Journal of Anaesthesia and Critical Care Reports最新文献

{"title":"Successful Management of Subcutaneous Infiltration of an Intubating dose of Rocuronium in a Morbidly Obese Patient: A Case Report","authors":"Nadia Awad, Scott Zalut, E. Deutsch","doi":"10.13107/jaccr.2018.v04i02.094","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.094","url":null,"abstract":"Introduction: Induction of anesthesia relies on multiple factors including appropriate monitoring, administration, and dosing of induction agents. In morbidly obese patients, placement and maintenance of intravenous lines may be difficult and accidental subcutaneous infiltration of medications may be challenging to identify. The treatment of accidental subcutaneous administration of neuromuscular blocking agents may be complex as the absorption and subsequent elimination is altered and not well known, and the inadvertent prolonged dosing could lead to catastrophic complications. Case Report: We present a case report of the successful management of the accidental subcutaneous administration of rocuronium in a morbidly obese, 65-year-old Caucasian female with multiple comorbidities undergoing an elective endovascular procedure. The perioperative management of the patient is discussed, and a review of the literature is provided. Conclusion: Relatively little information is available regarding the absorption of medications outside of the typical route of administration. The accidental subcutaneous infiltration of neuromuscular blockers could lead to airway compromise or prolonged blockade due to the unknown onset, peak effect, and duration of action. Open discussion among the many treatment team members after identification of accidental misadministration of medications is critical and clinical acumen is paramount to ensure optimal patient outcomes. Since intravenous line infiltration and subsequent subcutaneous extravasation are not a rare intraoperative event, more research into the effects of neuromuscular blocking agents is needed to aid clinical outcomes. Keywords: Anesthesia, critical care, drug administration routes, extravasation, neuromuscular blocker.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"23 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":"114390520","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":"Anesthetist and perioperative medicine","authors":"Sugam Kale, R. Agarwal, R. Priyadarshi","doi":"10.13107/jaccr.2018.v04i01.086","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.086","url":null,"abstract":"The practice of anaesthesiology goes through major upheavals every few decades similar to other medical disciplines. Historically anaesthetists were the glorious surgeon’s unsung companions keeping the patient still during surgery. As the science progressed, the process of anaesthesia became more refined and predictable. It also became safer than ever before. As a result of this progress, challenging surgery in patients with challenging co-morbid conditions is undertaken routinely now. Increase in overall life expectancy also adds to the list of physiological twists that interact with the stress of anaesthesia and surgery. A growing concern now is the ability of a single surgeon to be a good surgeon as well as a good cardiologist, nephrologist, haematologist, and so on to take on complex organ dysfunctions in the perioperative period. It is nearly impossible to expect majority of the surgeons to be masters of all trades as the progress of science in all fields is growing exponentially. How is it then that the idea of making the anaesthetist “the master of all trades” finds favor among many? Let’s examine the tenets on which this concept has been based. Is it possible? A designated physician can see a patient coming up for an elective surgery and manage his medications before and after his surgery. At present, the patient’s general practitioner fulfils this role. Going forward, if anaesthetists want to take this function over, can they be any better? Is it practical? Anaesthetist’s major clinical task will be giving anaesthesia. Then, there may be those who would wish not to give anesthetics but to play the general practitioner more often. They would be ideally suited to take on this role. However, the expectation will be that the care provided will be at par with that provided by a qualified and accredited cardiologist, endocrinologist, or nephrologist. As we saw previously, a surgeon cannot become all these while still trying to keep abreast with the advances in surgery. Why is it then thought that anaesthetist can somehow take overall these responsibilities while the surgeon cannot? A few decades ago, anaesthetists who were good at inserting tubes and catheters in various body parts were convinced that all the critical illnesses and organ failures that need such intervention were somehow best treated by the anaesthetists and not by the respective medical specialists. Thus, the anaesthetist managed critical care medicine. Is it legal? Whereas the surgeon making the post-operative rounds is not legally accredited to treat the patient’s post-operative myocardial infarct, neither would be the anaesthetist. Hence, if the same advice has to be sought from the same accredited cardiologist, does is matter much who signs the referral request? Furthermore, recognizing signs of organ dysfunction arethe remit of all doctors-whether they choose to become surgeons, anesthetists, or rheumatologist in later life ..","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"6 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":"117130497","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 Year on Ice-Humbling and Character building experience!","authors":"Madhubala Chinchalkar Joshi","doi":"10.13107/jaccr.2018.v05i01.076","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v05i01.076","url":null,"abstract":"Antarctica! The most hostile yet the breathtakingly beautiful landmass on the earth. It gives true feeling of vast dynamic forces of nature. Its haunting beauty is inspirational. It’s a place in the world where you experience absolute silence. Antarctica is the harshest, driest, coldest, windiest continent at the bottom of the earth. Treacherous weather yet a land of stunning panoramas, wide sweeping glaciers, turbulent ice-falls and vast majestic snow-covered landscapes. In summer, these are seen under a permanent sun that whirls relentlessly along the horizon and in winter continuous darkness obscures everything. Each sunrise and sunset are unique, and colours directly flow from heaven. The colours get reflected from pure white snow and there is a shower of many divine colours all around. Antarctica is a spiritual experience! Here the sun, moon do not always rise in the east and set in the west. The midnight sun sets for 10 minutes in the south at the beginning of winter here and the Polar night ends when sun rises for the first time in the North. Clouds with ice crystals give multiple images of sun, and cold weather plays tricks giving rise to astonishing mirages- don’t be surprised if you happen to see a ship or a piston bulley upside down! It is that part of the planet earth, where humans did not get a chance to interfere with nature. Southern Ocean encircling this continent freeze in winter resulting in doubling the size of the land mass-A pulsatile continent! Antarctica is cut off from the rest of the world during harsh winter months from March to October. Highest of all the continents, Lowest recorded temperatures (-89 degree) and violent snow storms (winds over 250 kmph); it’s indeed a unique place on earth! Its beauty is ethereal…On clear winter nights, there arise southern lights, or Aurora Australis from behind the ice shelf -often rolling waves of green, blue, red like a giant wheel of fairy dust. They are seen undulating over our head and spreading to fill the sky, moving like waves after waves; just like huge curtains spreading down from heaven. It was an emotional, life changing experience that one can only sit on the knees, hands folded, with tears in the eyes!","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"156 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":"126004606","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":"Ultrasound-guided 2-in-1 block – A technique to block both femoral nerve and lateral femoral cutaneous nerve using a single injection point","authors":"Tuhin Mistry, S. Singh","doi":"10.13107/jaccr.2018.v04i03.111","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.111","url":null,"abstract":"Dear Editor, Femoral nerve (FN) and the lateral femoral cutaneous nerve (LFCN) blocks with local anesthetic (LA) are required to provide perioperative anesthesia and/or analgesia for fractured neck of femur surgeries, skin grafting from the upper thigh, and biopsy from the quadriceps muscle for the diagnosis of muscular disorders. Fractured neck of the femur is common in the elderly and is often fixed with dynamic compression hip screw (DHS), cannulated screw fixation, or intramedullary nailing and hip screw. Some of these fractures might need total or hemi-hip arthroplasty. Of these surgeries, DHS is one of the most common procedures and the nerves that supply the area involved in the surgery include the FN and LFCN which arise from the lumbar plexus (LP). Although the FN that arises from the nerve roots L2-4 is the main nerve that needs to be blocked for analgesia, the incision in DHS is supplied by the LFCN that arises from L2,3. It has been noted that occasionally the LFCN may arise from the FN and not as a separate branch of LP. These two nerves can be blocked separately, as a part of the 3-in-1 or fascia iliaca compartment block (FICB) using a larger volume of LA (0.6–0.8 ml/kg of 0.25% Levobupivacaine). In most instances, ultrasound (US)-guided 3-in-1 or FICB can block the LFCN reliably, but the sample size in these studies to definitively conclude this finding is too small [1,2]. Individual nerve blocks of the femoral and lateral cutaneous FN would require two separate punctures. We describe an US-guided block technique that blocks both the femoral and LFCN using a single injection point and we call this “US guided 2-in-1 Block” for neck of femur fractures. Below the inguinal ligament, FN lies outside the femoral sheath and below the fascia iliaca, whereas LFCN lies above fascia iliaca. For this block, a patient lies supine, and after preparing the area aseptically, the US probe is placed below the inguinal ligament just medial to the anterior superior iliac spine (ASIS). The needle entry point is from lateral to medial, near to the ASIS. After piercing the fascia lata, 10 ml of LA is deposited under it to block the LFCN (Figs.1 a and b). The needle is then advanced further to pierce the fascia iliaca and the 15–20 ml of LA is deposited (Fig 2a). On moving the US probe medially, it can be observed that the LA surrounds the FN (Fig 2b). Since we do not need to go near to the FN, the chances of nerve injury and vascular puncture are almost negligible. This is a good technique for beginners in US-guided blocks who may be acquiring the hand–eye coordination and are afraid of nerve injuries or intravascular injection causing LA systemic toxicity. Although our technique seems to be safe and easy to perform, a randomized controlled trial with a larger sample size is needed to validate its superior efficacy and reliability compared to other described techniques.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"65 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":"123459473","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":"Cervical Epidural Anesthesia for Thyroidectomy in a Patient with a Potential Difficult and Compromised Airway","authors":"A. Verma, A. Amata, S. Amir","doi":"10.13107/jaccr.2018.v04i03.105","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.105","url":null,"abstract":"We report a case of a 45-year-old man with a large thyroid swelling with the potential to cause a difficult and compromised airway. Cervical epidural anesthesia was planned and successfully performed to avoid difficult airway management. We conclude that cervical epidural anesthesia can be used for thyroidectomy in a patient with potential difficult and compromised airway. Keywords: Cervical epidural, thyroidectomy.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"5 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":"123805443","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":"Unusual Skin tear caused by eye taping using acrylic-based adhesive tape in a adult patient with recurrent craniopharyngioma","authors":"","doi":"10.13107/jaccr.2021.v07i02.179","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.179","url":null,"abstract":"Skin tears due to medical adhesives are a ubiquitous but under documented complication that occurs in in almost all clinical settings and frequently in patients with certain risk factors. Due to lack of information regarding proper usage, suitable selection and the right technique for application of adhesive products can influence patient safety besides hampering the quality of life. Medical adhesives-related skin injuries (MARSI) is the latest term used, defined ‘an occurrence in which erythema and/or other manifestations of cutaneous abnormality (including, but not limited to, vesicle, bulla, erosion or tear) persists 30 min or more after removal of the adhesive’ [1]. We describe a report of skin tear due to acrylic based adhesive in a young male who underwent craniotomy and tumor excision.\u0000\u0000A 21 year-old male with a diagnosis of a recurrent craniopharyngioma was posted for a Pterional craniotomy and excision of the tumour. The patient had secondary hypothyroidism and secondary hypocortisolism on thyroid and steroid replacement respectively. He was shifted to the OT and after attaching all the standard ASA monitors, he was induced after adequate preoxygenation, with Fentanyl, Propofol and Vecuronium and intubated with a 8.5mm sized ET tube. A central venous catheter was inserted post induction in the right subclavian vein and was fixed with an adhesive tape. Before positioning the patient, scalp block with 15 ml of 0.5 % bupivacaine was administered. The eyelids were then taped with acrylic-based adhesive tape. The duration of the surgery was approximately 11 hours. In view of the prolonged nature of the surgery, the decision was made to not extubate the patient in the OT and to shift him to the Intensive Care Unit for further management and elective ventilation. Before the patient was shifted out of the OT, the adhesive tapes over his eyes were removed. While the left eye and periorbital region were found completely normal, the right periorbital region was mildl","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"21 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":"132652088","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 lumbar and sacral plexus block in geriatric high-risk patients undergoing an awake repair of fracture intertrochanteric of femur","authors":"S. Diwan, C. Pradhan, Atul A. Patil, Chetan Puram, P. Sancheti","doi":"10.13107/jaccr.2018.v04i01.082","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.082","url":null,"abstract":"The geriatric population with its multiple comorbid conditions are at risk of developing anesthesia-related complications. Data are inconclusive as to whether a general anesthesia , epidural or spinal (regional) anesthesia improves outcomes after hip fracture surgery. The author ( S M D ) subjected all ASA grade 3 and 4 intertrochanteric fractures to lumbosacral plexus block. Intraoperative haemodynamic stability was a key feature in all the patients which reflected in a stable postoperative scenario. The positive outcome, early patient – relative interaction and day 2 assisted mobility of the patient lead to an increase in demand for lumbosacral plexus block in high risk geriartrics with intertrochanteric fractures. Keywords: Fractures of intertrochanteric, local anesthesia, lumbar plexus block, nerve block, post-operative pain relief, sacral plexus block.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"108 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":"114833745","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":"Anaesthesia TV: Beginning of a New Revolution!","authors":"Pallavi Lande-Marghade","doi":"10.13107/jaccr.2018.v04i01.075","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.075","url":null,"abstract":"How about attending an online live streaming conference happening at Hawaii from the comforts of your home, doesn’t that sound exciting? Well, honestly speaking we cannot deny the invasion of technology into our day-to-day lives. The amalgamation of the technology into social media disseminating vital information is very evident. On 27th April our sister concern, Anaesthesia TV performed live streaming of the regional anaesthesia conference called PRAC 2018 (Pune Regional Anaesthesia Conference). This was the first time in the history of anaesthesia conferences in India, where it was streamed online and received a magnanimous response with over 7430 viewers across the globe over the period of two days. Viewers were from more than 30 countries namely India, Indonesia, Bangladesh, Pakistan, USA, UK, Brazil Egypt, Iran, Iraq, UAE, Muscat, Australia, Nigeria, Saudi Arabia, Palestine, Somalia, Bhutan, China Syria, Maldives Sudan, Sri Lanka, Malaysia and Russia. Thus, giving it a global outreach in a true sense. It was an excellent opportunity for the digital generation for broader content dissemination even to the remotest areas. We received excellent feedback from all the viewers regarding very good quality audiovisual transmission. Viewers also enjoyed re-running of the sessions they missed out or were interested over and over again. Anaesthesia TV relies on the concept of academic philanthropy and technology. It provides a unique concept of retaining the presentations on the website creating a record for posterity for both the speakers as well as the conference organizers. It is a joint effort undertaken by Dr Ashok Shyam who has founded Ortho TV and myself. The conference details will be available for posterity for a long time. Currently details of conferences and organisers are lost once the conference website goes offline [which happens in a year]. By putting conference details on Anaesthesia TV, the details will be available online on our website and the entire program can be put up in pdf format. Anaesthesia TV will also post the details of the conference and links to program and conference websites on our portals [Anaesthesia TV, Facebook, Twitter, etc]. This will help popularize the conference and get more delegates for the event. Information about the conference can be put up on our website much before the conference. All videos will be organized on Anaesthesia TV under the banner of the conference and this itself will work as a marketing tool for the society and conference which will help in adding to the reputation of the society. The primary aim of every speaker is to showcase their work and share their knowledge with peers. Anaesthesia TV will provide an open access forum where this knowledge can be showcased in front of the world and give a chance of worldwide recognition for the speaker. Since the portal is a global platform it will also invite comments and suggestions from peers across the globe and also develop new connections and n","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"3 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":"134322436","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":"It’s never too late- spontaneous rupture of spleen and life-threatening hypovolemic shock in a patient recuperating from legionnaire’s disease","authors":"","doi":"10.13107/jaccr.2021.v07i02.173","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.173","url":null,"abstract":"Spontaneous non-traumatic rupture of the spleen in the setting of Legionnaires’ disease is very uncommon but a life-threatening condition. The splenic rupture can present within a few days after symptom onset with significant hypotension with drop in haemoglobin along with left side upper quadrant pain. Most of the cases described in the previous literature have presented within 0-11 (mean 4) days of the pneumonia but this case we are reporting presented after 3 weeks after being treated with Legionella pneumonia. The case also highlights an atypical presentation and emphasises the need to maintain a low threshold for diagnosis especially in resource constrained setting so that patient can be transferred at the earliest to a centre where appropriate corrective measures including surgery can be safely undertaken.\u0000Keywords: splenic rupture, pneumonia, hypovolemic shock","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"8 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":"123633813","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":"Hyperbaric Intrathecal Ropivacaine in Patients Undergoing Endovenous Laser Ablation (EVLA) – A Case Series","authors":"K. Eswaran, Ashish Dhadas, S. Patil","doi":"10.13107/jaccr.2022.v08i02.198","DOIUrl":"https://doi.org/10.13107/jaccr.2022.v08i02.198","url":null,"abstract":"Spinal anaesthesia using 0.75% ropivacaine heavy/hyperbaric can be used safely and effectively for endovenous laser ablation procedures (EVLA) on bilateral limb varicose veins without the increased duration of hospital stay in elderly patients with comorbidities. Hyperbaric 0.75% ropivacaine was found to give the adequate duration of spinal block along with hemodynamic stability and excellent post-operative recovery for EVLA procedures. Keywords: Endovenous Laser Ablation (EVLA), Spinal anaesthesia, 0.75% hyperbaric ropivacaine","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"1 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":"129964765","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}