Research and Practice in Anesthesiology – Open Journal

Research and Practice in Anesthesiology – Open Journal

Basic info

  • Publisher: Openventio Publishers
  • Country of publisher: india
  • Date added to EuroPub: 2019/Nov/15

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  • Language of fulltext: english

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  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

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  • Open Access Statement: No
  • Year open access content began: 2016
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

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This journal has '26' articles

Anesthetic Considerations in a Case of Fahr and Primrose Syndrome

Anesthetic Considerations in a Case of Fahr and Primrose Syndrome

Authors: Bhavna Gupta
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Abstract

In this review article, brief description, concerns, anesthetic management, and perioperative care patients with Fahr syndrome and Primrose syndrome has been made. There is a paucity of literature with respect to management of such cases. There are limited case reports reported in the literature. The literature search has been made by using Google scholar, PubMed, Medline, Medscape and other search-related search engines with the following keywords.

Keywords: Fahr syndrome. Primrose syndrome. Anesthesia. Calcium.
Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia

Effect of the Irrigation Fluid Temperature on Core Temperature in Transurethral Resection of Prostate Patients Under Spinal Versus General Anaesthesia

Authors: Veena Asthana Asthana
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Abstract

Study Design:Prospective, randomized control trial. Objectives:To evaluate and compare the effect of warm and unwarmed irrigation fluid and anaesthetic technique on core temperature in patients undergoing Transurethral resection of prostate. Summary of Background Data Material and Methods: The present study was conducted in 80 patients belonging to age group18-75 yrs of posted for TURP under general anaesthesia or spinal anaesthesia. Group A: General Anaesthesia with irrigation fluid at room temperature. Group B: GeneralAnaesthesia with irrigation fluid at 37 °C. Group C: Spinal Anaesthesia with irrigation fluid at room temperature. Group D: Spinal Anaesthesia with irrigation fluid at at 37 °C. Results:Amongst the four Groups, all the subjects showed consistently reduced core temperature which was statistically significant (p<0.05) at all time intervals. Core temperatures were lower in the group receiving unwarmed irrigation fluid compared with the prewarmed irrigation fluid group at the end of surgery. The mean decrease in core temperature at the end of surgery 4.2105 °F in Group A 1.1105 °F. in Group B, 4.2700 °F. in Group C, 1.4250 °F in Group D. The difference in mean core temperature was not statistically significant in Groups receiving unwarmed fluid. Statistically significant difference in mean core temperature was seen in Group B and Group D. Conclusion:Use of prewarm irrigation fluid resulted in lesser drop in core temperature as compared than that receiving unwarmed irrigation fluid. The drop was relatively least in patients under general anaesthesia.

Keywords: Spinal Anesthesia. General Anaesthesia. Randomized control trial.
Anticipated Difficult Intubation Due to Polypoidal Squamous Cell Carcinoma on Posterior One Third of Tongue

Anticipated Difficult Intubation Due to Polypoidal Squamous Cell Carcinoma on Posterior One Third of Tongue

Authors: Alka Kewalramani (Chhabra)
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Abstract

The most common type of tongue malignancy is squamous cell carcinoma (SCC) which constitutes about 36.5% of all oral malignancies.1 It usually presents as painless swelling which is oftenignored by the patient until late when it is symptomatic because of demonstrable growth in the oral cavity.2 Airway management in carcinoma posterior one third of tongue is always a concern to the anaesthesiologist due to possibility of trauma, bleeding,dislodgement of fractured tissue, chances of aspiration, difficulty in mask ventilation following induction of anaesthesia and compromisedairway consequent to difficulty during laryngoscopy and intubation.

Keywords: Polypoidal Squamous Cell Carcinoma. Tongue malignancy. Intubation.
SuperNOVA Nasal Mask Ventilation Maintains Oxygenation during Deep Sedation in High-Risk Patients: A Case Series

SuperNOVA Nasal Mask Ventilation Maintains Oxygenation during Deep Sedation in High-Risk Patients: A Case Series

Authors: Jessica Feinleib
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Abstract

With the convergence of two major medical trends, increasing obesity and the expansion of minimally invasive procedures come new challenges for airway management. In this case series we describe the use of a nasal ventilation mask, SuperNO2VATM, in 10 patients at high-risk for sedation-induced airway obstruction and hypoxemia that required procedural sedation. This well tolerated device produced nasal oxygenation and positive airway pressure (PAP) that maintained oxygen saturation (SpO2) > 97.0% throughout the cases. These encouraging outcomes suggest the utility of pressurized nasal ventilation masks, such as the SuperNO2 VATM, in patients at risk for airway obstruction requiring procedural sedation.

Keywords: SuperNOVA nasal mask ventilation. Hypoxemia. Oxygenating devices.
Post intubation Pharyngolaryngeal Pain in Otorhinolaryngology Surgery: Efficiency of Intra cuff and Extra cuff Lidocaine

Post intubation Pharyngolaryngeal Pain in Otorhinolaryngology Surgery: Efficiency of Intra cuff and Extra cuff Lidocaine

Authors: Hafiane Reda
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Abstract

Introduction:Post-operative sore throat (POST) represents a real discomfort for patients. In short duration surgeries, sore throat complain can replace the post-operative pain. Many studies intended to reduce its incidence using multiples medications. Objective: Assess the efficiency of extra cuff lidocaine jelly 2% associated with intra cuff liquid lidocaine 2% on the post extubation syndrome. Materials and method:Prospective study lead during 3 months in Otorhinolaryngology operating rooms. Inclusion criteria: Every intubation (naso or orotracheal) performed during this period. Exclusion criteria: upper airways surgery, tonsillectomy and patient’s refusal. Patients were randomized in 3 groups: First (G1): Control group (inflated cuff with air), Second (G2): liquid lidocaine 2% injected intra cuff, Third (G3): Lidocaine 2% jelly applied on the external surface of the cuff associated with liquid lidocaine intra cuff. Patients were assessed for post-operative sore throat, cough, and hoarseness at 1, 6, and 24 hours after surgery. Results:Ninety-nine patients were randomized (G1 n=30, G2 n=34, G3 n=35). The association of liquid and jelly lidocaine reduced POST at H1, H6, and H24 after patient’s discharge (p respectively at 0.0001; 0.002; 0.003 and 0.004). There was no significant difference in blunting coughing (p=0.053) and post-operative nausea and vomiting (p=0.198) Conclusion: The association of liquid and jelly lidocaine was efficient in reducing the POST. This result needs to be supported by a larger study including an important number of patients.

Keywords: Intubation. Pharyngolaryngeal Pain. Otorhinolaryngology Surgery. Post-operative sore throat.
Lost in Translation

Lost in Translation

Authors: Francesco Vetri
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Abstract

As anesthesiologists, in whatever part of the world we live in, it is very common to be exposed to different cultures and languages. In some hospitals it happens on a daily basis, in others seldom, but the challenge of dealing with the “other” remains. In many institutions, like the one where the Author works, it is mandatory to use a professional medical translator, at least for the consent.

Keywords: Anesthesiologists. Language. Medical translator
Hemostasis Management during Adult Extracorporeal Membrane Oxygenation: A Shot in the Dark?

Hemostasis Management during Adult Extracorporeal Membrane Oxygenation: A Shot in the Dark?

Authors: Michael Mazzeffi
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Abstract

Extracorporeal membrane oxygenation (ECMO) has been used increasingly in adult patients with cardiopulmonary failure.1 According to the Extracorporeal Life Support Organization’s (ELSO’s) 2012 report over 51,000 patients have received ECMO. Most cases are for neonates; however, an increasing proportion is for adults.2 ECMO is a unique life saving therapy, but many patients experience complications including: hemolysis, systemic thromboembolism, neurologic complications, and bleeding.3 We previously reported that up to 56% of patients experience at least one significant bleeding event during ECMO and the rate of serious bleeding events is approximately 10 per 100 ECMO days.4 Our data also suggest that bleeding events and the amount of transfusion on ECMO are associated with decreased survival.

Keywords: Bleeding, Coagulation, Extracorporeal membrane oxygenation (ECMO).
Pediatric Emergence Agitation

Pediatric Emergence Agitation

Authors: Mehtap Honca
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Abstract

Emergence Agitation (EA) is still remaining as a major problem during the early stage of recovery from general anesthesia in children. EA was first reported in 1960’s and it has been considered as a mental disturbance during recovery from general anesthesia which consists of hallucinations, delusions and confusion manifested by moaning, restlessness, involuntary physical activity and thrashing about in the bed.1 The incidence of EA is variable and can reach to 80%.

Keywords: Emergence Agitation. Children
Positioning and Anesthesia Challenges
In a Morbidly Obese Patient Undergoing
Cervical Spine Surgery

Positioning and Anesthesia Challenges In a Morbidly Obese Patient Undergoing Cervical Spine Surgery

Authors: Keyuri Popat
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Abstract

Background Context: By itself, the perioperative anesthesia management of morbidly obese patients is challenging; this task is further complicated when such patients have to be placed in the prone position for surgery. In these cases, challenges may include positioning, intubation and ventilation. Purpose: Herein, we describe the safe perioperative anesthesia care of a morbidly obese patient undergoing cervical spine surgery for an enlarging schwannoma. Study Setting: Morbidly obese patient care at a tertiary cancer institute. Patient Sample: Single case report. Methods: Describing the preparation and planning for this complex case and the perioperative care of a patient with several comorbidities. No conflict of interest to report for any of the authors. Results: Good patient outcome. Conclusion: Careful multi-disciplinary planning facilitates, good patient outcome, given the challenging nature of the case. Highlighting the use of a trial run in the operating prior to the day of surgery.

Keywords: Obesity. Surgical complications. Cervical Spine Surgery
Isolated Prolonged Activated Partial Thromboplastin Time and Contact Factor Deficiencies: Case Series and
Management Review

Isolated Prolonged Activated Partial Thromboplastin Time and Contact Factor Deficiencies: Case Series and Management Review

Authors: Majed A. Refaai
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Abstract

Background: Contact factor deficiencies are rare disorders that can cause grossly prolonged activated partial thromboplastin time (aPTT) and activated clotting time (ACT) while rarely affecting in vivo hemostasis. This in vitro laboratory phenomenon poses a particular challenge in surgical procedures that require anticoagulation monitoring. Case: Here we report two cases of contact factor deficiencies; a 67-year-old morbidly obese female with factor XII deficiency requiring revascularization of a graft and a 58-year-old female with prekallikrein (PK) deficiency undergoing routine muscle biopsy. Conclusion: Peri-operative anticoagulation monitoring poses a significant challenge in contact factor deficiency patients. Awareness of the challenges of contact factor deficiencies allows for optimal peri-operative management. Emerging literature supports that contact factors play a role in fibrinolysis. Increased surveillance of thrombotic events as well as avoidance of fibrinolytics may be necessary in these patients.

Keywords: Prekallikrein (PK). Factor XII. Activated partial thromboplastin time (aPTT). Contact factors. Fibrinolysis. Anticoagulation. Prolonged clotting time. Thrombosis.
Case Report in Anesthesiology: Essential Pulmonary Hypertension in a Primigravida

Case Report in Anesthesiology: Essential Pulmonary Hypertension in a Primigravida

Authors: Charles Youngblood
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Abstract

A 21-year old gravida 1, para 0, female with a past medical history of Pulmonary Hypertension (PH) secondary to a congenital heart disease (patent foramen ovale), diaphragmatic hernia status post repair, asthma, and attention-deficit/hyperactivity disorder presented to a tertiary care hospital at 30 weeks gestation for a right heart catheterization. The catheterization was completed without complications and it was found that the patient’s Pulmonary Arterial Pressure (PAP) was 54/32 with a mean value of 39. The PAP was only minimally improved to 46/30 with a mean of 35 after nitric oxide administration.

Keywords: Pulmonary Hypertension. Primigravida.
Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient
Satisfaction

Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction

Authors: Mark D. Reisbig
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Abstract

Peripheral nerve blockade is an effective modality involved in controlling perioperative pain. When compared with patient controlled analgesia, neuraxial analgesia, and other anesthetic methods such as periarticular infiltration, peripheral nerve blocks yield superior pain control and reduce length of hospitalization. Not only do these techniques help with patient satisfaction and health care costs, they also have physiologic advantages. In murine models, peripheral nerve blockade reduces expression of different inflammatory markers such as IL-1, IL-6, TNFα and cortisol. Such advantages make this an attractive modality for pain control.

Keywords: Peripheral Nerve Blockade. Perioperative pain. Opioids
A Comparative Study of Ropivacaine Alone Versus Ropivacaine With Dexmedetomidine in Supraclavicular
Brachial Plexus Block

A Comparative Study of Ropivacaine Alone Versus Ropivacaine With Dexmedetomidine in Supraclavicular Brachial Plexus Block

Authors: Surath Manimala Rao
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Abstract

Background and Aims: Supraclavicular brachial plexus block is frequently used procedure to provide anaesthesia and good post-operative analgesia for surgery on upper limb. The purpose of this study was to compare the hemodynamic, sedative and analgesic effects of ropivacaine alone versus ropivacaine given along with dexmedetomidine. Materials and Methodology: This prospective, randomized and double-blinded study included total 60 patients of either sex with age between 18-60 years posted for various elective upper limb surgery and randomly allocated into 2 equal groups of 30 each. Control Group-R received injection ropivacaine (0.75%) 30 ml plus 1 ml normal saline and Group-RD received injection ropivacaine (0.75%) 30 ml plus dexmedetomidine 25 µg (1 ml) for supraclavicular brachial plexus block using the peripheral nerve stimulator. Sensory and motor block, monitoring of vitals (systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)), presence of any side effect, Ramsay sedation score and visual analogue scale or visual analog scale (VAS) score were determined every 5 mins in 1st 30 mins and then every 15 mins during 1st hr followed by every 2nd hourly during 24 hrs. Results: There was no significant difference in the study groups with regards to demographic profile and duration of surgery. The onset of sensory and motor blockade was faster in Group-RD than Group-R. {Onset of sensory block: (Group-R=14.133±1.676 min and Group-RD=12.667± 1.213 min) (p=0.000), Onset of motor block: (Group-R=25.967±2.748 min and Group-RD=23.333±3.467 min) (p=0.002). Also total duration of sensory blockade {Group-R=547.833±26.152 mins, Group-RD=811.667±25.405 mins (p value=0.000)}, motor blockade {Group-R=509.667±24.703 mins, Group-RD=760.667±28.062 mins (p value=0.000)} and number of rescue injections in 24 hrs {Group-R=2.733±0.450, Group-RD=1.400±0.498 (p value=0.000)} was significantly different in 2 groups. There was good haemodynamic stability in both groups. SBP and DBP in Group-R and Group-RD with p values 0.416 and 0.784 were comparable between the groups. The difference was statistically not significant. There was no incidence of any side effects like hypotension and bradycardia in any of the 60 patients. Conclusion: Dexmedetomidine in a dose of 25 µg added to ropivacaine in supraclavicular brachial block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor block without producing sedation in patients.

Keywords: Ropivacaine. Dexmedetomidine. Adjuvant. Supraclavicular brachial plexus block.
The Importance of Optimizing Acute
Post-Surgical Pain

The Importance of Optimizing Acute Post-Surgical Pain

Authors: Jerry Jones
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Abstract

In February 1992, AHCPR released a clinical practice guideline1 to help surgeons, nurses, and anesthesiologists manage acute post-operative pain more effectively. The guideline was developed by an 18-member private-sector panel of pain experts. The multidisciplinary panel reviewed the research literature on pain management to develop the scientific base for the guideline. The guidelines indicate that unrelieved pain causes suffering, can lead to other health problems, and delays recovery, thereby adding unnecessarily to health care costs. The acute pain management guideline had four major goals: • To reduce the incidence and severity of acute post-operative or post-traumatic pain • To educate patients about the need to communicate about their unrelieved pain • To enhance patient comfort and satisfaction • To reduce post-operative complications and, in some cases, shorten stays after surgical procedures.

Keywords: Post-Surgical Pain. Guidelines; Oral opioids
Factors Affecting Post-Operative Mortality
Rate after Major Lower Extremity
Amputations in a Tertiary Institution in
Singapore

Factors Affecting Post-Operative Mortality Rate after Major Lower Extremity Amputations in a Tertiary Institution in Singapore

Authors: Ong Ee Teng
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Abstract

Background: Non-traumatic Major Lower Extremity Amputation (MLEA) surgeries are associated with high post-operative morbidity and mortality rates. There are few studies evaluating factors associated with post-operative mortality rates for MLEA among Asian patients. Objective: To identify factors that affect post-operative mortality rate and ICU admission rates in patients undergoing non-traumatic MLEA surgeries in a tertiary institution in Singapore. Method: A retrospective study was performed by using the operating theatre electronic database to identify patients who underwent non-traumatic MLEA surgeries in Singapore General Hospital during the period of January 1, 2010 to December 31, 2011. Results: Data was collected from 186 non-traumatic MLEA surgeries performed during the study period. Overall post-operative in hospital mortality rate was 8.6%, higher for above knee amputation (AKA), than Through Knee Amputation (TKA) than Below Knee Amputation (BKA) (18.4% vs. 8% vs. 4.5%, p=0.015). In multivariate logistic regression analysis, site of amputation of AKA compared to BKA (odds ratio 3.9, 95% confidence interval 1.1-14.5, p=0.04), ASA 4 status (odds ratio 4.3, 95% confidence interval 1.2-14.6, p=0.02) and presence of septic shock (odds ratio 4.9, 95% confidence interval 1.4-17.3, p=0.01) were significant predictors of post-operative in hospital mortality rate. The same 3 factors were significant predictors of post-operative ICU admission rate. Use of peripheral nerve block as the sole anaesthetic technique did not affect in-hospital mortality rate (adjusted odds ratio 1.3, 95% confidence interval 0.3-5.6). Conclusion: Patients with ASA 4 status and pre-operative septic shock, especially those undergoing AKA, should be considered as high risk group and therefore managed appropriately. The higher incidence of post-operative ICU admission rate in this group of patients also necessitates pre-operative organization of bed availability. Using peripheral nerve block as the sole anaesthetic technique did not significantly affect outcomes measured.

Keywords: Major lower extremity amputation. In-hospital mortality rate. Peripheral nerve block.

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