Journal of Anaesthesia and Critical Care Reports最新文献

{"title":"Failed Nerve Blocks: Prevention and Management","authors":"S. Sharma","doi":"10.13107/jaccr.2018.v04i03.101","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i03.101","url":null,"abstract":"“The secret of success is constancy of purpose” – Benjamin Disraeli, British politician Success and failure go side by side in regional anesthesia. No anesthesiologist can claim a 100% success record while giving nerve blocks. Hence, it is always better to focus on how to prevent causes of block failure rather than focusing on managing a failed block. Abdallah and Brull did a comprehensive literature hunt to find out the meaning of block “success” which were used by various authors in their studies and found that it was highly variable and there was lack of consensus regarding its meaning [1]. The most common definition of block success was an achievement of a surgical block within a designated period. There are essentially four stakeholders for defining success criteria: Namely the patient, the anesthesiologist, the surgeon, and the hospital administrator. The various parameters of success for a patient which included post-operative pain and patient satisfaction were evaluated in four trials only. The anesthesiologist-related indicators such as block onset time and complications were reported most frequently. The surgeon and hospital administrator-related indicators were not collected in any trial. For all practical purposes, especially from our perspective, a block failure may be accepted when complying with any one of the following after giving an adequate time of approximately 30 min: Conversion to general anesthesia (GA) after surgical incision. Use of intravenous (IV) opioid analgesics ≥100 μg fentanyl or equivalent after incision. Rescue peripheral nerve block given (a second block after completion of an initial block). Infiltration of local anesthetic agent (LA) into the surgical site. The above four criteria are routinely recorded in medical records and have also been accepted in previous research papers. We may have (a) a total failure which is defined as block where bolus of LA completely misses its target and surgery cannot proceed, (b) an incomplete block where patient has numbness in the area of nerve distribution but not adequate for incision, (c) a patchy block in which some areas in distribution of plexus usually have escaped, (d) a wear off block or secondary failure seen when surgery outlasts the duration of block, and (e) a misdirected block is when part or whole of the drug is injected into the neighboring structures, for example, into a different fascial or muscular plane or a vessel. Morgan had stated that “Regional anesthesia always works – provided you put the right dose of the right drug in the right place.” Failure occurs due to blocking the wrong nerve or not blocking all the nerves for planned surgery. Three primary keys to successful regional anesthesia are, therefore, nerve location, nerve location, and nerve location! – N.M. Denny. Every anesthesiologist must “pause” just before placing the needle at the site of nerve block. While doing so, he re-confirms the patient’s identity, the intended procedure and the corre","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"29 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":"122236396","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":"Perineural and fascial plane catheters- how to iron out the kinks","authors":"M. Narayanan, S. Phillips","doi":"10.13107/jaccr.2018.v04i02.098","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.098","url":null,"abstract":"At our hospital, we have a growing regional anaesthesia service providing over 400 peripheral nerve or fascial plane catheters so far in 2017. We have recently had 2 episodes where rectus sheath catheters, which are our first line pain management for midline laparotomies, have become knotted whilst in situ and therefore been difficult to remove. One catheter required a small surgical incision (on the ward under local anaesthetic) to remove it, whilst the other was removed using artery forceps. Both were found to be knotted after removal from the patient (see picture). On both occasions the insertion of the catheter had not been documented. At out institution, most rectus sheath catheters are inserted by an anaesthetist using ultrasound, however some are placed at the end of the operation, by the surgeon under direct vision. It is well known that perineural and fascial plane catheters may kink and knot, however this is a rare phenomenon with an incidence of 0.13% [1]. Our recent problems have caused us to re-think our practice and highlight some key issues. Documentation of any procedure is essential. When the same procedure maybe carried out by 2 specialities documentation is potentially even more important. The surgeons at our institution often suture the rectus sheath catheters after insertion, whereas anaesthetists do not. This information is key when attempting to remove the catheter. We have changed our practice, so that any rectus sheath catheter (inserted by either surgeon or anaesthetist) will now be documented by the anaesthetist within the notes (although, obviously, it would be expected that the surgeons do document any procedure they perform). The decision for this was prompted by the fact that anaesthetists are the first port of call when a rectus sheath catheter is difficult to remove, and we needed a mechanism to improve access to information as to how the catheter had been secured. We routinely leave rectus sheath catheters in for 3-5 days. After this amount of time, we would expect that they may be easily removed with minimal resistance. If there is any difficulty in removing the catheter first line management should be to flush the catheter with 10 mls of 0.9% saline, to make space around the catheter and dislodge any fibrous tissue attached to the catheter. This may fail if the catheter is knotted as the catheter is often occluded. We would then advocate using artery forceps to grasp the most proximal exposed part of the catheter, allowing increased tension and better manipulation of the angle at which force is applied to the catheter. If this fails surgical exploration may be required, depending on how much catheter is left in the patient, this may be done in a ward based setting as opposed to a return to theatre. Fluoroscopy guided catheter removal has also been described [1]. We have now changed our practice with regards to how much catheter is left in situ. The optimal length of rectus sheath catheter insertion (or any fasc","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"35 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":"127372886","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":"Dilated internal mammary veins in liver disease – A potential pitfall in central venous cannulation","authors":"","doi":"10.13107/jaccr.2021.v07i02.178","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.178","url":null,"abstract":"Introduction: Portal hypertension leads to dilation of internal mammary veins. Among the various sites of misplacement of a catheter inserted via the internal jugular vein, misplacement in the internal mammary vein is relatively rare in the general population, when compared to liver disease patients. Catheter misplacement during central venous cannulation can be associated with thrombosis, wedging, erosion, and perforation. The option of replacing or removing the catheter is not always risk-free, particularly with associated coagulopathy. We describe the management of a misplaced CVC which was accessed through the left internal jugular vein and repositioned under fluoroscopic guidance.\u0000Keywords: Central venous catheter, Repositioning of central venous catheter, central venous catheter in left internal mammary vein, portal hypertension, fluoroscopy","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"11 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":"133878707","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":"Delayed onset acute massive haemothorax after traumatic rib fractures-A Case Report","authors":"","doi":"10.13107/jaccr.2021.v07i02.175","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.175","url":null,"abstract":"Rib fractures are common injuries that frequently necessitate intensive care admission for pain management, respiratory support, in addition to managing possible complications. The most common complications of rib fractures are pain, haemothorax, pneumothorax, pulmonary contusions and lacerations, vascular injuries, and intra-abdominal organ injury. After a high impact road traffic accident, a polytrauma 26-year-old Irish gentleman presented with right-sided posterior rib series fractures (from 8th to 12th rib), lung contusion, hepatic laceration, pelvic ring crush injury and urinary bladder disruption. Resuscitation and emergency management including suprapubic catheterisation and external pelvic fixation were performed successfully. Although complications of multiple rib fractures were excluded clinically and radiologically on admission, the patient developed acute massive haemothorax 5 days after the primary injury which has been managed appropriately. This incident raises the concern that haemothoraces and pneumothoraces can occur late after the original injury and high level of suspicion associated with follow-up chest x-ray images are essential in patients with rib fractures.\u0000Keywords: Polytrauma, Rib fracture, Haemothorax.","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":"115794021","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":"Anaesthetic management of placenta accreta in hybrid operation theatre – A case report","authors":"Kritika Sharma, Karnik Mamtora, Sandip S Katkade, Tapas Mandal, Hemant H. Mehta","doi":"10.13107/jaccr.2021.v07i02.177","DOIUrl":"https://doi.org/10.13107/jaccr.2021.v07i02.177","url":null,"abstract":"Introduction: Placenta accreta is a type of abnormal placentation where the placenta is adherent to the implantation site with an absent decidua and may produce life threatening challenges including major obstetric haemorrhage, need for peripartum hysterectomy and maternal and foetal morbidity and mortality. Although patients with placenta accreta are at high risk of massive haemorrhage, by using multi-disciplinary team approach and careful planning we can manage a patient with placenta accreta under neuraxial anaesthesia in hybrid operation theatre. We report a case of successful obstetric and anaesthetic management of a patient with diagnosed placenta accreta.\u0000Keywords: Placenta accreta, placenta increta, obstetric haemorrhage, hybrid theatre, multidisciplinary approach, subarachnoid block.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"130 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":"123225285","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":"Management of Perioperative Pulmonary Edema in a Case of Preeclampsia for Cesarean Section","authors":"Pavan Tayde, Aariz Ansar, I. Loutfy, H. Sharma","doi":"10.13107/jaccr.2018.v04i02.092","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i02.092","url":null,"abstract":"Introduction: Although rare, pulmonary edema is a life-threatening complication occurring in preeclampsia. It is also a significant cause of maternal and perinatal morbidity and mortality. Hence, it is imperative to identify the at-risk parturient, recognize signs of critical illness and manage these patients with a skilled multidisciplinary team. We herein describe successful management of a parturient who developed pulmonary edema in a perioperative period. We emphasize the importance of a thorough preoperative assessment, vigilance and early intervention in managing parturient with the history of preeclampsia. Keywords: Cesarean delivery, preeclampsia, oligohydramnios, acute pulmonary edema, general anesthesia","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"45 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":"127235798","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 implications of homocystinuria: A case report","authors":"S. Upadhyay","doi":"10.13107/jaccr.2018.v04i01.079","DOIUrl":"https://doi.org/10.13107/jaccr.2018.v04i01.079","url":null,"abstract":"Introduction: Homocystinuria is an inherited metabolic disorder associated with cystathionine beta-synthase deficiency leading to accumulation of both methionine and homocysteine in various tive tissues and blood manifesting clinically as multisystem disorder. It is associated with a high incidence of thromboembolic complications and high mortality during the perioperative period. Homocystinuria imposed number of anesthetic challenges during the perioperative period. Case Report: A 10-year-old male presented with dimness of vision and was found to have ectopia lentis. Based on his clinical findings, he was suspected to have homocystinuria. This was confirmed by his high serum homocysteine levels. The child was posted for lensectomy with vitrectomy. The homocysteine and methionine level were brought down to the safer limit by monthlong medical and nutritional therapy before taking up for the surgery. The surgery was done under general anesthesia and peribulbar block. The perioperative measure included avoidance of prolonged fasting, avoidance of nitrous oxide, mechanical and chemical thromboprophylaxis, and early mobilization. The patient had an uneventful post-operative period. Conclusion: Understanding the perioperative hazards and complications of homocystinuria can be avoided with proper preparation of the patient, judicious use of anesthetic techniques. This case report described some of the anesthetic challenges during management of such a patient. Keywords: Homocystinuria, general anesthesia, thromboembolism, nitrous oxide.","PeriodicalId":448126,"journal":{"name":"Journal of Anaesthesia and Critical Care Reports","volume":"125 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":"124153658","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}