Pub Date : 2023-09-01DOI: 10.1136/rapm-2023-esra.433
Rhys Williams, Mruthunjaya Hulgur
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Fasting guidelines have been established to reduce the risk of a pulmonary aspiration event in patients undergoing anaesthesia. Excessive fasting can contribute to anxiety, nausea, dehydration and physiological derangement. In practice, patients are likely to be fasted for longer than the conventional times. The aim of our project was to identify the average length of fluid fast in our elective patients.
Methods
This was a retrospective case-note review of 50 patients undergoing elective upper limb surgery in our tertiary orthopaedic institution. Their reported fasting times for solids and liquids were recorded. Their sent for operation times were interrogated from Operating Room Management Information System (ORMIS) computer system. This information was subsequently compiled into a datasheet.
Results
The average fasting time for solids was 14h 30mins. The average conventional fluid fasting time was 3h 29 mins. When this adjusted to a sent for operating time, the average time was 6 h 11min (range 0min to 18h 10 min). 16% of patients included in the study were fluid fasted for greater than 12 hours.
Conclusions
Our study revealed excessive fasting times in the majority of our patients. Evidently a two-hour fluid fasting target becomes a longer fast in the real world. We have adapted out current fasting guidelines to align with progressive institutions which use a sip-till-send approach to allow 170ml of water each hour until sent for operating (Checketts 2023). We will re-audit these times after implementation of the guideline.
{"title":"#35875 Perioperative fluid fasting in elective upper limb surgery in a tretiary orthopaedic hospital","authors":"Rhys Williams, Mruthunjaya Hulgur","doi":"10.1136/rapm-2023-esra.433","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.433","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Fasting guidelines have been established to reduce the risk of a pulmonary aspiration event in patients undergoing anaesthesia. Excessive fasting can contribute to anxiety, nausea, dehydration and physiological derangement. In practice, patients are likely to be fasted for longer than the conventional times. The aim of our project was to identify the average length of fluid fast in our elective patients. <h3>Methods</h3> This was a retrospective case-note review of 50 patients undergoing elective upper limb surgery in our tertiary orthopaedic institution. Their reported fasting times for solids and liquids were recorded. Their sent for operation times were interrogated from Operating Room Management Information System (ORMIS) computer system. This information was subsequently compiled into a datasheet. <h3>Results</h3> The average fasting time for solids was 14h 30mins. The average conventional fluid fasting time was 3h 29 mins. When this adjusted to a sent for operating time, the average time was 6 h 11min (range 0min to 18h 10 min). 16% of patients included in the study were fluid fasted for greater than 12 hours. <h3>Conclusions</h3> Our study revealed excessive fasting times in the majority of our patients. Evidently a two-hour fluid fasting target becomes a longer fast in the real world. We have adapted out current fasting guidelines to align with progressive institutions which use a sip-till-send approach to allow 170ml of water each hour until sent for operating (Checketts 2023). We will re-audit these times after implementation of the guideline.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686577","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.391
Bok Eum Kim
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Chronic otitis media (COM) is an inflammatory disease of the middle ear. The symptoms of COM are ear pain, intracranial complication. Skull base osteomyelitis (SBO) may occur by transmission of infection based on COM. In this paper, we present a patient with untreated COM who was diagnosed with SBO.
Methods
A-67-year-old man visited our clinic with left TMJ pain. He had taken NSAIDs, and his symptoms had been relieved but not disappeared. CT showed no abnormal finding. But he showed familiar pain in the left TMJ. He was diagnosed with left TMJ arthralgia. After medication, the pain in the left TMJ was disappeared. 6 months later, he re-visited clinic and presented with pricking pain in the same area. CT revealed erosive change in left TMJ. He was diagnosed with left TMJ osteoarthritis and prescribed medicines including amoxicillin, ketorolac. However, his severe pain had been persisted.
Results
CRP is 49.1. A MRI showed heterogeneous enhancement in the left condyle. He was referred to ENT and left mastoidectomy was performed. When the microbial cultures of resected specimens were performed, candida was found, which led to the final diagnosis of SBO.
Conclusions
In case of atypical pain on TMJ, it is necessary to take a careful history taking. Untreated COM can spread, leading to SBO. Untreated SBO can lead to death. If COM patient has a history of systemic diseases, fungal osteomyelitis may develop up to the skull base, leading to bony change. It is important to diagnose by using CT/MRI.
{"title":"#35801 Fungal osteomyelitis of TMJ and skull base caused by chronic otitis media","authors":"Bok Eum Kim","doi":"10.1136/rapm-2023-esra.391","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.391","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Chronic otitis media (COM) is an inflammatory disease of the middle ear. The symptoms of COM are ear pain, intracranial complication. Skull base osteomyelitis (SBO) may occur by transmission of infection based on COM. In this paper, we present a patient with untreated COM who was diagnosed with SBO. <h3>Methods</h3> A-67-year-old man visited our clinic with left TMJ pain. He had taken NSAIDs, and his symptoms had been relieved but not disappeared. CT showed no abnormal finding. But he showed familiar pain in the left TMJ. He was diagnosed with left TMJ arthralgia. After medication, the pain in the left TMJ was disappeared. 6 months later, he re-visited clinic and presented with pricking pain in the same area. CT revealed erosive change in left TMJ. He was diagnosed with left TMJ osteoarthritis and prescribed medicines including amoxicillin, ketorolac. However, his severe pain had been persisted. <h3>Results</h3> CRP is 49.1. A MRI showed heterogeneous enhancement in the left condyle. He was referred to ENT and left mastoidectomy was performed. When the microbial cultures of resected specimens were performed, candida was found, which led to the final diagnosis of SBO. <h3>Conclusions</h3> In case of atypical pain on TMJ, it is necessary to take a careful history taking. Untreated COM can spread, leading to SBO. Untreated SBO can lead to death. If COM patient has a history of systemic diseases, fungal osteomyelitis may develop up to the skull base, leading to bony change. It is important to diagnose by using CT/MRI.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135687517","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.436
Arvind Chaturvedi
Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Propofol causes hypotension and respiratory depression while Ketamine preserves airway reflexes and respiration, prevents hypotension. Ketofol (combination of Propofol and Ketamine) has shown to have cumulative effects on analgesia, and hypnosis,requiring lower dose of drug and less adverse effects ,maintains hemodynamics. Effect of various intravenous anaesthetic agents on cerebral oxygenation has not been evaluated. We compared the effects of Ketofol&Propofol on cerebral oxygenation in patients undergoing pituitary surgery.
Methods
Study ,conducted on 50 patients,undergoing pituitary surgery.Patients divided into Ketofol&Propofol groups,25 patients each. Intra-operative cerebral oxygenation (rSO2), hemodynamic parameters ,SpO2, Total analgesic,time to emergence and time to first post-operative analgesia ,recorded.
Results
In both groups, baseline values of rSO2 were within normal limits. rSO2 values were significantly higher in Ketofol-group than Propofol-group all- time, on both sides. rSO2 during surgery were higher in Ketofol-group and lower in Propofol-group on both sides . rSO2 values at specific stages of surgery/anaesthesia were higher than baseline in Ketofol-group and lower in Propofol-group on both side, .Intraoperative hemodynamic parameters was similar in the two groups, but significant increase in HR and MAP in Propofol group was observed during various stimuli (anaesthesia/surgical) compared to Ketofol. Episodes of hypotension were significantly higher in Propofol compared to Ketofol group Intraoperative requirement of opioid , propofol was significantly reduced in Ketofol-group .Time to first analgesic was longer in Ketofol than Propofol-group, emergence from anaesthesia was significantly longer in Propofol group.
Conclusions
In patients with pituitary surgery, Ketofol provides better cerebral oxygenation, hemodynamic stability , rapid emergence , prolong analgesia, compared to Propofol.
{"title":"#35918 A randomized control trial to evaluate the effects of Ketofol versus propofol on cerebral oxygenation in patients undergoing Trans-sphenoidal pituitary surgery under total intravenous anesthesia","authors":"Arvind Chaturvedi","doi":"10.1136/rapm-2023-esra.436","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.436","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Propofol causes hypotension and respiratory depression while Ketamine preserves airway reflexes and respiration, prevents hypotension. Ketofol (combination of Propofol and Ketamine) has shown to have cumulative effects on analgesia, and hypnosis,requiring lower dose of drug and less adverse effects ,maintains hemodynamics. Effect of various intravenous anaesthetic agents on cerebral oxygenation has not been evaluated. We compared the effects of Ketofol&Propofol on cerebral oxygenation in patients undergoing pituitary surgery. <h3>Methods</h3> Study ,conducted on 50 patients,undergoing pituitary surgery.Patients divided into Ketofol&Propofol groups,25 patients each. Intra-operative cerebral oxygenation (rSO2), hemodynamic parameters ,SpO2, Total analgesic,time to emergence and time to first post-operative analgesia ,recorded. <h3>Results</h3> In both groups, baseline values of rSO2 were within normal limits. rSO2 values were significantly higher in Ketofol-group than Propofol-group all- time, on both sides. rSO2 during surgery were higher in Ketofol-group and lower in Propofol-group on both sides . rSO2 values at specific stages of surgery/anaesthesia were higher than baseline in Ketofol-group and lower in Propofol-group on both side, .Intraoperative hemodynamic parameters was similar in the two groups, but significant increase in HR and MAP in Propofol group was observed during various stimuli (anaesthesia/surgical) compared to Ketofol. Episodes of hypotension were significantly higher in Propofol compared to Ketofol group Intraoperative requirement of opioid , propofol was significantly reduced in Ketofol-group .Time to first analgesic was longer in Ketofol than Propofol-group, emergence from anaesthesia was significantly longer in Propofol group. <h3>Conclusions</h3> In patients with pituitary surgery, Ketofol provides better cerebral oxygenation, hemodynamic stability , rapid emergence , prolong analgesia, compared to Propofol. <h3>Attachment</h3> Sudeshna , ethics.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135685777","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.406
Prashanth Prabhu, Suvina N, Sitara AY, Hemashree G, Poornashree G
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
30year old male patient weighing 40kg with a known case of myasthenia gravis was posted for right percutaneous nephrolithotomy and left open urethrolithotomy. Patient had a muscle power of 3/5, hence we wanted to avoid skeletal muscle relaxant to the patient.
Methods
Patient was shifted to operation room, monitors connected, IV cannula established. Anterior neck area was disinfected with surgical spirit. – Bilateral superior Laryngeal nerve block given using 2ml of 2%lignocaine + 2ml of 0.5%bupivacaine. – Translaryngeal block given using 1ml of 2%lignocaine + 1ml of 0.5%bupivacaine. – 2 sprays of 10%lignocaine spray was administered in the posterior pharyngeal area. Later epidural was established at L1-L2. After test dose, epidural was activated with 10ml of 0.5% bupivacaine. BIS monitor was connected. Inj. Dexmedetomidine was administered 40mcg IV over 10 minutes. The patient was preoxygenated for 3 minutes and later Induced with Inj. Propofol 80mg IV. Once BIS was <60, patient was intubated using 7.0 cuffed endotracheal tube and fixed at 21cm. The endotracheal tube cuff was inflated with 5ml of 1%lignocaine to prevent intubation related complications during extubation process.
Results
If BIS>80, Inj. Propofol 20mg IV bolus was given. BIS was maintained around 60 intraoperatively. Patient was maintained intraoperatively by O2: Air = 0.5l:2l. Inj.Propofol at 160 to 320mg/hr, Inj. Dexmedetomidine at 10 to 20mcg/hr and epidural infusion was maintained with 4 to 6ml of 0.25%bupivacaine. Post-Operative patient was extubated the next day in ICU.
Conclusions
Airway block helped in successful management of myasthenia gravis patient without skeletal muscle relaxant for successful surgery.
{"title":"#35931 Regional anaesthesia for intubation and maintenance in myasthenia gravis patient with bilateral renal calculi","authors":"Prashanth Prabhu, Suvina N, Sitara AY, Hemashree G, Poornashree G","doi":"10.1136/rapm-2023-esra.406","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.406","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> 30year old male patient weighing 40kg with a known case of myasthenia gravis was posted for right percutaneous nephrolithotomy and left open urethrolithotomy. Patient had a muscle power of 3/5, hence we wanted to avoid skeletal muscle relaxant to the patient. <h3>Methods</h3> Patient was shifted to operation room, monitors connected, IV cannula established. Anterior neck area was disinfected with surgical spirit. – Bilateral superior Laryngeal nerve block given using 2ml of 2%lignocaine + 2ml of 0.5%bupivacaine. – Translaryngeal block given using 1ml of 2%lignocaine + 1ml of 0.5%bupivacaine. – 2 sprays of 10%lignocaine spray was administered in the posterior pharyngeal area. Later epidural was established at L1-L2. After test dose, epidural was activated with 10ml of 0.5% bupivacaine. BIS monitor was connected. Inj. Dexmedetomidine was administered 40mcg IV over 10 minutes. The patient was preoxygenated for 3 minutes and later Induced with Inj. Propofol 80mg IV. Once BIS was <60, patient was intubated using 7.0 cuffed endotracheal tube and fixed at 21cm. The endotracheal tube cuff was inflated with 5ml of 1%lignocaine to prevent intubation related complications during extubation process. <h3>Results</h3> If BIS>80, Inj. Propofol 20mg IV bolus was given. BIS was maintained around 60 intraoperatively. Patient was maintained intraoperatively by O2: Air = 0.5l:2l. Inj.Propofol at 160 to 320mg/hr, Inj. Dexmedetomidine at 10 to 20mcg/hr and epidural infusion was maintained with 4 to 6ml of 0.25%bupivacaine. Post-Operative patient was extubated the next day in ICU. <h3>Conclusions</h3> Airway block helped in successful management of myasthenia gravis patient without skeletal muscle relaxant for successful surgery.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"2013 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135685778","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.400
Anderson Gonçalves, Paulo Sérgio M M Serzedo, Flávio Coelho Barroso
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Perioperative hypersensitivity reactions (PHR) are of great concern to anesthesiologists daily. During a procedure, several agents are administered sequentially in any anesthesia, which can trigger allergic reactions of lesser or greater severity. Otherwise, anaphylaxis is a severe, life-threatening, systemic allergic reaction that occurs rapidly after exposure to a sensitizing agent.
Results
Case report: 56 years-old female, ASA P1, without any known allergies, was admitted to right eye trabeculectomy. Sedation was performed with midazolam and fentanyl to perform the peribulbar block of the eye under adequate asepsis, with injection of 5 ml of 1% ropivacaine and 300 UI of hyaluronidase, with Nicoll Scale, equal to 8, four-quadrant akinesia. After 3 hours, the patient presented slight edema in periorbital tissue, with spontaneous regression of the condition. After 5 days, the patient returned to the clinic to perform the same surgery the eye due procedure failure. After a few minutes from the blockade, the patient presented an important periorbital cold edema, associated with nauseas and urticaria, and the diagnostic hypothesis of PHR class II of Ring & Messmer Scale was suggested. The treatment was immediately performed with aliquots of 20mcg of adrenaline, 250 mg of hydrocortisone and clinical support, that led to regression of the symptoms.
Conclusions
Discussion
Recently, a new consensus was released about the nomenclature of perioperative hypersensitivity, since some terms are not used anymore. Besides that, the variability of symptoms challenges the anesthesiologist in care of the patient, that can be able to diagnose and treat any suspected perioperative allergic reactions.
{"title":"#36044 Perioperative hypersensitivity reaction after an ophtalmologic block: case report","authors":"Anderson Gonçalves, Paulo Sérgio M M Serzedo, Flávio Coelho Barroso","doi":"10.1136/rapm-2023-esra.400","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.400","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Perioperative hypersensitivity reactions (PHR) are of great concern to anesthesiologists daily. During a procedure, several agents are administered sequentially in any anesthesia, which can trigger allergic reactions of lesser or greater severity. Otherwise, anaphylaxis is a severe, life-threatening, systemic allergic reaction that occurs rapidly after exposure to a sensitizing agent. <h3>Results</h3> Case report: 56 years-old female, ASA P1, without any known allergies, was admitted to right eye trabeculectomy. Sedation was performed with midazolam and fentanyl to perform the peribulbar block of the eye under adequate asepsis, with injection of 5 ml of 1% ropivacaine and 300 UI of hyaluronidase, with Nicoll Scale, equal to 8, four-quadrant akinesia. After 3 hours, the patient presented slight edema in periorbital tissue, with spontaneous regression of the condition. After 5 days, the patient returned to the clinic to perform the same surgery the eye due procedure failure. After a few minutes from the blockade, the patient presented an important periorbital cold edema, associated with nauseas and urticaria, and the diagnostic hypothesis of PHR class II of Ring & Messmer Scale was suggested. The treatment was immediately performed with aliquots of 20mcg of adrenaline, 250 mg of hydrocortisone and clinical support, that led to regression of the symptoms. <h3>Conclusions</h3> <h3>Discussion</h3> Recently, a new consensus was released about the nomenclature of perioperative hypersensitivity, since some terms are not used anymore. Besides that, the variability of symptoms challenges the anesthesiologist in care of the patient, that can be able to diagnose and treat any suspected perioperative allergic reactions.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686903","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.397
Zanariah Yahaya
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Anti-synthetase syndrome (ASS ) is a rare chronic autoimmune disorder of unknown cause. The hallmark of ASS is the presence of serum autoantibodies directed against amino act-tRNA synthetase. ASS is 2-3 times more common in women than in men. The morbidity and mortality of ASS are usually linked to pulmonary findings .
Methods
48 years old lady who was diagnosed having Anti -Synthetase syndrome in 2020. She has interstitial lung disease with pulmonary function test of FeV1 1.4 (61%) FVC 1.65 (61%) and DLLO 40% .She was scheduled for total laparoscopic hysterectomy and salphingoophrectomy . She was assessed by respiratory unit pre operative where surgical risk was moderate , aim for early mobilisation and suggested for spinal anaesthesia if possible . Rheumatologist was also consulted preoperatively .The surgery was conducted under general anaesthesia with IPPV and securing the airway , neuromuscular blockade monitoring and surgeon was told to be careful with the intraabdominal pressure . The surgery went well she was extubated with sugamadex .
Conclusions
ASS is a rare idiopathic inflammatory multi system disorder which can lead to serious postoperative complications secondary to muscle weakness and respiratory complications. As laparoscopic surgery requires inflation of gas to intra abdominal cavity and head down position during the surgery , regional anaesthesia would be a challenge for this patient . A multidisciplinary teams including respiratory unit , rheumatology , physiotherapist and anaesthesiology is essential in the care of a patient with ASS.
{"title":"#36390 A case of Anti Synthetase Syndrome with Interstial lung disease for laparoscopic surgery","authors":"Zanariah Yahaya","doi":"10.1136/rapm-2023-esra.397","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.397","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Anti-synthetase syndrome (ASS ) is a rare chronic autoimmune disorder of unknown cause. The hallmark of ASS is the presence of serum autoantibodies directed against amino act-tRNA synthetase. ASS is 2-3 times more common in women than in men. The morbidity and mortality of ASS are usually linked to pulmonary findings . <h3>Methods</h3> 48 years old lady who was diagnosed having Anti -Synthetase syndrome in 2020. She has interstitial lung disease with pulmonary function test of FeV1 1.4 (61%) FVC 1.65 (61%) and DLLO 40% .She was scheduled for total laparoscopic hysterectomy and salphingoophrectomy . She was assessed by respiratory unit pre operative where surgical risk was moderate , aim for early mobilisation and suggested for spinal anaesthesia if possible . Rheumatologist was also consulted preoperatively .The surgery was conducted under general anaesthesia with IPPV and securing the airway , neuromuscular blockade monitoring and surgeon was told to be careful with the intraabdominal pressure . The surgery went well she was extubated with sugamadex . <h3>Conclusions</h3> ASS is a rare idiopathic inflammatory multi system disorder which can lead to serious postoperative complications secondary to muscle weakness and respiratory complications. As laparoscopic surgery requires inflation of gas to intra abdominal cavity and head down position during the surgery , regional anaesthesia would be a challenge for this patient . A multidisciplinary teams including respiratory unit , rheumatology , physiotherapist and anaesthesiology is essential in the care of a patient with ASS. <h3>Attachment</h3> Esra Abstract.pdf","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686998","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.437
Sami Ur Rehman
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)
Background and Aims
Antimicrobial resistance (AMR) has become a global issue. Not only decreasing the treatment options but serious threat to low-income countries associated with both misuse and overuse of antibiotics. This study has determined the antibiogram profile of patients admitted in SURGICAL icu (SICU) at Doctors Hospital and Medical Centre, Lahore.
Methods
This study was retrospective cross-sectional in nature.Total 502 patients were admitted in ICU during our study period.Blood, tracheal and urine culture reports of 364 patients were recorded for the purpose of study.All cultures were processed in accordance with standard microbiological protocols defined by CLSI. CLED used for urine cultures, while Mac-Conkey, Choclate and Blood Agar were being used for tracheal and sputum cultures. Blood cultures were processed on BACT/ALERT automated blood culture system.Statistical analysis were performed using the SPSS 64-bit version.
Results
Among 364 patients analyzed in the study, the cultures obtained from different sites were Blood (54%), Urine (33%) and tracheal (13%). Among blood cultures, no organism was isolated.Among tracheal cultures, most common organisms isolated were Klebsiella (5), followed by Acinetobacter (4) and Pseudomonas (3).Among urine cultures, most common organism isolated was E. coli (4), then Klebsiella (3) and Pseudomonas (2).Vancomycin and Linezolid showed zero percent resistance to Staphylococcus sp. Collistin showed zero percent resistance for Acinetobacter and Klebsiella. Moxifloxacin was resistant for E. coli.
Conclusions
The gram-negative bacteria were the major cause of infection in the ICU. Gram negative organisms(88.46%) were detected more than gram positive organisms(11.53%). We need to prescribe broad-spectrum antibiotics more wisely to reduce pressure on sensitive strains.
{"title":"#35209 Incidence of nosocomial infections in icu of a tertiary care hospital and antibiogram","authors":"Sami Ur Rehman","doi":"10.1136/rapm-2023-esra.437","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.437","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Antimicrobial resistance (AMR) has become a global issue. Not only decreasing the treatment options but serious threat to low-income countries associated with both misuse and overuse of antibiotics. This study has determined the antibiogram profile of patients admitted in SURGICAL icu (SICU) at Doctors Hospital and Medical Centre, Lahore. <h3>Methods</h3> This study was retrospective cross-sectional in nature.Total 502 patients were admitted in ICU during our study period.Blood, tracheal and urine culture reports of 364 patients were recorded for the purpose of study.All cultures were processed in accordance with standard microbiological protocols defined by CLSI. CLED used for urine cultures, while Mac-Conkey, Choclate and Blood Agar were being used for tracheal and sputum cultures. Blood cultures were processed on BACT/ALERT automated blood culture system.Statistical analysis were performed using the SPSS 64-bit version. <h3>Results</h3> Among 364 patients analyzed in the study, the cultures obtained from different sites were Blood (54%), Urine (33%) and tracheal (13%). Among blood cultures, no organism was isolated.Among tracheal cultures, most common organisms isolated were Klebsiella (5), followed by Acinetobacter (4) and Pseudomonas (3).Among urine cultures, most common organism isolated was E. coli (4), then Klebsiella (3) and Pseudomonas (2).Vancomycin and Linezolid showed zero percent resistance to Staphylococcus sp. Collistin showed zero percent resistance for Acinetobacter and Klebsiella. Moxifloxacin was resistant for E. coli. <h3>Conclusions</h3> The gram-negative bacteria were the major cause of infection in the ICU. Gram negative organisms(88.46%) were detected more than gram positive organisms(11.53%). We need to prescribe broad-spectrum antibiotics more wisely to reduce pressure on sensitive strains. <h3>Attachment</h3> antibiogram dhmc.docx","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135685903","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.420
Amparo Izquierdo Aicart, Maria Sempere, Alba Montoya, Rafael Badenes
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
Hip fracture surgery has a huge prevalence and morbimortality. One of the main reasons of delaying surgery is the use of anticoagulants/antiplatelet therapies, being these patients old and with comorbidities. Risks of delay surgery are higher than surgical bleeding or vertebral canal haematoma; so promp surgery in first 48 hours should be facilitated.
Methods
In this review we search the main guidelines about perioperative management of antithrombotic drugs and locorregional guidelines; focusing in hip fracture surgery and also its management when neuroaxial anesthesia is performed.
Results
-With antiplatelet drugs therapy surgery should not be delay. In case of PY12 inhibitors neuraxial anesthesia is not recommended. -With vitamin K antagonists therapy, reversal with vitamin K/prothrombin complex concentrate (PCC) should be done for ensure INR <1,8. Neuraxial anesthesia can be performed when INR <1,5. -With new oral anticoagulants (NOAC) interruption intervals of 1-2 half-life is recommended (12-24 hours without impaired kidney function). Neuraxial anesthesia is not recommended in early surgery without a specific coagulation test. If there is a risk performing general anesthesia we should consider use of reversal agents or specific tests.
Conclusions
Early hip fracture surgery is safe in patients taking anticoagulant/antiplatelet drugs. Special attention should we pay in perioperative timing when neuraxial anesthesia is performed.
{"title":"#36517 Perioperative management of antithrombotic therapy in hip fracture surgery","authors":"Amparo Izquierdo Aicart, Maria Sempere, Alba Montoya, Rafael Badenes","doi":"10.1136/rapm-2023-esra.420","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.420","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> Hip fracture surgery has a huge prevalence and morbimortality. One of the main reasons of delaying surgery is the use of anticoagulants/antiplatelet therapies, being these patients old and with comorbidities. Risks of delay surgery are higher than surgical bleeding or vertebral canal haematoma; so promp surgery in first 48 hours should be facilitated. <h3>Methods</h3> In this review we search the main guidelines about perioperative management of antithrombotic drugs and locorregional guidelines; focusing in hip fracture surgery and also its management when neuroaxial anesthesia is performed. <h3>Results</h3> -With antiplatelet drugs therapy surgery should not be delay. In case of PY12 inhibitors neuraxial anesthesia is not recommended. -With vitamin K antagonists therapy, reversal with vitamin K/prothrombin complex concentrate (PCC) should be done for ensure INR <1,8. Neuraxial anesthesia can be performed when INR <1,5. -With new oral anticoagulants (NOAC) interruption intervals of 1-2 half-life is recommended (12-24 hours without impaired kidney function). Neuraxial anesthesia is not recommended in early surgery without a specific coagulation test. If there is a risk performing general anesthesia we should consider use of reversal agents or specific tests. <h3>Conclusions</h3> Early hip fracture surgery is safe in patients taking anticoagulant/antiplatelet drugs. Special attention should we pay in perioperative timing when neuraxial anesthesia is performed.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686160","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.427
Serkan Tulgar, Dilan Akyurt, Caner Genc
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims
Ultrasound-guided Serratus posterior superior intercostal plane (SPSIP) block is a newly defined interfascial plane block and targets the shoulder and hemithorax. Ultrasound-guided Serratsu posterior superior plane (SPSIP) block is a newly defined interfascial plane block and targets the shoulder and hemithorax. Extensive spread was reported from C7 to T7 in the cadaveric study, and from C3 to T10 in clinical applications [1]. Herein, we report our SPSIP block and first catheterization in a critical patient.
Methods
A 48-year-old male patient presented with a fall, resulting in fractures of the left scapula, radius, pelvis, and acetabulum, along with multiple rib fractures and a pneumothorax.He had severe pain due to scapula and rib fractures, thoracic tube, and began to desaturate (88-90%) because he had difficulty in breathing deeply and atelectasis was developing.
Results
Despite routine analgesia, the patient started to deteriorate and left SPSIP block was applied with 40 mL of local anesthetic. Despite routine analgesia, the patient started to deteriorate and left SPSIP block was applied with 40 mL of local anesthetic. When asked about the patient‘s pain originating from the shoulder and thorax, he reported that his NRS decreased from 9 to 2. The next day, a catheter was inserted in the same plane. 20 ml of contrast was administered, allowing determination of the contrast spread from T1 to T4, reaching up to the anterior axillary line (figure 1).
Conclusions
Ultrasound-guided SPSIP block can effectively alleviate pain in the shoulder and hemithorax and may be beneficial in patients with scapula and rib fractures.
{"title":"#36494 Ultrasound-guided serratus posterior superior block in a case of multitrauma: first catheter application in the novel block","authors":"Serkan Tulgar, Dilan Akyurt, Caner Genc","doi":"10.1136/rapm-2023-esra.427","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.427","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> Ultrasound-guided Serratus posterior superior intercostal plane (SPSIP) block is a newly defined interfascial plane block and targets the shoulder and hemithorax. Ultrasound-guided Serratsu posterior superior plane (SPSIP) block is a newly defined interfascial plane block and targets the shoulder and hemithorax. Extensive spread was reported from C7 to T7 in the cadaveric study, and from C3 to T10 in clinical applications [1]. Herein, we report our SPSIP block and first catheterization in a critical patient. <h3>Methods</h3> A 48-year-old male patient presented with a fall, resulting in fractures of the left scapula, radius, pelvis, and acetabulum, along with multiple rib fractures and a pneumothorax.He had severe pain due to scapula and rib fractures, thoracic tube, and began to desaturate (88-90%) because he had difficulty in breathing deeply and atelectasis was developing. <h3>Results</h3> Despite routine analgesia, the patient started to deteriorate and left SPSIP block was applied with 40 mL of local anesthetic. Despite routine analgesia, the patient started to deteriorate and left SPSIP block was applied with 40 mL of local anesthetic. When asked about the patient‘s pain originating from the shoulder and thorax, he reported that his NRS decreased from 9 to 2. The next day, a catheter was inserted in the same plane. 20 ml of contrast was administered, allowing determination of the contrast spread from T1 to T4, reaching up to the anterior axillary line (figure 1). <h3>Conclusions</h3> Ultrasound-guided SPSIP block can effectively alleviate pain in the shoulder and hemithorax and may be beneficial in patients with scapula and rib fractures.","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686237","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 : 2023-09-01DOI: 10.1136/rapm-2023-esra.402
Tong-Khee Tan
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes
Background and Aims
Informed consent forms the cornerstone of regional anaesthesia. In patients lacking mental capacity, risks of a performing a particular regional technique/alternatives would not be able to be conveyed. The decision to use regional techniques may make anaesthetists uncomfortable especially if the incompetent patient has no family members/legal representatives. This poster suggests using Jonsens’s 4box approach(1) to aid anaesthetists’decision-making/justification when using regional techniques in sub-optimal patients.
Methods
85 year old severely demented Mr.X, bedbound, was from state-run nursing home for destitutes. He was admitted with wet gangrene of right forefoot,in severe distress. He developed a sepsis-related myocardial infarction needing dual anti-platelets(clopidogrel,aspirin). A debridement/toes amputation was planned,under popliteal/saphenous nerve block,despite his coagulopathic state.
Results
Box1:Medical indications. To remove source of sepsis and pain relief, without general anaesthetic risks. Box2:Patient preference. Would he want surgery under regional block when coagulopathic, with complications such as haematoma/nerve injury? Lacking capacity and needing urgent procedure, the anaesthetist made decisions based on best interest/neccesity. Box3:Quality of life. His premorbid state was miserable but his current state worse as he was in pain and septic. Box4:Contextual features. There was no dignity having a smelly/painful septic gangrenous foot. Regional technique was safer than general anaesthetic in view of his recent infarction. Not without risks, the peripheral nature of the block and using ultrasound guidance made it safer.
Conclusions
The four box approach was used to guide decision to perform a nerve block in a coagulopathic patient, who was unable to discuss risks and alternatives. The over-riding consideration acutely was his dignity, comfort.
{"title":"#34837 Decision-making framework to undertake regional anaethesia in patients with poor comorbidities and diminished mental capacity","authors":"Tong-Khee Tan","doi":"10.1136/rapm-2023-esra.402","DOIUrl":"https://doi.org/10.1136/rapm-2023-esra.402","url":null,"abstract":"<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Not relevant (see information at the bottom of this page) <b>Application for ESRA Abstract Prizes:</b> I don’t wish to apply for the ESRA Prizes <h3>Background and Aims</h3> Informed consent forms the cornerstone of regional anaesthesia. In patients lacking mental capacity, risks of a performing a particular regional technique/alternatives would not be able to be conveyed. The decision to use regional techniques may make anaesthetists uncomfortable especially if the incompetent patient has no family members/legal representatives. This poster suggests using Jonsens’s 4box approach(1) to aid anaesthetists’decision-making/justification when using regional techniques in sub-optimal patients. <h3>Methods</h3> 85 year old severely demented Mr.X, bedbound, was from state-run nursing home for destitutes. He was admitted with wet gangrene of right forefoot,in severe distress. He developed a sepsis-related myocardial infarction needing dual anti-platelets(clopidogrel,aspirin). A debridement/toes amputation was planned,under popliteal/saphenous nerve block,despite his coagulopathic state. <h3>Results</h3> Box1:Medical indications. To remove source of sepsis and pain relief, without general anaesthetic risks. Box2:Patient preference. Would he want surgery under regional block when coagulopathic, with complications such as haematoma/nerve injury? Lacking capacity and needing urgent procedure, the anaesthetist made decisions based on best interest/neccesity. Box3:Quality of life. His premorbid state was miserable but his current state worse as he was in pain and septic. Box4:Contextual features. There was no dignity having a smelly/painful septic gangrenous foot. Regional technique was safer than general anaesthetic in view of his recent infarction. Not without risks, the peripheral nature of the block and using ultrasound guidance made it safer. <h3>Conclusions</h3> The four box approach was used to guide decision to perform a nerve block in a coagulopathic patient, who was unable to discuss risks and alternatives. The over-riding consideration acutely was his dignity, comfort. <h3>Attachment</h3> AbstractJonsen AR.docx","PeriodicalId":80519,"journal":{"name":"Archaeologia aeliana, or, Miscellaneous tracts relating to antiquity","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686273","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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