Journal of Anaesthesia and Critical Care Reports最新文献

{"title":"Unilateral Acute Renal Cortical Necrosis in a patient with Sepsis","authors":"R. Vadala, Ebenezer R, N. Ramakrishnan, V. Reddy","doi":"10.13107/jaccr.2018.v04i03.108","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.108","url":null,"abstract":"Unilateral renal cortical necrosis is a rare entity with few cases reported across the globe. Acute kidney injury occurs as a complication of the cascade of immunological events that ensue once the host`s system is compromised due to invasion of microorganisms or due to other noninfectious causes. We present a case of unilateral acute renal cortical necrosis in a patient presenting with acute respiratory distress syndrome (ARDS) and sepsis with multi-organ failure that required extracorporeal cytokine adsorber therapy Keywords: Extracorporeal cytokine adsorber therapy, Sepsis, Renal cortical necrosis, ARDS.","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":"128764603","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":"Peripheral nerve stimulator guided pectoralis (PEC-I) block: A novel approach to the chest wall block","authors":"R. Roy, S. Singh, G. Agarwal, C. Pradhan","doi":"10.13107/jaccr.2018.v04i01.083","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.083","url":null,"abstract":"Introduction: Thoracic epidural and paravertebral blocks, the gold standard for post-operative analgesia for chest wall surgeries have a high incidence of complications and adverse effects. The pectoralis (PEC) blocks, first described by Blanco et al., have been proven to provide good analgesia postoperatively for breast surgeries, wide pectoral dissections, upper chest injuries, pacemaker insertions, port-a-cath placements, and intercostal chest drains. To widen the scope of this simple and useful analgesia technique, which mandates the availability of ultrasound machine and indepth knowledge of the sonoanatomy of the area, we are describing the conduct of PEC-I block using peripheral nerve stimulator, which is easily available to most anesthetists. Description of the Technique: Medial and lateral pectoral nerves (LPNs) are motor nerves originating in the brachial plexus innervate the pectoral muscles. The LPN runs in between pectoralis major and pectoralis minor muscle alongside the pectoral branch of thoracoacromial artery and supplies the pectoralis major muscle. The LPN communicates with the medial pectoral nerve and is known to carry nociceptive and proprioceptive fibers. The patient lies in a supine position with ipsilateral arm slightly abducted. The injection point is the intersection of a line drawn from the angle of Louis (2nd rib) and the anterior axillary line. After local infiltration of the skin with 1% lignocaine, a 50 mm insulated nerve stimulator needle with syringe filled with local anesthetic attached to the extension tubing is inserted perpendicular to the skin. The peripheral nerve stimulators (PNS)are initially set at 1.0–1.5 mA current, 0.1ms duration, and frequency of 1Hz. The needle is slowly advanced till the pectoralis muscle contractions is noted, with a current threshold of 0.3–0.5 mA. Persistence of contraction of pectoralis muscle at this level confirms the needle placement at the target site. The LA is then slowly injected in increments with frequent negative aspirations. Discussion: An increasing numbers of breast surgeries warrant better post-operative analgesia techniques, with fewer complications.Thoracic epidural analgesia, thoracic paravertebral blocks (TPVB), and intercostal nerve blocks have all been very effective for such surgeries but, are associated with complications such as epidural hemat omas, nerve injuries, pneumothorax,and hypotension. Analgesia technique like TPVB was unreliable with a single injection, and pectoral nerves were still spared producing inadequate analgesia of the chest wall and needed post-operative monitoring. The pectoralis block (PEC block), a novel technique, was described by Blanco et al. in 2011 using ultrasound and was easy, reliable, and associated with fewer complications. Peripheral nerve stimulator for such an easy and superficial block increases the utilization and benefits wider population. We have described the use of PNS for PEC-I block that can be used as a sole an","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"160 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":"127369353","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 West Syndrome","authors":"Prerna Phulkar, Pallavi V. Waghalkar","doi":"10.13107/jaccr.2018.v04i03.104","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.104","url":null,"abstract":"West syndrome is a rare and severe form of epilepsy that occurs in early infancy. It is characterized by a triad consisting of infantile spasms, mental retardation, and interictal electroencephalogram pattern termed hypsarrhythmia. A thorough preoperative assessment forms a very important part in the anesthetic management of such patients considering the possibility of difficult intubation because of the coexisting anatomical malformations, establishment of peripheral intravascular access, and careful positioning due to contractures, seizures, and the adverse effects of drugs taken for it. We present anesthesia management of a case of West syndrome with subtrochanteric fracture femur posted for intramedullary nailing. Keywords: Difficult intubation, infantile spasms, mental retardation, West syndrome.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"78 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":"114377866","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":"Improving safety and quality in regional anesthesia: An innovative app for Indian national regional anesthesia audit database, regional anesthesia database App","authors":"S. Singh","doi":"10.13107/jaccr.2018.v04i02.089","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.089","url":null,"abstract":"Regular audit of our own practice has shown to improve quality and safety. Practitioners across the world are able to do it at individual levels but are unable to benchmark it due to unavailability of national or international data. Regional anesthesia has seen an exponential growth in the recent years [1]. In the enthusiasm, many are adopting the newer techniques without appropriate training. Do they know, how well they are doing?, Do they know, they are not causing any harm, and do they know, they are up to standards? In the end, we are all accountable for the service we provide to our patients, surgeons, and institutions [2]. Audits are contractual requirement across many institutions and medical boards around the world. Many anesthetists are quite aware of the audit requirements in their practice but rarely have the time and resources. Moreover, there are significant hurdles and difficulty in establishing clinical audits in real-world practice [7, 8].","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":"114474798","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":"Emergency Cesarean Section under Spinal Anesthesia in an Operated Patient of Meningocele during Her Infancy: A Case Report","authors":"Vineet Gupta, G. Arora","doi":"10.13107/jaccr.2018.v04i02.095","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.095","url":null,"abstract":"Introduction: Neuraxial techniques of anesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anesthesia in patients with occult neural tube defects, regarding both labor analgesia and anesthesia for cesarean section. Here, we discuss the case of a pregnant woman attending at our institution with operated case of asymptomatic Meningocele who landed up for emergency cesarean section. She underwent emergency operative delivery with spinal anesthesia with no complications. Keywords: Full stomach, hypothyroidism, meningocele, prematurity 28th week, severe fetal growth restriction, severe pregnancy-induced hypertension, spinal anesthesia.","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":"121536297","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":"Full neurological recovery following a hypothermic, near-drowning cardiac arrest with a 34 minute submersion time: A case repor","authors":"D. Eden","doi":"10.13107/jaccr.2018.v04i03.110","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.110","url":null,"abstract":"Hypothermia increases the ischemic tolerance of the brain and can lead to a remarkable recovery in prolonged cardiac arrest. Neurological outcomes can be very favorable, particularly if cardiac arrest precedes hypothermia or if the onset of hypothermia following cardiac arrest is rapid. Case reports of good neurological recovery following up to 7 h submersion and core temperatures as low as 13.7°C can be found. Our case involved a 43-year-old male who presented following a collapse and out of hospital cardiac arrest. A 34 min period of face-down submersion in a canal on a cold February evening was followed by a brief period of cardiopulmonary resuscitation on extrication. He was transferred to our emergency department with a core temperature of 26°C. He went onto make a full neurological recovery. The UK’s temperate climate means that case reports of prolonged hypothermic cardiac arrest are rare. While this gentleman had many favorable circumstances to his predicament, including age, cardiovascular fitness and rapid cooling, prompt and effective resuscitation, and a controlled warming regime would also have contributed. Keywords: Hypothermia cardiac arrest, neurological recovery.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"60 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":"116987276","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":"Airway management in morbidly obese with cervical instability using awake insertion of supra glottic device and Aintree intubation catheter","authors":"A. Sinha, L. Jayaraman, Dinesh Punhani","doi":"10.13107/jaccr.2018.v04i03.109","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.109","url":null,"abstract":"We report airway management of a morbidly obese with possible difficult mask ventilation and previous cervical fixation, posted for bariatric surgery under general anesthesia. We achieved insertion of the supra glottic device (SGD ) under conscious sedation. Endotracheal intubation was further facilitated using Aintree intubation catheter (AIC) and flexible endoscope assisted intubation via the SGD. Consent from the patient and the IEC approval was obtained prior topublication. We reviewed evidence-based anaesthetic concerns and described our airway management. Our aim was to maintaining continuous oxygenation and achieve a secure airway with minimal neck move-ment. This further guides anesthesia practitioners caring for the obese patients withanticipated difficulty in mask ventilation and additionalrisks and need for continuous oxygenation. Keywords: Obese, bariatric, difficult airway, mask ventilation, BMI, neck circumference, Aintree, Cervical instability","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"4 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":"127973262","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":"SVC Duplication: The case of the erroneous catheter tip","authors":"Daniel James Edenm, R. Baker","doi":"10.13107/jaccr.2018.v04i01.084","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.084","url":null,"abstract":"In most individuals with normal anatomy, the SVC lies to the right of the heart and drains into the right atrium. SVC duplication is one of several possible explanations if a central venous catheter tip is found to the left of the heart. It is thought to occur in around 0.1% of the general population and in 10% of those with congenital heart disease. It is a mostly benign condition. Our case involved a 73-year-old lady who was admitted to our critical care department for vasopressor support following an acetabular ORIF. Her left internal jugular vein was cannulated with a 16cm quad-lumen CVC using an USS-guided, seldinger technique. A routine post-insertion chest x-ray demonstrated the line to follow a course to the left ofthe cardiac shadow with the tip along the left margin. Due to the unusual location and the uncertainty as to whether this line was safe to use, the case was discussed with the on-call radiologist who recommended a CT thorax to confirm the line position. This scan showed SVC duplication, with the CVC tip lying within a left-sided SVC terminating in the heart (likely the left-atrium). There was no dextrocardia or situs invertus. Whilst rare, this case highlights the importance of chest imaging following CVC insertion. In terms of the safety in using such a catheter, that should be determined by the drugs being infused, the possible locations and abnormalities presented by such a position and whether there are any other suspected complications as a result of insertion. This should be determined on a case-by-case basis. Keywords: SVC duplication, central venous catheter position, central line.","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":"127866344","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":"Tongue depressor as an intubation aid in a patient with vallecular cyst: A case report","authors":"A. Monem, F. Khan, S. Awan","doi":"10.13107/jaccr.2018.v04i01.080","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.080","url":null,"abstract":"Introduction: Vallecular cyst is a rare occurring often encountered incidentally, which may compromise the airway during induction of anesthesia. There is a high risk for cyst rupture and soiling of the airway during manipulation of the airway. Case Report: We report a case of a young 23-year-old female with a history of difficulty in breathing and swallowing for the past 1½ years. She underwent emergency tracheostomy and excision of some oral swelling 10years back. She was electively booked for excision of the cyst. Various techniques and instruments have been described in the past. We used a tongue depressor to gently push the cyst aside and successfully rail loaded a reinforced endotracheal tube over a gum elastic bougie. Conclusion: Intubation in a patient with oropharyngeal cyst poses a significant risk in view of complete airway obstruction or aspiration of the contents in case rupture of the cyst. Various techniques for intubation have been reported, either awake or under general anesthesia. We successfully used a tongue depressor to shift the cyst away as an aid for intubation. This technique has so far not been reported in the literature. Keywords: Vallecular cyst, induction, tongue depressor.","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":"130733796","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":"Are we starving our cesarean patients too much postoperatively?","authors":"K. Sathe, H. Wagh, A. Kakde, Pranav Thusay","doi":"10.13107/jaccr.2018.v04i02.099","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.099","url":null,"abstract":"Introduction: Cesarean section is a common operation in obstetric care. Delayed initiation of oral fluids and food may be uncomfortable for women in the postoperative period. Early feeding should be initiated without any fear of side effects. Patients have early postoperative recovery; it is cost effective and results in higher patient satisfaction. Early oral intake post cesarean section regardless of objective signs of the return of bowel functions was demonstrated to be safe and effective, with added patient comfort as the primary benefit. Keywords: Cesarean section, Early feeding, Early recovery.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"602 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":"116331061","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}