Journal of Anaesthesia and Critical Care Reports最新文献

{"title":"Role of ECMO in Transplant Recipient","authors":"J. Haji","doi":"10.13107/jaccr.2019.v05i03.132","DOIUrl":"https://doi.org/10.13107/jaccr.2019.v05i03.132","url":null,"abstract":"Extracorporeal life support (ECLS) for heart/lung in a patient in cardiorespiratory failure is a highly specialized technique which needs careful patient selection, resources, infrastructure and interdisciplinary expertise much like a transplant program. The aim of this editorial is to outline the scope of Extracorporeal membrane oxygenator (ECMO) in preoperative bridging and perioperative management of sick patients with organ failure awaiting transplant as well as post-transplant. The attempt is to collate data of international and national experience for reference. ECMO is a validated tool as a bridge to heart or lung transplant if the patients decompensate while awaiting a transplant. The method, timing of initiation and end objectives of ECMO in these patients is not\u0000the same as that for conventional patients with sudden onset heart lung failure. Of greater challenge is the role of ECMO in liver transplant recipient perioperatively as it is definitely not a bridge to liver transplant. However, with careful selection and in ideal candidates ECMO can be used to stabilize a patient with liver failure or chronic liver disease who may otherwise be deemed too sick to transplant.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"319 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133367093","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":"Let Go’ technique in ultrasound guided Regional Anaesthesia","authors":"S. Singh, Tuhin Mistry","doi":"10.13107/jaccr.2019.v05i03.133","DOIUrl":"https://doi.org/10.13107/jaccr.2019.v05i03.133","url":null,"abstract":"Background: The local anaesthetic(LA) injection technique during ultrasound guided nerve blocks varies worldwide. This online poll was conceived to explore the current practice among the anaesthesiologists.\u0000Methodology: Two separate polls were created and posted at the same time with appropriate multiple choices in a closed Facebook group ‘The Anaesthetist’. Participants were allowed to take part in these online-based polls over a period of seven days. The responses were collected and put down in the Excel sheet to calculate absolute numbers and percentages.\u0000Results: Among the respondents, 63.45% of the ultrasound users keep hold on to the needle and let a trained assistant inject the LA while 14.61 % of the responders use ‘Let Go’ of the needle technique and inject the LA themselves. Amongst 248 ultrasound users, only one anaesthesiologist use Jedi grip but no one is currently using other grips described in the literature.\u0000Conclusion: LA injection technique varies among the anaesthesiologists throughout the globe. Majority of the\u0000anaesthesiologists let a trained assistant inject the LA and some inject the LA themselves.\u0000Keywords: Ultrasound, Regional Anaesthesia, Jedi grip, Bedforth grip, On-lock grip, ‘let-go’ of the needle, Single-handed injection technique, Online poll","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"176 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114409604","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":"Nasopharyngeal Airway As A Supraglottic Ventilation Device For Bronchoscopic Interventions","authors":"Astha Kanaparthi, V. Nair, Pramod L. Kale, Arvind H Kate","doi":"10.13107/jaccr.2019.v05i03.134","DOIUrl":"https://doi.org/10.13107/jaccr.2019.v05i03.134","url":null,"abstract":"Introduction: Bronchoscopy is performed for diagnostic and therapeutic purposes. It is a challenge for the anaesthesiologist to maintain ventilation for the patient as the patients’ airway is shared between the anaesthetist and the bronchoscopist. Many modalities have been used for anaesthesia and airway management for bronchoscopies. We present a case of bronchoscopy guided foreign body removal under anaesthesia. Spontaneous ventilation was maintained in the patient with the help of nasal airways.\u0000Keywords: Bronchoscopy, Ventilation, Nasal airway.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124681621","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":"Case Report: A Woman with Fever, Acute Changes in Mental State, and Progressive Neurological Degeneration","authors":"C. Orlando, Rivero-Sigarroa Eduardo, Loeza-Guemez Alejandro","doi":"10.13107/jaccr.2018.v04i03.106","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.106","url":null,"abstract":"Introduction: Anaplastic large cell lymphoma (ALCL), which was first described by Stein in 1985 as a feature of CD30 positivity, is now acknowledged as a distinct subset of T-cell non-Hodgkin lymphomas (NHL). It accounts for approximately 3% of adult NHL while constitutes as many as 30%–40% of pediatric large-cell lymphomas. It is rarely metastasized to other sites, especially to the central nervous system (CNS). Case Report: We present a case of a 73-year-old woman hospitalized for fever, acute behavioral changes, and progressive neurological degeneration; a rare case of systemic ALCL which metastasized to the brain. There are very few case reports of this matter in the literature. Conclusion: In the management of patients with neurological impairment, cognitive, and behavioral changes, we suspect the presence of lymphomas associated with the CNS still suspicious of other primary causes. Keywords: Anaplastic large-cell lymphoma, anaplastic lymphoma kinase gene, primary central nervous system lymphoma, non-Hodgkin lymphoma, T-cell lymphoma, lymph node enlargement.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124943671","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":"Operating Theatre Mannerisms & Etiquette: Revisited!","authors":"Pallavi Lande-Marghade","doi":"10.13107/jaccr.2018.v04i02.088","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.088","url":null,"abstract":"The operating theatre in a hospital is a highly critical and complex area which requires high hygienic standards. A certain code of conduct must be followed at all times to maintain a pedagogical model of excellence. There is indeed a very narrow margin for errors and critical incidents are waiting to happen with any lapses in the standard of care. The core idea of possessing certain etiquettes and mannerisms is therefore quintessential for excellence and safety in patient care and a good outcome. We as anesthetists play a pivotal role in maintaining the requisite standards. Let us revisit these sequentially to better equip ourselves in our temple of work- The Operating Theatre (OT) Basic house rules mandate entering the OT in a well laundered clean two piece scrub suit, cap, disposable mask and proper footwear to minimize cross infection. The scrub suit is made up of cotton with a high weave density that minimizes the risk of bacterial strike- through. These should be changed immediately if soiled or contaminated. Long sleeves are not allowed and bare below elbows must be strictly followed in all clinical areas. Proper footwear has ridged rubber soles to make it antistatic and anti skid to prevent slip and falls. (1) Our next portal of contact is the patient which has to be impactful! This is a game changing opportunity and one must make the most of it! Through each and every step of anesthesia, one must be courteous, empathetic, reassuring and communicate adequately with the patient. (2) This would set the patient at ease and half the battle will be won! Vigilance with multitasking must be reflected at every step with positive communication. Dutt-Gupta et al have shown that negative communication during intravenous cannulation is known to have increased analgesic requirements in one study. (3) Leave apart the humour, sattire, sarcasm but the best surgeon – anesthetist relationship actually is a symbiotic one which thrives on professionalism, punctuality, discipline, mutual respect and assertiveness. We all do possess technical skills with great dexterity but one must possess non technical skills which sets us apart from others. Arrive before time for performing the blocks. One must turn their penchant off for people pleasing and maintain integrity at all times. Strong work ethics is a must for success. Mistakes do happen and one must apologize and explain them. Perfect documentation of all events in the OT is essential as the law is very clear about it, if it is not mentioned in the anesthetic chart-it has not happened! In the recently concluded FIFA world cup 2018, the Croatian team taught us lessons for a lifetime. They did an unmitigated display of non-technical skills which are equally important for our working in theatre. These nontechnical skills are none other than task management, team work, situation awareness and decision making. Flin et al in their excellent article on Anesthetists’ and non-technical skills have pointed out that defi","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123499147","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":"Anesthesia and Infection Control","authors":"M. Kannan, S. Santhosh","doi":"10.13107/jaccr.2018.v04i02.090","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.090","url":null,"abstract":"Anesthesiologists are well versed in the aseptic nature of surgical procedures. Maintaining sterility of the operating field is in the DNA of every anesthesiologist. In this background, it is intriguing that Infection Control within Anesthesia Work Environment (AWE) garners little to no interest. To most anesthesiologists, Infection Control is changing breathing circuits in between cases, drawing new medications, administering antibiotics, wearing gloves while administering care and performing procedures with universal precautions. There are complex layers of reason for this unique situation. 1. The lack of training in Infection Control. The traditional training of anesthesiologists involves a three to four year residency program that provides exposure to different facets of anesthesiology. Most anesthesiologists are familiar with checklists and protocols for different problems during the peri-operative period. During training, most anesthesiologists get introduced to sterile surgical technique. However there is no formal training or education in Infection Control in the AWE. 2. “What the eye does not see and the mind does not know, doesn’t exist- D.H Lawrence- English Poet.” During the perioperative process,an anesthesiologist frequently encounter problems in a patient- the symptoms and signs of these problems readily manifest. It is a reflex for anesthesiologists to handle these problems. However poor infection control processes do not manifest in any immediate issues for the anesthesiologists. In most cases, patients may be discharged from the hospital and most anesthesiologist may never have a second encounter with the same patient. 3. The lack of resources or tools to improve Infection Control. AWE is contaminated with blood and biological matter from the patient. Clean and dirty equipments are frequently mixed. Clean areas are touched with contaminated gloved hands. Hand Hygiene as per WHO guidelines has been shown to be difficult to adhere during the peri-operative process. 4. The protocol to clean AWE primarily remains wiping the Anesthesia Machine and work surfaces with sanitizing wipes. There is little monitoring, training and validation of cleaning protocols. After a wipe down, there are no checks or validated assessment to ensure AWE is clean. It is important to differentiate between clean versus sterile environment. Sterile environment which is used for surgical environment denotes an absence of microorganism. Clean environment which is generally accepted for AWE means free of dirt, marks or stains to reduce the overall number of organisms[1]. Current Evidences demonstrate that Environmental Hygiene play an important role in development of infections during hospitalization. Patients placed in contaminated rooms or surroundings have a higher chance of acquiring an infection[26]. Several pathogens like Multidrug resistant Acinetobacter, Vancomycin Resistant Enterococci (VRE), pseudomonas are known to exist on surfaces of healthcare fac","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121934126","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":"Intraoperative Priapism during Neuraxial Anaesthesia Resulting in Trouble to the Urologist: A Case Report","authors":"J. Garg, Hong Kian, C. N. K. Reddy","doi":"10.13107/jaccr.2018.v04i02.097","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.097","url":null,"abstract":"Introduction: Priapism following neuraxial anaesthesia for urological endoscopic procedures is uncommon and may result in delay or even postponement of scheduled operations. An imbalance between sympathetic and parasympathetic nervous system usually contributes to intraoperative penile erection, although local stimulation before complete sensory blockade may also lead to priapism. Case Report: We discuss a case of successful management of priapism in 47-year-old Chinese male patient listed for transurethral resection of bladder tumor following a subarachnoid block. Conclusion: With a detailed knowledge about the pathophysiology of intraoperative penile erection, anaesthesiologist can appropriately direct treatment depending on the individual patient and hence minimize the risks of subsequent complications. Keywords: Priapism, spinal anaesthesia, glycopyrrolate, phenylephrine.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"130 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117213548","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":"Transplant Anesthesia","authors":"V. Shetty","doi":"10.13107/jaccr.2018.v04i01.077","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.077","url":null,"abstract":"Solid organ transplants are slowly increasing across the world. As the societies evolve and communities begin to realize the value of organ donation after brain death, the number of donations after brain death will continue to the rise. These numbers, however, encouraging are far inadequate to meet the demands from the ever-growing number of recipients. This gap is filled in some measure by live donors who are subjected to an invasive procedure to provide kidneys, part of the liver, or even lung. In comparison, the patients with end-stage heart disease have no such options and continue their vigil on the waiting list. This has also led to a huge increase in the number of implantable devices like the left ventricular assist device in developing countries in recent times.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124021969","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":"Successful Anesthetic Management of Coronary Artery Bypass Graft Patients with Very Low Ejection Fraction: Two Case Reports","authors":"Meenakshi Kumar, M. Panwar, Swarnendu Dey","doi":"10.13107/jaccr.2018.v04i02.093","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.093","url":null,"abstract":"Introduction: The incidence of patients posted for coronary artery bypass graft (CABG) with low ejection fraction (EF) is on the rise. These patients present a challenge for the attending anesthesiologist in the perioperative period as they have a poor tolerance to the stress of anesthesia as well as surgery. Maintaining forward flow with avoidance of arrhythmias and hypotension is the primary goals of balanced anesthesia. Case Report: We describe successful anesthetic management in two adult male patients with Very low EF undergoing CABG. Conclusion: Both patients were successfully managed with pre-operative dobutamine infusion which improved the EF and intraoperative use of intra-aortic balloon pump which led to stable hemodynamics. Keywords: Coronary artery bypass graft, low ejection fraction, dobutamine, intra-aortic balloon pump","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125214647","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":"Case report on anaesthetic management of a patient with self embedding syndrome and difficult airway due to pins in and around trachea","authors":"","doi":"10.13107/jaccr.2021.v07i02.174","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.174","url":null,"abstract":"Management of a “difficult airway” remains one of the most relevant and challenging tasks for anaesthesiologists. Although practice guidelines and algorithms may help in such situations, yet modifications are required according to the situations. In this case report the anaesthetic management of a patient with self-embedding syndrome having multiple pins inside his trachea and neck has been described. We present our method of successful management in this case and reiterate the role of different methods of correct positioning and intubation in such circumstances. The use of dexmedetomidine helped in achieving spontaneously breathing patient and fiberoptic bronchoscopy used for assessing the tracheal condition before tracheostomy.\u0000Keywords: Difficult airway, Awake fiberoptic.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128147550","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}