Sri Lankan Journal of Anaesthesiology最新文献

{"title":"Internal Carotid Artery Blood Flow Response to Anaesthesia, Pneumoperitoneum and Head-Up Tilt During Laparoscopic Cholecystectomy: A Clinical Study","authors":"Avnish Bharadwaj, Shubhina Gupta, Ayush Gupta, Shruti Singhal, Vijay Mathur, Vikrant Goswami","doi":"10.4038/slja.v31i2.9050","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9050","url":null,"abstract":"Background: Control of cerebral blood flow (CBF) is complex and is only beginning to be elucidated. There is paucity of information on how implementation of pneumoperitoneum and head-up tilt under general anaesthesia affects CBF. This study was designed to observe changes that occur in the internal carotid artery (ICA) blood flow with pneumoperitoneum and head-up position and corelate these changes with changes in cardiac output in patients undergoing laparoscopic cholecystectomy.Methods: ICA blood velocity and diameter was measured by Doppler ultrasound in 35 ASA grade I and II patients undergoing laparoscopic cholecystectomy, at four time points: awake, after anaesthesia induction, after induction of pneumoperitoneum, and after head-up tilt; and ICA blood flow was calculated. Simultaneously, heart rate, blood pressure, and end-tidal carbon dioxide (ETCO2) were recorded, and cardiac output was calculated.Results: ICA blood flow decreased upon anesthesia induction from 164 mL/minute to 151 ml/minute (p>0.05). ICA blood flow increased with pneumoperitoneum (from 164 mL/minute to 179ml/minute p= 0.04). Head-up tilt resulted in decrease in ICA blood flow (from 164 mL/minute to 151ml/ minute, P = 0.09).Conclusion: ICA blood flow significantly increased after the creation of pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy under general anaesthesia. Induction of anaesthesia and head-up tilt, however, did not have any significant change in ICA blood flow. We suggest that ICA blood flow during anaesthesia is influenced by an interplay of actions of anaesthetic agents, positive pressure ventilation and patient position besides the changes in blood pressure, ETCO2 and cardiac output.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645411","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":"An Audit on Unnecessary Preoperative Investigations and Their Cost in Dental Hospital Peradeniya Sri Lanka","authors":"Samadhi Madugalle, Kasun Rajapakshe, Razna Imtiaz, Neranjana Waidyalankara, Ashani Ratnayake, Anura Abeysundara","doi":"10.4038/slja.v31i2.9240","DOIUrl":"https://doi.org/10.4038/slja.v31i2.9240","url":null,"abstract":"Preoperative investigations are important elements of preoperative evaluation to determine the fitness for anaesthesia and surgery. [1,2,3].The objectives were to assess the number of unnecessary preoperative investigations carried out and repeated in Dental Hospital, Peradeniya and to analyze the cost of investigations that are performed unnecessarily. Reference guidelines were the NICE Preoperative Investigations Guideline (2016) [4] and the National Preoperative Investigations Guideline (2022) [5].The study was carried out on patients undergoing elective surgeries in the main theatre complex of Dental Hospital, Peradeniya, over a month. Pediatric surgeries, emergency surgeries, repeated surgeries and ICUbound patients undergoing surgeries were excluded.Forty-nine cases were performed during the study period (11 minor, 26 intermediates, and 12 major cases).According to the results; FBC- 15, BU-12, SCr- 20, SE (Na, K)- 25, SCl- 9, AST/ALT- 4, PT/INR- 9, CXR- 6, ECG- 11, 2D echocardiogram- 1, FBS/CRP- 1 were performed unnecessarily. The total unnecessary cost was 107,400 LKR over that month. This reveals an average of 2200 LKR unnecessary investigation costs per surgery. In conclusion, a considerable number of inappropriate investigations are performed in an elective preoperative setting which also has cost implications.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135645985","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":"Publishing as an Amateur Author, Probability of the ‘Improbable’","authors":"B.M Munasinghe","doi":"10.4038/slja.v31i1.9150","DOIUrl":"https://doi.org/10.4038/slja.v31i1.9150","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44137314","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":"A Young Female with SARS-CoV-2 Infection Presenting with Concurrent Neurological and Pulmonary Manifestations: A Case Report","authors":"P. Makuloluwa, Kavisha P. Dissanayake, M. Jayasekera","doi":"10.4038/slja.v31i1.9071","DOIUrl":"https://doi.org/10.4038/slja.v31i1.9071","url":null,"abstract":"Coronavirus disease 2019 (COVID-19), besides its well-known deleterious effects on the respiratory system, is also reported to affect the central nervous system (CNS), presenting with neurological manifestations, that are commoner among older patients with associated co-morbidities and in the critically ill with COVID pneumonia. Infective, cerebrovascular, and hypoxic-toxic-metabolic etiology have been implicated. Reported outcomes have been poor with persistent neurological deficits among the majority who have survived. We report a young lady who presented with neurological manifestations alongside moderately severe COVID-19 pneumonia. Diagnosed early and managed as severe encephalopathy after excluding infective and cerebrovascular aetiology. Responded well to conservative measures and made a complete recovery. Early recognition of neurological manifestations of COVID-19 disease followed by the institution of appropriate therapies improved the outcomes.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44075711","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":"Intravenous Anaesthetic Drug Wastage and Its Financial Burden on A Tertiary Care Hospital in Sri Lanka","authors":"Minura Hapugoda, Sammani Wasundara Wijerathne","doi":"10.4038/slja.v31i1.9027","DOIUrl":"https://doi.org/10.4038/slja.v31i1.9027","url":null,"abstract":"With recent advancements in anaesthetic management where newer drugs and innovative treatment modalities are being introduced, the healthcare cost has increased and it is prudent to reduce the healthcare expenditure in a developing country such as Sri Lanka without compromising on patient care. Reducing drug wastage, can reduce the impact on hospitals pharmaceutical budget. The present study was conducted to assess the wastage of intravenous anaesthetic drugs and to assess its economic impact at a tertiary hospital in Sri Lanka. Following ethical clearance and institutional approval, a prospective study was conducted at all operations rooms at a tertiary care hospital for four consecutive weeks. Intravenous anaesthetic drugs left in syringes, vials and opened ampules not used were documented at the end of each day. The total and daily cost of drug wastage was calculated using the unit price list issued by the Ministry Of Health, Sri Lanka. The largest volume of drug wastage was from Propofol 1489.28 mg. per day followed by Ephedrine (145.35 mg per day). The total financial loss during the study period was Rupees. 164477.95, and the average daily loss was Rupees. 5874.21. The maximum daily cost of drug wastage was due to Metaraminol (Rupees. 3537.9) followed by Propofol (Rupees. 616.35). The financial impact form anaesthetic drug wastage was considerable with Metaraminol and Propofol being the main contributors. Educating the staff on drug costs, employing practical methods to reduce wastage and frequent audits can be used as a wastage cost reduction strategy.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46739687","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 in A Case of Temporomandibular Joint Ankylosis Using A Newer Bronchoscope-Ambu Ascope","authors":".. Priya, S. Dulara, G. Naveen","doi":"10.4038/slja.v31i1.8884","DOIUrl":"https://doi.org/10.4038/slja.v31i1.8884","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48317729","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":"Anaphylactic Reaction to Cryoprecipitate in a Patient with Von Willebrand Disease During Factor Correction for Elective Cesarean Section","authors":"Samanka Bandara, Maduka Imali, Madura Wanasinghe, C. Ratnayake, V. Pinto, Padmalal Desilva","doi":"10.4038/slja.v31i1.8794","DOIUrl":"https://doi.org/10.4038/slja.v31i1.8794","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42431292","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":"Black Water Fever Complicated by Acute Kidney Injury: A Case Report","authors":"Sasika Wijayasinghe, Namal Ulluvisheva, Roshana Mallawaarachchi, Ruwani Dharmabandu, Gimhani Palliyaguruge","doi":"10.4038/slja.v31i1.9082","DOIUrl":"https://doi.org/10.4038/slja.v31i1.9082","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70154161","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":"Sitting Position in Neuro Anesthesia – Current Perspective and The Way Forward","authors":"Ravi Weerakoon","doi":"10.4038/slja.v31i1.9185","DOIUrl":"https://doi.org/10.4038/slja.v31i1.9185","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41607934","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":"Utility of the Brixia CXR score, C-Reactive Protein and Absolute Neutrophil Count in Predicting the Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Mortality in Moderate to Severe COVID-19 Patients","authors":"V. Shanbhag, Souvik Chaudhuri, N. Arjun, A. Pandey, P. Vishwas, Megha Sharma","doi":"10.4038/slja.v31i1.8905","DOIUrl":"https://doi.org/10.4038/slja.v31i1.8905","url":null,"abstract":"Background: The Brixia Chest X-ray (CXR) score, C-reactive protein (CRP), and the absolute neutrophil count (ANC) have been useful to predict outcomes in Coronavirus disease 2019 (COVID-19 patients). We studied the utility of the Brixia CXR score, CRP, and ANC in predicting the outcomes in terms of the need for invasive mechanical ventilation, length of stay, and mortality in moderate-severe COVID-19 patients. Material(s) and Method(s): This was a single-centre, retrospective, study on 122 COVID-19 patients. Brixia CXR score, CRP, and ANC on admission to the hospital and the fifth day of hospital stay were noted along with the need for invasive mechanical ventilation (IMV), prolonged length of stay (LOS) >= 14 days, and mortality. Result(s): 122 patients were included for analysis. The median and interquartile range (IQR) for baseline CRP was 81.50 (39-151) mg/L and 11.0 (4-30) mg/L (p < 0.001) on the fifth day. The median and IQR for baseline Brixia score was 10.0 (7-13), and on the fifth day was 7 (4-11) (p <0.001). The receiver operating characteristic curve (ROC) showed that the baseline CRP >= 52.5mg/L predicted both the need for IMV, with an area under the curve (AUC) of 0.628, and prolonged LOS with an AUC of 0.608. The ROC curve depicted that the baseline ANC >8500/muL predicted IMV requirement with an AUC of 0.657. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality in hospitalized patients. Conclusion(s): Baseline CRP (> 52.5mg/L) predicts the need for IMV and a prolonged LOS, but not mortality. Baseline ANC (> 8500/muL) predicted the need for IMV. CRP, Brixia CXR score, and ANC on the fifth day were not useful to predict LOS or mortality, though there was a significant reduction in CRP and Brixia CXR score on the fifth day compared to baseline after treatment. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42421270","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}