Edorium Journal of Anesthesia最新文献

{"title":"Primary transport on extracorporeal membrane oxygenation: Two Indian center experience","authors":"Sandip Gupta, A. Chakraborty, K. Sarkar, D. Chatterjee, Pranay Oza","doi":"10.5348/100021a05sg2021ra","DOIUrl":"https://doi.org/10.5348/100021a05sg2021ra","url":null,"abstract":"Aims: Extracorporeal membrane oxygenation (ECMO) can be a lifesaving modality for patients with severe reversible pulmonary and/or cardiac failure, but its use remains restricted to a few highly equipped referral centers. Conventional transports to an ECMO center can be hazardous. Transport teams are usually trained to transfer stable patients across hospitals. As ECMO patients are extremely sick, specially trained critical care teams to deal with all possible complications in these critically ill patients will be required. Therefore, many ECMO centers have developed transport programs with the mobile ECMO team. In this study, we aim to present a brief account of the two-center experience of ECMO transport from India.\u0000\u0000 Methods: Retrospective observational study is depicting the data of two mobile ECMO teams over 4 years, where 21 patients (16–74 years) were evaluated. Analysis was done for the transport arrangements, different characteristics of ECMO retrieval patients, their outcomes, and predictors of mortality of a total of 21 patients from two different referral centers of India. As it is a retrospective observational study, hence institutional ethical committee approval was waived off.\u0000\u0000 Results: The mean distance of travel was 87.24±104.5 km (range 2–250 km) and transportation was by road in all cases. About 38% (n=8/21), patients had suffered from complications during transport like hypotension, cardiac arrest. There were no deaths in connection with transportation. The overall mortality rate was 33.3% with no difference over gender, age, duration of pre-ECMO ventilation, or duration of transport. The most common indication associated with ECMO transport was H1N1 infection.\u0000\u0000 Conclusion: We found that patient transfer if done with proper protocols by a prepared team with full knowledge of problem areas to a referral institution while on ECMO support seems to be safe and adds no significant risk of mortality to ECMO patients.","PeriodicalId":193456,"journal":{"name":"Edorium Journal of Anesthesia","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130075107","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":"Implementation of new protocol for pain management following cardiac surgery","authors":"Z. Milan, Amy Rene Gomes, Mimi R. Borrelli, Mimi R. Borrelli, Gudran Kunst, K. Katyayni","doi":"10.5348/100020a05zm2020ra","DOIUrl":"https://doi.org/10.5348/100020a05zm2020ra","url":null,"abstract":"Aims: We assessed the implementation and effectiveness of an updated protocol designed to improve pain management in cardiac surgery patients. The new updated protocol was recommended systemic pain assessment every four hours unless patients were unstable, using the numerical rating score (NRS) after the endotracheal extubation. Our secondary aim was to analyze the factors predicting patients’ postoperative pain to guide development of future pain management protocols.\u0000\u0000 Methods: Fifty patients undergoing cardiac surgery with median sternotomy were evaluated in this audit. Perioperative details and details regarding analgesic administration were collected. High-risk patients were classified as ones with a history of substance misuse, chronic pain, and preoperative opioid use. Pain was measured at rest, on coughing and on moving, for the first three postoperative days (POD), using 11-point NRS (0–10). Pain was considered “unacceptable” if it was NRS ≥4 at rest, and NRS ≥8 on activity. A univariate and multivariate mixed model linear regression was used to investigate factors that may contribute to pain following cardiac surgery.\u0000\u0000 Results: On POD1 38% of patients reported unacceptable pain at rest, and 27% reported unacceptable pain on coughing or moving. There was limited implementation of the new protocol, thus we cannot comment on the effectiveness of the updated protocol. Multivariate analysis demonstrated an overall significant interaction effect between postoperative day and risk (p = 0.032). It was found that high-risk patients reported pain to be greater than pain reported by low-risk patients on POD3 (2.14, CI −0.32 to 4.26, p = 0.054). Use of preoperative gabapentin did not affect pain at rest nor pain on coughing or moving (p > 0.5).\u0000\u0000 Conclusion: The new pain protocol was not followed in the majority of patient cases. Preoperatively, only 25 (56%) patients received gabapentin. No patients received patient-controlled analgesia (PCA) postoperatively. Seven (15%) patients identified as high risk received no differential pharmacological management contrary to the updated protocol. It is believed that e-mail is not sufficient to implement a new protocol such as this, thus resulting in protocol implementation failure. However, it was found that postoperative pain differed between high-and low-risk patients, especially at rest. This indicates that risk assessment and individualized pain protocols are important to optimize postoperative pain management following cardiac surgery. We have discussed the efforts required to improve future protocol implementation and pain management across disciplines.","PeriodicalId":193456,"journal":{"name":"Edorium Journal of Anesthesia","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126934927","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":"Prevalence of preoperative anemia in pediatric surgical patients and its impact on perioperative blood transfusion","authors":"Ioannis A Ioannou, R. Newton, B. Clevenger, David A H de Beer","doi":"10.5348/100019a05ii2019ra","DOIUrl":"https://doi.org/10.5348/100019a05ii2019ra","url":null,"abstract":"Aim: To determine the prevalence of preoperative anemia in children presenting for surgery at our institution and to establish whether preoperative anemia increased the likelihood of perioperative transfusion.\u0000 Methods: A retrospective review of all noncardiac surgical patients over a 2-week period. Data were collected for demographics, type of surgery, hemoglobin concentration within 28 days of surgery, severity of anemia and whether a blood transfusion was administered within 28 days of surgery.\u0000 Results: 723 patients underwent non-cardiac surgery during the study period, of which 334 had a preoperative hemoglobin measurement, 116 of those were anemic. Blood transfusion was administered in 19.9% of all anemic patients, compared to 5.4% of non-anemic patients (odd ratio [OR] 4.383; 95% confidence interval [CI], 2.10–9.53; p less than 0.0001). In anemic children over six months of age, 75.3% were of moderate severity, 22.6% were mild, and 2.1% severe, with transfusion rates being similar 23.6, 15.1, and 33.0%, respectively. The prevalence of anemia increased with ASA severity with blood transfusion occurring more often in anemic than non-anemic patients in all ASA grades. Anemic patients who underwent intermediate or major procedures were significantly more likely to be transfused than their non-anemic counterparts, with no significant difference seen for minor procedures.\u0000 Conclusion: Preoperative anemia is common in children presenting for surgery at our institution and in the majority of cases, this is of moderate severity. Preoperative anemia is associated with an increased likelihood of perioperative blood transfusion compared to patients with hemoglobin concentrations within the normal range.","PeriodicalId":193456,"journal":{"name":"Edorium Journal of Anesthesia","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126554646","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":"Anaesthetic management of organ transplant patients","authors":"Ž. Milan, M. Cortes-Cerisuelo","doi":"10.5348/100018a05zm2019ed","DOIUrl":"https://doi.org/10.5348/100018a05zm2019ed","url":null,"abstract":"No Abstract","PeriodicalId":193456,"journal":{"name":"Edorium Journal of Anesthesia","volume":"303 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123668604","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":"Perioperative risk factors for acute kidney injury following liver resection surgery","authors":"Milan Zoka, R. Amy","doi":"10.5348/100017a05zm2019oa","DOIUrl":"https://doi.org/10.5348/100017a05zm2019oa","url":null,"abstract":"Aim: To investigate and identify potential perioperative risk factors for developing acute kidney injury (AKI) in patients undergoing liver resection.\u0000\u0000 Methods: This is a retrospective analysis of a single cohort centre of 110 patients undergoing liver resection. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used for acute kidney injury (AKI) diagnosis. Preoperative, intraoperative and postoperative variables were recorded. These were then statistically analysed through univariate and multivariate regression analysis.\u0000\u0000 Results: Acute kidney injury occurred in 17 patients (15.45%). Twelve patients were stage 1 AKI (70.6%), four were reportedly in stage 2 (23.5%) and one patient was in stage 3 (5.9%). Risk factors were identified through univariate regression analysis were ASA status (p=0.023), weight (p=0.001), gender (p=0.01) and baseline serum creatinine (p=0.031). Weight and Americal Society of Anaesthesiologists (ASA) status were also identified in the multivariate regression analysis as being independent predictors for the development of AKI (p=0.014, p=0.021 respectively).\u0000\u0000 Conclusion: Acute kidney injury stage 1–3 is a common complication following hepatectomy. Risk factors including obesity and presence of comorbidities can contribute to the development of AKI and thus may provide appropriate targets for perioperative treatment.","PeriodicalId":193456,"journal":{"name":"Edorium Journal of Anesthesia","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133596514","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":"Limb amputation of an infant with transposition of great arteries using spinal anesthesia","authors":"Blind G. Al-Talabani, Twana Kareem, Seerwan O. Hasan, Jwan Rasheed","doi":"10.5348/100016a05ba2018cr","DOIUrl":"https://doi.org/10.5348/100016a05ba2018cr","url":null,"abstract":"Introduction: Spinal and caudal anesthesia are useful anesthetic techniques for infants compared to general anesthesia. In case of infants lumbar puncture can be safely performed at or just below the intercristal line. Due to the presence of loose fatty tissues in the caudal extradural space, it becomes safe and easy to insert a cannula enabling easy cranial spread of local anesthetic drugs. Increased production and absorption of cerebrospinal fluid in infants lead to administration of higher doses of local anesthetics. However, this spinal and caudal anesthesia has lesser risk of post-operative apnea in infants compared to general anesthesia.\u0000\u0000 Case Report: A three-month-old male infant, whose body weight was seven and half kilograms, was afflicted with ischemia which extended to half of his right leg. There was gangrene on his right big toe as well. These developments occurred after cardiac catheterization was implemented through right femoral vein cannulation. Due to high-risk of transposition of great arteries in general anesthesia, the surgeons finalized under spinal anesthesia in order to bypass the infected respiratory system, prevent aspiration because of full stomach, and to get better postoperative analgesia.\u0000\u0000 Conclusion: Spinal anesthesia is an alternative option to general anesthesia in high risk patients owing to its safety. However, in case of spinal complications or failure of spinal anesthesia, the anesthetist should always get ready with the high risk general anesthesia.","PeriodicalId":193456,"journal":{"name":"Edorium Journal of Anesthesia","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114747889","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}