Journal of Anaesthesia and Critical Care Reports最新文献

{"title":"A Rare Case of Brugada Syndrome of a Female Patient Presented for Labour: Structured Anesthetic and Analgesic Plan for Delivery Management","authors":"","doi":"10.13107/jaccr.2020.v06i02.151","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i02.151","url":null,"abstract":"Abstarct: 32 Years old Primigravida, with Brugada syndrome presented for analgesic and anesthetic management for normal vaginal delivery which progressed to emergency caesarean section. We are presenting a structured approach aiming for avoiding medication that can trigger malignant arrhythmia; Possibly achieving minimal local anesthetic serum concentration which could trigger such attacks.\u0000Key Words: Brugada syndrome; Combined spinal epidural; Local anaesthesia.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"161 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120940328","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":"Early Detection is Vital in Successful Resuscitation after Massive Mixed-air and Carbon dioxide Venous Embolism during Laparoscopic Surgery","authors":"","doi":"10.13107/jaccr.2020.v06i02.149","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i02.149","url":null,"abstract":"Air embolism is a life threatening condition, which is commonly reported in sitting position surgery or when the venous sinuses are open. Symptoms may appear depending on volume of air entrained and rate of entrainment. Lung acts as a filter and if the area exposed is more than the critical volume, then ventilation – perfusion (V/Q) mismatch leads to hypoxia and ultimately death. In contrast, carbon dioxide in large volume, lead to right ventricular outflow tract (RVOT) obstruction and reduce cardiac output. In people with probe patent patent foramen ovale, this can reach left atrium and lead to systemic embolism. Laparoscopic surgery, in general is safe and in situations, where there is abnormal organ placement and arterio venous connection may lead to gas placement into circulation. Detection is by trans esophageal echocardiography, precordial doppler, end tidal carbon dioxide monitoring and pulse oximetry. We present one such case with altered anatomy leading to ptosis of liver and massive mixed air and carbon dioxide embolism, which was successfully re-suscitated.\u0000Keywords: Air embolism; Carbon dioxide embolism; Laparoscopy.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134573610","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":"Anesthetic Management of Scoliosis Correction in Mainzer-Saldino Syndrome: A Case Report","authors":"","doi":"10.13107/jaccr.2020.v06i02.148","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i02.148","url":null,"abstract":"Introduction: Mainzer-Saldino Syndrome is a rare autosomal recessive disease with mutations in genes that encode components involved in ciliary transport. This syndrome is characterized by chronic renal failure, severe retinal dystrophy and skeletal abnormalities including spinal and chest wall deformity resulting in severe respiratory failure.\u0000Case presentation: We report the first successful anesthetic management of a 26-year-old man with Mainzer-Saldino Syndrome who underwent scoliosis deformity surgical correction. The severity of respiratory problems and renal dysfunction that characterize this syndrome require a multidisciplinary preoperative assessment and careful planning of intraoperative management, also in relation to surgical complications.\u0000Conclusions: A careful preoperative assessment is essential for the correct anesthetic management. General anesthesia was safely administered; however a constant modulation of controlled ventilation is required to avoid barotrauma and an invasive hemodynamic monitoring is critical to allow adequate fluid management. Lastly, intraoperative dialysis can be planned in long-lasting surgery with a significant loss and replacement of fluids.\u0000Keywords: Mainzer-Saldino Disease; Ciliopathy; Anaesthesia.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133067885","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":"Simplified Strategies for COVID-19 Surge Management in Critical Care in Resource-Limited Areas – An Aide-Mémoire","authors":"Mehraj Din, P. Hegde","doi":"10.13107/jaccr.2020.v06i01.145","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.145","url":null,"abstract":"Purpose of this document\u0000Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome (SARS) coronavirus 2. We are facing an unprecedented situation globally because of the COVID-19 pandemic\u0000where extraordinary measures are needed continually on war footing. The goal being to save maximum lives while protecting health care staff.\u0000A competent emergency response system must incorporate necessary resources, relevant knowledge, attitudes and skills. Ring-fencing by clustering patients, experts and pooling of resources will go a long way in containing the pandemic locally.\u0000While detailed disaster response policies and guidelines are available from different societies and national bodies, this concise paper presents an aide-mémoire in a simplistic manner, since clarity of thought is\u0000key to effective preparation and sustained response. [1-5]\u0000Based on a review of various guidelines and literature search, key considerations are presented in a concise format to facilitate chalking out a suitable response strategy locally. [6-10]\u0000The following five key areas should be considered in the hospital/institution while planning for increasing Critical Care capacity to cope with anticipated COVID-19 surge.\u00001. Structure\u00002. Staffing\u00003. Space\u00004. Supplies and equipment\u00005. Sustainability and Staff Well being\u0000\u0000Structure (Management & Chain of Command)\u0000Anticipate:\u0000• There is going to be a sudden peak and surge in COVID-19 patients with many requiring Intensive Care Unit (ICU) admission requiring organ support particularly m e c h a n i c a l v e n t i l a t i o n w h i c h w i l l overwhelm existing health care facilities.\u0000\u0000Blueprint:\u0000\u0000• Establish a central/regional ICU COVID- 19 coordination center with dedicated and expert man power, which will guide and monitor all the ICU admissions and resource allocation in the entire region while maintaining continual contact with networking hospitals.\u0000• Lay down and circulate policies and guidelines","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133793959","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 Unique Presentation of Posterior Reversible Encephalopathy Syndrome","authors":"A. Saxena, R. Kapoor, A. Saxena","doi":"10.13107/jaccr.2020.v06i01.151","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.151","url":null,"abstract":"Introduction: Posterior reversible encephalopathy syndrome is a neurologic condition which is often though not always is associated with Pregnancy induced Hypertension. A high index of suspicion in a pregnant patient who presents with seizure and altered sensorium, along with characteristic findings in magnetic resonance imaging which are pathognomic for this syndrome can help clinch the diagnosis. An early definitive diagnosis and prompt management is the key to prevent permanent neurological damage in the patient.\u0000Case Report: We report a case of delayed unusual presentation (6 days post partum) of Posterior reversible encephalopathy syndrome [PRES] in a 25 year old pregnant patient of Pregnancy Induced Hypertension, wherein the patient presented six days after the delivery of baby in a unconscious state. She was admitted in intensive care unit and was managed with mechanical ventilation along with other neuroprotective measures. MRI brain was done which helped to clinch the diagnosis of PRES. She had complete recovery without any residual neurologic deficits and was discharged.\u0000Conclusion: Prompt and early diagnosis and neuroprotective measures are the keys for an ideal management of Posterior Reversible Encephalopathy syndrome. Also MRI brain is essential to clinch the diagnosis.\u0000Keywords: PRES, Pregnancy, Preeclampsia, Eclampsia.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129943981","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 Novel Plant Based Ultrasound Phantom","authors":"S. Singh, Tuhin Mistry","doi":"10.13107/jaccr.2020.v06i01.146","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.146","url":null,"abstract":"Introduction\u0000\u0000In most of the ultrasound guided regional anaesthesia workshops, anaesthesiologists usually concentrate on identification of nerves & plexus on human volunteers and practice needling techniques on phantom. Proper needle insertion technique and correct manipulation are two important skills for ultrasound-guided peripheral nerve blocks. These skills can be sharpened by practicing on ultrasound phantom. It also helps anaesthesiologists to develop, practice and maintain the skills needed for regional anaesthesia and vascular access procedures [1]. But the use of phantoms is often limited due to the cost of the blue phantom [2]. Many courses use meat-based products like turkey legs or porcine models but these may not be acceptable to everyone [3,4]. Vegetable based models using gelatine also may not be acceptable as it too is made from animal products. We describe novel use of Aloe Vera (AV)stem as phantom for US guided needling training. This natural AV gel-based phantom can be used for scanning, needling and refine other relevant skills. The AV phantom can be constructed from low cost, readily available natural source and is reusable.\u0000Various materials have been used to make ultrasound training phantoms. Commercially available phantoms are expensive and homemade nerve block models are cumbersome to prepare [5]. The Aloe Vera gel is obtained from Aloe Vera plant (Aloe barbadensis miller). It is a natural product which has been used for centuries in various field specially in dermatology. Aloe Vera leaves are triangular and fleshy with serrated edges. Each leaf contains an inner clear gel which is made of 99% water and other substances (glucomannans, amino acids, lipids, sterols and vitamins) [6]. Aloe Vera is odorless and semi-transparent unlike meat-based models.\u0000\u0000Preparing the Aloe Vera US Model\u0000The covering of the leaves is non-echogenic and hence the pulp from Aloe Vera leaves is separated and placed in layers and covered with a Transparent Dressing(Te","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133791161","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":"COVID-19 experience from an Intensive Treatment Unit (ITU) in London","authors":"Gaurav Patil, C. Ng","doi":"10.13107/jaccr.2020.v06i01.144","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.144","url":null,"abstract":"This article will try to provide an insight into the CoViD – 19 situation in Barnet Hospital with regards to management of the hospital, disease pattern, ITU admission criteria & treatment plans, work pattern of doctors, staff safety, & a trainee doctor’s experience. Barnet Hospital is a District General Hospital (DGH) in North London, whereas, Chase Farm Hospital is an elective surgical Hospital in North East London.\u0000\u0000Overall management\u0000Barnet Hospital is a DGH with 450 beds which includes 2 wings of ITU consisting of 10 beds & 13 beds respectively. There are more than 100 confirmed cases, and they are increasing. During the emergency period, elective surgeries have been stopped. The only surgeries that are on are emergencies, trauma (directed to another dedicated trauma centre), cancer surgeries, and maternity. The high risk areas are Emergency dept., isolation wards (separate for confirmed cases and suspected cases), ITU, Theatres, & Maternity. These have been reasonably well stocked with Personal Protective Equipment (PPE).\u0000\u0000ITU expansion plan\u00002 extra beds have been setup in ITU North wing. Theatre recovery has been converted to an 8 bedded ITU with anaesthetic machines as ventilators. A ward adjacent to ITU South wing has been converted to an ITU wing with 6 beds with anaesthesia machine ventilators. That has expanded the ITU capacity to 39. If more beds are needed, 3 out of 5 Operation Theatres and Anaesthetic rooms will be converted to 9 beds with anaesthesia machines as ventilators. Anaesthesia machines have been transported from Chase Farm Hospital.\u0000There is also a plan to transfer acute patients, preferably with single organ failure, to other hospitals with less patient volume, and also a new facility (Nightingale Hospital, Excel Centre) with 4000 dedicated beds for CoViD-19 patients.\u0000\u0000Diagnosis\u0000Patients are coming in with a combination of any of the following symptoms : Fever, dry cough, sore throat, history of recent travel/contact, shortness of breath,","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121891161","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":"Efficacy, Safety And Patient Satisfaction Of A Simple Combination Of Readily Available Medications (Shiv-mix) For Perioperative Analgesia, Hemodynamic Stability And Postoperative Recovery Profile: Case Series And Narrative On Opioid Free Anaesthesia (OFA) In Spine Surgeries","authors":"I. A. Khan, S. Singh","doi":"10.13107/jaccr.2020.v06i01.143","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.143","url":null,"abstract":"Opioid-free anesthesia (OFA) is an emerging technique, is a boon especially for limited resource settings(LRS) where opioids availability is limited for perioperative pain management. The current study presents use of a combination of easily available medication as part of multimodal analgesia. These medications are easily available to any physician and our experience demonstrates that in addition to providing satisfactory analgesia, use of this combination also provides better hemodynamic stability and excellent post-operative recovery.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115108012","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":"Combined femoral and sciatic nerve block with Levobupivacaine in Brugada syndrome patient: A case report","authors":"Diego Tavoletti, E. Rosanò, E. Cerutti, L. Pecora","doi":"10.13107/jaccr.2020.v06i01.150","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.150","url":null,"abstract":"Introduction: Brugada syndrome is a rare arrhythmic disorder associated to ventricular fibrillation and sudden cardiac death. General recommendations in Brugada syndrome patient are focused on avoiding increases in vagal tone and precipitating agents such as electrolyte disorders, hypo/hyperthermia and drugs. Anesthetic management in Brugada syndrome patient has been described in many case reports, however it is still unknown which anesthesia is the safest. Local anesthetic may have a theoretical arrhythmogenic risk, but currently there is no clear evidence and their risk is still debated. Peripheral nerve block avoids autonomic nervous system changes that occur with other anesthetic techniques and it is associated to a lower level in the plasma concentration of the local anesthetic compared with neuraxial anesthesia.\u0000Case Report: We report a case of a 38-year-old man patient with Brugada syndrome who underwent urgent orthopedic surgery which was managed with a combined femoral and sciatic nerve blocks using levobupivacaine without any complications.\u0000Conclusions: Peripheral nerve block with levobupivacaine provided good analgesia, hemodynamic and cardiac stability in Brugada syndrome patient.\u0000Keywords: Brugada syndrome, Anesthesia, Levobupivacaine, Peripheral nerve block, Regional anesthesia","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125442303","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":"Desperate measures in desperate times : DIY PPE WITH RESPIRATOR (in areas with minimum resources)","authors":"Mahanti Venkataramana, Ejjapureddi Sireesha, K. Babu, P. Saroj","doi":"10.13107/jaccr.2020.v06i01.148","DOIUrl":"https://doi.org/10.13107/jaccr.2020.v06i01.148","url":null,"abstract":"COVID 19, is a novel disease in the humans which is terrorising the whole world and blew up to become a pandemic in just a span of few months. The virus because of its rapid spread & infectivity is giving the healthcare system of every country a tough time. In India, though not fully blown yet, it will be very difficult to face the situation because of dire lack in the infrastructure and resources. Not just the ventilators but we may even run out of proper masks and PPE as well. Proper PPE, giving complete protection i.e, including a respirator, is the right of every healthcare worker especially during aerosol generating procedures. But unfortunately neither the technology nor the resources in our country will be adequate to cater to the present rising demand. So, in order to protect ourselves to the best of our ability and with the minimum resources, we have come up with this little innovation.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122294841","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}