developed labored breathing with desaturation to 76% of room air, with hypotension and tachycardia. An urgent chest x-ray was ordered and showed features suggestive of right-sided hydrothorax, which improved after right-sided intercostal drainage. This case report highlights the presentation of a rare complication of CVC and its recognition in patients with diminished consciousness. It also emphasizes the optimum site of positioning the CVC tip and the need for increased vigilance by healthcare providers in ordering routine chest x-rays, aspirating from all catheter ports prior to administering substances through them.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43445460","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}
Vascular invasion is characteristic for follicular carcinoma of the thyroid and distant metastasis is common. Spinal cord compression due to metastases of differentiated thyroid carcinoma as the initial presentation is an extremely rare condition. We report a case of asymptomatic metastatic thyroid cancer which presented with spinal cord compression. This patient with metastasized follicular carcinoma of the thyroid to the spinal cord and narrowing of the airway posed many challenges to the anesthetist.
{"title":"Anaesthetic Management of Total Thyroidectomy in a Patient with Spinal Cord Compression due to Metastatic Follicular Thyroid Carcinoma","authors":"A. Siriwardane, N. Wijesuriya","doi":"10.4038/slja.v30i2.8871","DOIUrl":"https://doi.org/10.4038/slja.v30i2.8871","url":null,"abstract":"Vascular invasion is characteristic for follicular carcinoma of the thyroid and distant metastasis is common. Spinal cord compression due to metastases of differentiated thyroid carcinoma as the initial presentation is an extremely rare condition. We report a case of asymptomatic metastatic thyroid cancer which presented with spinal cord compression. This patient with metastasized follicular carcinoma of the thyroid to the spinal cord and narrowing of the airway posed many challenges to the anesthetist.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48906246","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":"Excellent Trainees, Idle Authors: Time to Revitalize Sri Lankan Anaesthetic Authorship","authors":"B.M Munasinghe","doi":"10.4038/slja.v30i2.9005","DOIUrl":"https://doi.org/10.4038/slja.v30i2.9005","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47804844","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":"Ketamine: Is It Pro-Epileptic or Anti-Epileptic? The Debate Continues. A Narrative Review with a Case Discussion","authors":"A.A.S.P. Jayasinghe, Ashani Rathnayake","doi":"10.4038/slja.v30i2.8946","DOIUrl":"https://doi.org/10.4038/slja.v30i2.8946","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42329603","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 : Use of neostigmine to reverse the non-depoloarizing neuromuscular block is a standard practice. Reversal with neostigmine based on body weight is still commonly followed. However, neostigmine may affect adversely if used empirically in the absence of residual blockade. This study compares the empirical technique of reversal based on body weight with reversal using neostigmine dose adjusted to train-of-four (TOF) response. Methods: This prospective, double-blinded, randomized controlled trial included 126 patients undergoing surgery under general anaesthesia, lasting for >1 hour. They were randomized into group control receiving weight-based reversal (0.05 mg/kg neostigmine) and group study receiving dose determined by TOF response. Signs of residual paralysis after extubation were observed. TOF ratios/count, reversal to extubation time, dose and side-effects of reversal agent were also noted. Results: Patient characteristics were comparable in both groups. Number of patients with signs of residual weakness was less in group study (26/63), but comparable to group control (40/63, p=0.094). Number of patients with TOF≥0.9 at reversal and extubation was significantly high in group study (40/63) than group control (22/63), and number of patients with TOF count <4 were significantly high in group control than group study (17/63 vs 8/63). Overall TOF ratio at reversal and extubation, reversal-extubation time, time taken to reach TOF 0.9 and side-effects were comparable. Conclusion : Reversal of neuromuscular block with neostigmine dose based on TOF ratio is comparable to weight-based reversal with respect to postoperative residual weakness, reversal-extubation time and side effects of reversal
背景和目的：使用新斯的明逆转非去泥化神经肌肉阻滞是一种标准做法。基于体重的新斯的明逆转仍然是常见的。然而，如果在没有残留阻断的情况下凭经验使用，新斯的明可能会产生不利影响。本研究比较了基于体重的逆转经验技术和根据TOF反应调整剂量的新斯的明逆转经验技术。方法：这项前瞻性、双盲、随机对照试验包括126名在全身麻醉下接受手术的患者，持续时间>1小时。他们被随机分为接受基于重量的逆转（0.05 mg/kg新斯的明）的对照组和接受TOF反应确定剂量的研究组。观察到拔管后残余麻痹的迹象。TOF比值/计数、逆转拔管时间、逆转剂的剂量和副作用。结果：两组患者的特征具有可比性。有残余无力迹象的患者数量在组研究中较少（26/63），但与组对照组（40/63，p=0.094）相当。逆转和拔管时TOF≥0.9的患者数量（40/63）显著高于组对照组的患者数量的（22/63），TOF计数＜4的患者数量组对照组显著高于组研究（17/63 vs 8/63）。逆转和拔管时的总TOF比率、逆转拔管时间、达到TOF 0.9所需的时间和副作用具有可比性。结论：在术后残余无力、拮抗拔管时间和拮抗副作用方面，基于TOF比的新斯的明剂量拮抗神经肌肉阻滞与基于重量的拮抗相当
{"title":"Reversal of Neuromuscular Blockade Based on Train of Four Response: a Prospective Randomized Controlled Trial","authors":"Spurti Kalburgi, H. M. Krishna, A. Pillai","doi":"10.4038/slja.v30i2.8790","DOIUrl":"https://doi.org/10.4038/slja.v30i2.8790","url":null,"abstract":"Background and aims : Use of neostigmine to reverse the non-depoloarizing neuromuscular block is a standard practice. Reversal with neostigmine based on body weight is still commonly followed. However, neostigmine may affect adversely if used empirically in the absence of residual blockade. This study compares the empirical technique of reversal based on body weight with reversal using neostigmine dose adjusted to train-of-four (TOF) response. Methods: This prospective, double-blinded, randomized controlled trial included 126 patients undergoing surgery under general anaesthesia, lasting for >1 hour. They were randomized into group control receiving weight-based reversal (0.05 mg/kg neostigmine) and group study receiving dose determined by TOF response. Signs of residual paralysis after extubation were observed. TOF ratios/count, reversal to extubation time, dose and side-effects of reversal agent were also noted. Results: Patient characteristics were comparable in both groups. Number of patients with signs of residual weakness was less in group study (26/63), but comparable to group control (40/63, p=0.094). Number of patients with TOF≥0.9 at reversal and extubation was significantly high in group study (40/63) than group control (22/63), and number of patients with TOF count <4 were significantly high in group control than group study (17/63 vs 8/63). Overall TOF ratio at reversal and extubation, reversal-extubation time, time taken to reach TOF 0.9 and side-effects were comparable. Conclusion : Reversal of neuromuscular block with neostigmine dose based on TOF ratio is comparable to weight-based reversal with respect to postoperative residual weakness, reversal-extubation time and side effects of reversal","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46689874","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}
With the increase in the aging population, the ICU requirement for frail patients is increasing. These patients have a lesser ability to recover from a stressor and there’s increased vulnerability for further complications such as delirium, hospitalacquired infections, delay in weaning, and early organ dysfunction. Hence, they will have a prolonged length of ICU stay, higher morbidity and mortality and also increased disability and poor quality of life even after discharge. Even though frailty demands more intensive care facility and resource utilization, the outcome is poorer compared to the non-frail population. Hence, it is of utmost importance to consider frailty in offering intensive care treatment. However, the ICU prognostic markers such as APACHE, and SOFA are based on medical and biochemical values rather than functional status. It is important to understand that the recovery from a critical illness not only depends on the severity of the acute disease but also on the functional capacity of the patient and frailty is described in such terms.
{"title":"“Frailty and Intensive Care”, Emerging Topic Amidst Economic Crisis in Sri Lanka","authors":"A.A.S.P. Jayasinghe, V. Pinto","doi":"10.4038/slja.v30i2.9111","DOIUrl":"https://doi.org/10.4038/slja.v30i2.9111","url":null,"abstract":"With the increase in the aging population, the ICU requirement for frail patients is increasing. These patients have a lesser ability to recover from a stressor and there’s increased vulnerability for further complications such as delirium, hospitalacquired infections, delay in weaning, and early organ dysfunction. Hence, they will have a prolonged length of ICU stay, higher morbidity and mortality and also increased disability and poor quality of life even after discharge. Even though frailty demands more intensive care facility and resource utilization, the outcome is poorer compared to the non-frail population. Hence, it is of utmost importance to consider frailty in offering intensive care treatment. However, the ICU prognostic markers such as APACHE, and SOFA are based on medical and biochemical values rather than functional status. It is important to understand that the recovery from a critical illness not only depends on the severity of the acute disease but also on the functional capacity of the patient and frailty is described in such terms.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41504199","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}
An endotracheal tube is an integral part of general anaesthesia especially in long duration head and neck surgeries. Often, in such surgeries, the airway is shared by the surgeon and the anaesthetist. Any damage to the Endotracheal tube cuff may cause improper ventilation and airway contamination. We propose an algorithm through this case to prevent such complications and correct them if they happen.
{"title":"Intraoperative Endotracheal Tube Cuff Deflation - Stitch in Time Saves Nine!","authors":"A. Pahade, Ashita Mowar, V. Singh","doi":"10.4038/slja.v30i2.8866","DOIUrl":"https://doi.org/10.4038/slja.v30i2.8866","url":null,"abstract":"An endotracheal tube is an integral part of general anaesthesia especially in long duration head and neck surgeries. Often, in such surgeries, the airway is shared by the surgeon and the anaesthetist. Any damage to the Endotracheal tube cuff may cause improper ventilation and airway contamination. We propose an algorithm through this case to prevent such complications and correct them if they happen.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44890919","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}
Murugesh Wali, U. D. Kumar, S. P. Shetty, K. Sujay
{"title":"Low Dose Ketamine Infusion Versus Thoracic Epidural Infusion for Post Thoracotomy Analgesia","authors":"Murugesh Wali, U. D. Kumar, S. P. Shetty, K. Sujay","doi":"10.4038/slja.v30i2.8775","DOIUrl":"https://doi.org/10.4038/slja.v30i2.8775","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46692126","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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