Journal of Anaesthesia and Critical Care Reports最新文献

{"title":"One-Year Prospective Audit of Truncal Blocks Using Regional Anesthesia Database App","authors":"H. Vadera, S. Singh, G. Murthy, Vedha Balasubramaniam","doi":"10.13107/jaccr.2018.v04i02.091","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.091","url":null,"abstract":"Aims and Objectives: Truncal blocks like chest and abdominal wall peripheral nerve blocks have been reported to be an effective method of providing analgesia for surgeries on the chest wall and the abdomen. We present results of a prospective audit of the practice and outcomes of these techniques using a novel mobile app and web-based e-audit tool (RAD app and national database ®) to identify safety and quality with description of newer blocks. Design: Prospective single centre audit over a 1-year period using e-clinical audit tool (RAD app and national database®) Setting: 210 bedded NABH accredited multi-speciality Private hospital. Patients: All patients who had Peripheral nerve blocks for chest and abdominal surgeries Measurements: Data on practice, clinical and patient related outcome measures were prospectively entered in the mobile app and web-entries. Data analysis is automated and summary statistics with comparison to national data is presented here. Results: Data analysis is automated and summary statistics with comparison to national data is presented. 147 patients received 199 blocks between 3rd July 2017 to 2nd July 2018.Youngest patient was 1 year old and oldest being 84 years of age. 40% of patients were males and 15.4% of surgeries were for emergency reasons. Few new blocks were added into our practice during this year including the erector spinae plane block, quadratus lumborum block and serratus plane block. The overall quality and safety of these new blocks are comparable to Indian national benchmark and available literature.A number of differences in practice compared to national sample data is identified including greater use of ultrasound in our practice(70% vs 31.6% nationally), significantly, more blocks are done pre-operatively (75% compared to 50% nationally). Outcomes in terms of success rates and post-operative analgesia, opioid consumption are comparable.40% of our patients had opioid free surgery and 85% of the patients had no analgesic requirement in their recovery period.Quality assurance audit data shows that only 63.3% of the patients had correct site check/block specific time-out done. Ultrasound probe cover was not used in 95% of the cases. Patient related outcome measures are reported for the first time showing high rates of satisfaction and likelihood of having regional anaesthesia/analgesia again. Conclusions: This is the first reported audit of peripheral nerve blocks of chest and abdomen in India. This audit was enabled by an e-audit tool (RAD app and database®) which removed many barriers in doing clinical audit in busy day-to-day practice. The audit was done with minimal effort using smart entry system and automated analysis of graphs and charts. The project is ongoing and data from 1st year is reported to identify practice and outcomes of our regional anaesthesia practice. A number of practice changing recommendations are identified to further improve quality and safety of our regional anaesthesia practi","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"50 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":"121923642","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 a patient with congenital complete heart block posted for emergency cesarean section","authors":"C. Mohanty, S. Guru, Upendra Hansda, Sadananda Barik","doi":"10.13107/jaccr.2018.v04i01.081","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.081","url":null,"abstract":"Introduction: Complete heart block is a rare disorder of conduction system which can be congenital oracquired.Anesthesia in patients with complete heart block can be challenging to anesthetist. Case Report: We report a 25-year-old female presented for emergency cesarean section with fetal distress found to have complete heart block. We discuss the management of patient with complete block posted for surgery according to advanced cardiac support guidelines with review of literature. Conclusion: Anesthesia in patients with complete heart block can be challenging due to uncontrolled hemodynamics unresponsive to conventional drugs. Anesthetic management in such patients should be according advanced cardiac life support guidelines. General anesthesia is preferred over spinal anesthesia for better control of hemodynamics. Keywords: Transcutaneous pacemaker, complete heart block, emergency cesarean section.","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":"123488362","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":"Thyroid Surgeries under bilateral superficial cervical plexus block – A Case Series","authors":"S. Kamat, Prabhakar Subramanian, K. Eswaran","doi":"10.13107/jaccr.2021.v07i02.176","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.176","url":null,"abstract":"Superficial cervical plexus block is a simple regional anesthesia procedure which can be performed by landmark guided as well as ultrasound-guided techniques. It has been used to provide anesthesia or analgesia for various procedures involving superficial surgeries in the neck and shoulder. The pain after thyroid surgery is of mild to moderate intensity and of short duration. I describe 12 cases in which bilateral superficial cervical plexus block was performed to conduct awake thyroid surgeries.\u0000Keywords: Thyroid surgery, Superficial cervical plexus block, regional anesthesia, neck surgeries, analgesia.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"44 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":"124914405","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":"Primigravida with trilogy of Fallot (severe pulmonary stenosis, right ventricular hypertrophy and huge atrial septal defect) for emergency lower segment caesarean section","authors":"P. Ghodki, S. Sardesai, J. Deshpande, K. Patil, Kedar Bangal","doi":"10.13107/jaccr.2018.v04i01.078","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.078","url":null,"abstract":"Trilogy of Fallot; a triad of pulmonary stenosis, right ventricular hypertrophy and atrial septal defect is an uncommon acyanotic congenital heart disease. We present a severe case of trilogy of Fallot diagnosed for the first time in pregnancy. The patient was otherwise in a compensated state and had become symptomatic due to physiological changes in pregnancy. The anaesthetic goals therefore included maintaining the existing physiology and preventing decompensation thereby avoiding Eisenmengerisation. The anaesthetic management of the severe and complex heart disease keeping patient safety at the core is discussed. Keywords: Caesarean section, congenital heart disease, trilogy of Fallot.","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":"126890734","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":"From The Editor’s Desk","authors":"Pallavi Lande-Marghade","doi":"10.13107/jaccr.2018.v04i03.100","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.100","url":null,"abstract":"We thank Dr. Santosh Kumar Sharma for the guest editorial “Failed Nerve Blocks: Prevention and Management” and Dr. Muralidhar Thondebhavi for the guest editorial “Mental Models and the Anaesthetist”. Journal of Anaesthesia & Critical Care Case Reports thank following authors for their efforts put in contributing in this issue. Piyush Mallick Innovation – Tascope – Innovative Intubation Aid by Mangal Dave Anesthetic Management of a Patient with West Syndrome by Prerna Phulkar and Pallavi Waghalkar Cervical Epidural Anesthesia for Thyroidectomy in a Patient with a Potential Difficult and Compromised Airway by A. Verma, A. O. Amata and S. Amir Case Report: A Woman with Fever, Acute Changes in Mental State, and Progressive Neurological Degeneration by MCarrillo-Torres Orlando, Rivero-Sigarroa Eduardo, Loeza-Guemez Alejandro Unique presentation and clinical course of shingles by Luis M. Rivera and Timothy Furnish Unilateral Acute Renal Cortical Necrosis in a patient with Sepsis by Rohit Vadala, Ebenezer R, Nagarajan Ramakrishnan, Visweswar Reddy Airway management in morbidly obese with cervical instability using awake insertion of supra glottic device and Aintree intubation catheter by Aparna Sinha, Lakshmi Jayaraman, Dinesh Punhani Full neurological recovery following a hypothermic, near-drowning cardiac arrest with a 34 minute submersion time: A case report by Daniel Eden Ultrasound-guided 2-in-1 block – A technique to block both femoral nerve and lateral femoral cutaneous nerve using a single injection point by Tuhin Mistry and Shiv Kumar Singh Journal of Anaesthesia & Critical Care Case Reports is fortunate to serve in the field of Anaesthesia and Research with contribution from Doctors and Scientists working all over the world. We welcome articles for our upcoming issue.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"26 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":"125930275","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":"Unique presentation and clinical course of shingles: A case report","authors":"L. M. Rivera, T. Furnish","doi":"10.13107/jaccr.2018.v04i03.107","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.107","url":null,"abstract":"We report the unique presentation of a Varicella Zoster Virus reoccurrence, commonly referred to as shingles, in a patient who developed three concurrent but different manifestations: 1. A cutaneous rash in a cervical dermatome; 2. A rash-free reoccurrence of a previous Post Herpetic Neuralgia in a different dermatome, and; 3. A rash-free, new-onset of Bell’s palsy. Literature searches did not produce any reported cases with this triad of concomitant events. The patient is a 58-year-old immunocompetent Hispanic man whose only risk factor is age greater than 50 years. He had been treated with immunosuppressants in the past for Inflammatory Bowel Disease. Immunosuppression was stopped eight years ago after undergoing a total colectomy as definitive treatment. Now immunocompetent, he develops shingles for the second time in his life, with a very unusual presentation and disease course. The presentation and course of his disease promoted the use of empiric pharmacologic treatment courses, including three courses of oral corticosteroids, for which no current guidelines exist. It is hoped that the observations drawn from the clinical course of this patient may shed light into the better understanding and treatment of Varicella Zoster Virus and Post Herpetic Neuralgia. We also discuss the possibility that each of these individual manifestations may constitute separate disease processes, requiring individual and unique evaluation and treatment. Keywords: Varicella Zoster Virus, Shingles, Post-Herpetic Neuralgia, Zoster Sine Herpete, Bell’s palsy","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":"131271751","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":"Mental Models and the Anaesthetist","authors":"Muralidhar Thondebhavi","doi":"10.13107/jaccr.2018.v04i03.102","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.102","url":null,"abstract":"Mental models, to put in simple words, are the representation of how anything works (from Smartphone to complex financial systems). We cannot carry the complexity of the world we inhabit, and hence simplify it through mental models into easily understandable concepts. This helps us reason, judge and take better decisions. Each field of study has a set of most important principles on which the foundations of that discipline are built on. They form the key mental models which should be incorporated for better decision making. The quality of thinking and decision making is proportional to the number of good quality mental models we carry in our head. This equates to more tools in our mental toolbox and hence more options to deal with a certain problem. Many of us consider ourselves specialists. Instead of a collection of mental models, we have a few from our field. A psychologist thinks in incentives, an engineer in systems and a mathematician in algorithms. They, as specialists are limited to thinking in one way to solve a problem. By incorporating these three disciplines in our head, we can tackle a problem in a multidimensional way. This decreases the blind spots and improves decision quality. Just carrying few models in our head will not make a difference. Arranging them in a nice latticework is paramount. Learning should take place with this framework in the head and we should make it a lifelong project to acquire more models as we go along. As doctors, in general, we are limited to our field and resist learning mental models from other unrelated fields. However, there are some general mental models which can be learnt easily such as ‘circle of competence’, ‘map is not the territory’, ‘first principles thinking’, ‘thought experiment’, ‘second order thinking’ and ‘inversion’. I would like to highlight a few models with examples: – Model of ‘Circle of Competence’ teaches us to know the perimeter of things that we know how to perform with high confidence (Eg: Intubation in a patient with easy airway for consultant anaesthesiologist). We have to stay within this circle and try to expand it by training. Outside this inner circle lies a dangerous zone wherein “we think we know” and trying to do things here leads to disaster (Eg: Trying to use a new airway tool in a difficult airway situation without appropriate training). – Model of ‘First Principles Thinking’. Unless we understand the basic concepts of ‘why’ we do certain things we cannot execute high quality care for our patients. An example is not understanding the physiological basis of preoxygenation and just concentrating on the time prescribed in the text books for the same. This might lead to inadequate preoxygenation in certain group of patients. This model also highlights the need to impart first principles concepts during the training period with emphasis on understanding ‘why’ we do rather than ‘what and how’ we do. – Model of ‘Compounding’. This is an important model of the finance world","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"10 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":"132905512","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":"Incapacitating Mediastinal Pain and Hemodynamic Compromise Due to a Non-Displaced, Acutely Kinked Nasogastric Tube in a Post-operative Esophagectomy Patient – A Case Report","authors":"C. Mehra, Atish Pal","doi":"10.13107/jaccr.2018.v04i02.096","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.096","url":null,"abstract":"Introduction: A case of incapacitating mediastinal stretch pain and hemodynamic compromise, caused by a non-displaced, non-functional acutely kinked naso-gatsric tube (NGT). Post-operative esophagectomy patient started complaining of severe retrosternal pain after 2 h. Epidural boluses of bupivacaine and other intravenous analgesics were given with no relief. After some time, the patient went into atrial fibrillation and subsequent hypotension. Chest X-ray revealed mediastinal shadow caused by distended neoesophagus, and NGT was found to be acutely kinked, which prevented complete decompression of esophagus. Expanded neoesophagus caused a mass effect irritating the right atrium and causing atrial fibrillation, while stretching of nociceptive rich mediastinal structures led to persistent severe pain. NGT was manipulated, in an attempt to resolve the kink and although the kink could not be removed completely, it smoothened out enough to deflate the expanded neoesophagus. The pain subsided within 45 min of the NGT manipulation. Electrocardiography pattern also reverted to sinus rhythm within 24 h. Keywords: Hemodynamic compromise, Esophagectomy, Kinked Nasogastric tube, Mediastinal pain","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"38 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":"116299682","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":"Scavenging Port Obstruction: A Case of Spinal Surgery in Prone Position","authors":"Deepak Madankar, Neelesh K Mathankar","doi":"10.13107/jaccr.2018.v04i01.085","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.085","url":null,"abstract":"Scavenging port obstruction in anesthesia machine can cause increased pressure within the circuit and can lead to extreme physiological disruptions. We present an unusual case scenario where scavenging port obstruction led to increased airway pressures and reduced tidal volume.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"14 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":"121004769","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":"Tascope – Innovative Intubation Aid","authors":"Mangal Dave","doi":"10.13107/jaccr.2018.v04i03.103","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.103","url":null,"abstract":"First of all thanks to Dr. Pallavi Lande and Dr. Shiv Kumar Singh Sir for inviting me to write this article. The Anaesthetist Society (TAS) is the major contributor and driving force behind successful development of TASCOPE. Well, TASCOPE is a video intubation aid to help passage of tube in difficult airways. It involves the use of endoscope or borescope camera (5.5 mm diameter HD camera) which is either connected to laptop/or even compatible mobiles or tablet, and the camera is attached on our customized TASCOPE blades. Thus, the laptop or mobile becomes screen for our intubation. Now with the help to WiFi box, even iPhone, iPad, and other noncompatible devices can also be used as screen. We have also customized channel for insertion of bougie. Then, endotracheal tube is railroaded over bougie under vision. Tascope history Having been working in neurotrauma center and facing difficult intubation, cervical spine injuries, and faciomaxillary trauma, we felt the definite need of a device which is affordable, easy to use, and lightweight for difficult intubation. Thus, initially fixing larger endoscope camera to extended tongue retractor, we gradually developed design with much anatomical curve and hyperacute angle for vision for difficult intubation and also found insertion of bougie initially easier than guiding styletted tube into larynx. Now, we also have design to enter even in one finger mouth opening in cases with restricted mouth opening and have developed TASCOPE PEDIA for pediatric intubation. Intubation technique Intubation technique remains much similar as other intubation devices such as midline insertion, pushing blade over base tongue further to visualize epiglottis, reaching up to glossoepiglottic fold, then little lift up and visualization of larynx, insertion of bougie into larynx, and then railroad tube into larynx under vision. Sometimes difficulty faced in inserting bougie, as sometime bougie might be coming out of its channel in ABS (plastic) adult blade, in which case giving proper shape (curve) to bougie and inserting it in 11 o’clock position gently will solve the issue, some friends also find the use of cut suction catheter attached over edge of blade useful. Furthermore, there can be impingement of tube bevel between arytenoids, in which tube is not getting pushed inside larynx, in these cases counterclockwise rotation of tube from 90 to 180 degrees will solve the problem. Journey so far I, myself, have intubated >600 difficult intubation cases with TASCOPE in the past 5 years, with 99% success, which include patient with ankylosis, fixed neck, with Philadelphia collar, and with faciomaxillary injury and fractured mandible, obese, short neck, in anticipated difficult intubation. Friends across India and abroad are using our device and find it useful in difficult intubation. At present, we have two types of adult blade (metal and ABS plastic) and three sizes pediatric blades available.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"58 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":"122942899","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}