Anaesthesia, Pain & Intensive Care最新文献

{"title":"Effect of retrograde autologous priming on lactate and hemoglobin levels of adult patients undergoing coronary artery bypass grafting","authors":"Mehwish Naseer, R. Feroze, M. Akram, F. Fayaz","doi":"10.35975/apic.v26i1.1761","DOIUrl":"https://doi.org/10.35975/apic.v26i1.1761","url":null,"abstract":"Background:   Reduced hemoglobin, excessive transfusions and raised lactate levels are important determinants of patient outcome after cardiopulmonary bypass. Many strategies have been studied for optimum management of these parameters. In this study, we evaluated the impact of retrograde autologous priming (RAP) method on hemoglobin and lactate levels in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass. \u0000Methodology: This prospective randomized controlled trial was conducted at Army Cardiac Centre, CMH, Lahore, from January 01, 2021 to June 30, 2021. After approval of institutional ethical committee and taking informed consent from patients, 272 patients undergoing CABG were enrolled. Patients with ages less than 18 y, LVEF ≤ 20%, emergency operations, repeat operations, valvular or combined procedures, recent myocardial infarction, with preoperative lactate levels of more than 2 mmol/L and Hb of less than 9 gm/dL and other preoperative systemic diseases or infection were excluded.  Patients were divided into two groups. Group A received conventional priming of bypass circuit with ringer lactate, and Group B received RAP with patient’s own blood. Hb and lactate levels were measured in arterial blood gases before induction and upon weaning from bypass. \u0000Results: The demographic features of both groups were identical, Group A patients had significantly high levels of lactate (3.76 ± 0.81 vs. 2.64 ± 0.47 mmol/L, P < 0.01). Hb levels of patients in RAP (RAP) (Group B) were significantly better (9 ± 0.31 vs. 7.9 ± 0.39 gm/dL, P < 0.01) than Group A. \u0000Conclusion: Our study concludes that when compared with crystalloid priming, retrograde autologous priming technique is associated with reduced lactate levels and better hemoglobin levels after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting. \u0000Abbreviations: CABG - Coronary artery bypass grafting; CPB - cardiopulmonary bypass; LVEF – Left ventricular ejection fraction; Hb – Hemoglobin; RAP – Retrograde autologous priming; FFP - Fresh frozen plasma; \u0000Key words: cardiopulmonary bypass; coronary artery bypass grafting; lactate levels, retrograde autologous priming. \u0000Citation: Naseer M, Feroze R, Akram MA, Fakhar-e-Fayaz. Effect of retrograde autologous priming on lactate and hemoglobin levels of adult patients undergoing coronary artery bypass grafting. Anaesth. pain intensive care 2022;26(1):20–24   \u0000DOI: 10.35975/apic.v26i1.1761 \u0000Received: October 4, 2021, Reviewed: November 14, 2021,, Accepted: January 19, 2022","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49217896","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":"Perioperative challenges in the management of a Jehovah’s Witness patient undergoing parenchyma sparing hepatectomy","authors":"V. Dassanayake, S. Sivaganesh, D. Subasinghe, Prabodha Pitigala","doi":"10.35975/apic.v26i1.1787","DOIUrl":"https://doi.org/10.35975/apic.v26i1.1787","url":null,"abstract":"Jehovah’s Witness patients presenting for liver surgery pose challenges to the anesthetists as well as the surgeons, due to their abstinence from receiving blood products. Despite this, surgery is the only curative option for operable colorectal liver metastases (CRLM). We report a case of a Jehovah’s Witness with multiple comorbidities who had a parenchyma sparing hepatectomy (PSH) complicated by intraoperative bleeding. A 52-year-old ASA II patient with hypertension, diabetes and ischemic heart disease on dual antiplatelet therapy was scheduled for open PSH for multiple bilobar CRLMs. He was prehabilitated with an emphasis on enhancing erythropoiesis and improving his functional capacity. PSH was done using a Cavitron ultrasonic surgical aspirator (CUSA) with intermittent Pringle maneuver, a low central venous pressure and restricted intravenous fluids. His postoperative recovery was complicated by a minor upper gastrointestinal bleed that was managed conservatively. \u0000The authors certify that informed written consent has been obtained from patient for publication. \u0000Keywords: Jehovah’s Witness; Liver surgery; Anesthesia; Hepatectomy \u0000Citation: Dassanayake V, Sivaganesh S, Subasinghe D, Pitigala P. Perioperative challenges in the management of a Jehovah’s Witness patient undergoing parenchyma sparing hepatectomy. Anaesth. pain intensive care 2021;26(1):119–122 ; \u0000DOI: 10.35975/apic.v26i1.1787 \u0000Received: October 16, 2021, Reviewed: October 28, 2021, Accepted: November 07, 2021 ","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46408446","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":"Status of artificial intelligence in Pakistan and its implications in anesthesiology","authors":"Muhammad Imran Khan","doi":"10.35975/apic.v26i1.1776","DOIUrl":"https://doi.org/10.35975/apic.v26i1.1776","url":null,"abstract":"Artificial intelligence (AI) refers to the technology that enables machine-based intelligent behavior. This descriptive article gives an overview of the implementation of artificial intelligence in the following disciplines within the field of clinical medicine: Anesthesiology, Cardiology, Pulmonology, Endocrinology, Nephrology, Gastroenterology, Neurology, Histopathology, and Radiology. In this article, we will discuss the employment of artificial intelligence in anesthesiology and provide an analysis of the several areas in which it is being utilized. We will also evaluate the current status of AI and its future in Pakistan. The importance of this manuscript is to highlight the benefits of artificial intelligence so that the benefits can be realized in Pakistan. Key words: Artificial intelligence; Anesthesiology; Clinical medicine; Endocrinology; Gastroenterology; Histopathology; Nephrology; Neurology; Pakistan; Radiology Citation: Khan MI. Status of artificial intelligence in Pakistan and its implications in anesthesiology. Anaesth. pain intensive care 2021;26(1):110-114. DOI: 10.35975/apic.v26i1.1776 Received: September 12, 2021, Reviewed: November 24, 2021, Accepted: December 10, 2021","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70085080","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":"Depression, anxiety and stress among healthcare workers in COVID-19 ICUs","authors":"Sairah Sadaf","doi":"10.35975/apic.v26i2.1835","DOIUrl":"https://doi.org/10.35975/apic.v26i2.1835","url":null,"abstract":"Background & Objective: In most of the countries, the intensive care, airway management, and emergency resuscitation teams are largely constituted of the anesthetists, laying a great deal of physical, mental, and emotional pressure on them. In the ongoing COVID-19 outbreak, the anesthetists have been on the fore-front. We compared the level of anxiety, depression, and stress among healthcare workers (HCWs) of COVID-19 ICU (CICUs) and non- COVID ICUs (NCICUs) in the tertiary care hospitals of south Punjab. Methodology: It was a cross-sectional study was conducted after ethical approval from the institutional review board, and completed from December 10, 2020 to January 20, 2021, through Google forms by generating online structured questionnaires i.e. DASS-21 and GHQ-12. Our target population was HCWs of Anesthesia & Critical care of all the public sector tertiary care hospitals of South Punjab. A total of 100 participants has filled the self-reported questionnaire. After sorting the data, we divided the participants into two groups;CICU and NCICU groups. Results: Out of 100 participants, 31% were in the COVID ICU group and 69% in the NCICU group. Females were 54% of the total. 55% of the participants were below 30 y of age, 77% were married, and 48% were post-graduates. Overall 50% of HCWs had a probable psychological illness, while 25% had anxiety, 21% depression and 12% had stress. Anxiety, depression, and stress were more in COVID ICU group as compared to the non-COVID group [(35% vs. 20%), (32% vs. 16%) and (31% vs. 3%) respectively]. Conclusion: Coronavirus pandemic has affected the mental health of healthcare workers. Those working in COVID ICUs are more prone to develop psychological distress than non-COVID ICU healthcare workers. [ FROM AUTHOR] Copyright of Anaesthesia, Pain & Intensive Care is the property of Department of Anaesthesia, Pain & Intensive Care and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"26 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70085151","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":"Prognostic significance of non-thyroidal illness syndrome in sepsis and septic shock cases: a systematic review and meta-analysis","authors":"Rio Wironegoro, Nabila A Kloping, A. P. Witarto, David Nugraha, Niwanda Yogiswara, Kevin Luke, Y. Kloping, Maulydia Maulydia, S. Adi","doi":"10.35975/apic.v26i1.1768","DOIUrl":"https://doi.org/10.35975/apic.v26i1.1768","url":null,"abstract":"Background: This study aimed to assess non-thyroidal illness syndrome (NTIS) as a prognostic determinant in patients with sepsis, severe sepsis, and septic shock by evaluating thyroid hormone (TH) levels. Methodology: A systematic search was performed through electronic databases including PubMed, Embase, Scopus, and Medline. Following medical subject headings (MeSH) and free-text terms: \"euthyroid sick syndrome\" or \"Euthyroid Sick Syndromes\" or \"non–thyroidal illness syndrome\" or \"non–thyroidal illness syndrome\" or \"sick euthyroid syndrome\" or \"low T3 syndrome\" or \"low tri-iodothyronine syndrome\" AND \"sepsis\" or \"septic shock\" or \"systemic inflammatory response syndrome\" or \"septicemia\" or \"bacteremia\". Boolean operators’ combinations were applied to broaden and narrow the search results. Investigators independently reviewed the search results. For the purpose of the meta-analysis each thyroid hormone level was converted into the same unit: nmol/L for T3, T4 and rT3; μIU/mL for TSH; and pmol/L for fT3 and fT4. Statistical analysis was performed using Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC. Results: A total of 843 patients from 9 studies were included in this analysis. In septic patients, the lowest effect size of thyroid function parameter was TSH (g = 2.05; 95% CI = 1.56-2.54), while T3, fT3, and fT4 had the lowest effect size in severe septic patients (g [95%CI]: 0.83 [0.22-1.44]; 1.92 [0.57-3.27]; 1.00 [0.87-1.13]). Patients with septic shock had the highest effect size of TSH (g = 2.08; 95% CI = 1.54-2.61) and fT4 (g = 9.26; 95% CI = 0.98-17.53). Meanwhile, the lowest was T4 (g = 65.60; 95% CI = 64.63-66.57) and rT3 (g = 0.29; 95% CI = 0.24-0.34). A lower effect size of T3 (g = 0.83; 95% CI = 0.76-0.91), T4 (g = 59.48; 95% CI = 57.92-61.04), fT3 (g = 2.25; 95% CI = 1.83-2.66), and fT4 (g = 9.19; 95% CI = 1.56-16.81) were found in non-survivor groups. Conclusion: Thyroid hormone levels differ according to the severity of sepsis in septic patients. Non-thyroidal illness syndrome is a prognostic factor in septic patients and is associated with the risk of the mortality. Abbreviations: ESS - Euthyroid Sick Syndrome; NTIS - Non-Thyroidal Illness Syndrome; Tg - Thyroglobulin Key words: Non-thyroidal illness syndrome; Euthyroid sick syndrome; Sepsis; Septic shock; Prognosis Citation: Wironegoro R, Kloping NA, Witarto AP, Nugraha D, Yogiswara N, Luke K, KlopingYP, Maulydia M, Adi S. Prognostic significance of non-thyroidal illness syndrome in sepsis and septic shock cases: a systematic review and meta-analysis. Anaesth. pain intensive care 2021;26(1):54-62. DOI: 10.35975/apic.v26i1.1768 Received: July 16, 2021, Reviewed: December 15, 2021, Accepted: December 28, 2021","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70085413","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":"CLINIPICS: Intra–arterial line: a nightmare!!","authors":"Perundurai Chinnaswamy Vijayakumar","doi":"10.35975/apic.v25i6.1721","DOIUrl":"https://doi.org/10.35975/apic.v25i6.1721","url":null,"abstract":"A patient had invasive hemodynamic monitoring for Whipple’s procedure. Upper limb arterial cannulation failed due to vasospastic arteries. So her right femoral artery was cannulated and used for 48 h postop to manage the hypotension with continuous thoracic epidural analgesia.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49072093","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":"How well do you know COVID-19?","authors":"B.M Munasinghe","doi":"10.35975/apic.v25i6.1726","DOIUrl":"https://doi.org/10.35975/apic.v25i6.1726","url":null,"abstract":"ACROSS1. Defined as thickened interlobular septa and intralobular lines superimposed on diffuse ground-glass opacities, a radiological feature of progressive COVID-19 disease but non-specific.5. A humanized monoclonal antibody used as a therapy in","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44205002","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":"Aneurysm of interventricular septum: what an anaesthesiologist must know","authors":"S. Kiran, T. Bansal, Pardeep Jakhar","doi":"10.35975/apic.v25i6.1714","DOIUrl":"https://doi.org/10.35975/apic.v25i6.1714","url":null,"abstract":"Aneurysm of interventricular septum (IVSA) is a rare congenital anomaly. It has been documented in isolation but is seen in association with congenital heart disease in 0.3% of cases and in association with ventricular septal defect in 19% of cases. Etiologies are considered to be idiopathic formation, trauma, infection or spontaneous closure of pre-existing ventricular septal defect. Clinical manifestations are variable, some patients are asymptomatic whereas others can present with hemodynamic compromise. \u0000Key words: Anesthesia; Cardiac aneurysm \u0000Citation: Kiran S, Bansal T, Jakhar P. Aneurysm of interventricular septum: what an anesthesiologist must know. Anaesth. pain intensive care 2021;25(6):832–833; \u0000DOI: 10.35975/apic.v25i6.1714 \u0000 ","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48395718","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":"Intracranial subdural hematoma: a rare but serious complication following neuraxial anesthesia in obstetric anesthesia","authors":"Taizoon Q Dhoon, Jasmin Joshi, D. Portnoy, Govind C. Rajan","doi":"10.35975/apic.v25i6.1719","DOIUrl":"https://doi.org/10.35975/apic.v25i6.1719","url":null,"abstract":"Intracranial subdural hematoma (SDH) formation is an uncommon but serious complication of planned or unintentional dural puncture (DP) during straight epidural anesthesia, combined spinal-epidural, dural puncture epidural, or spinal anesthesia. Diagnosis of intracranial SDH following neuraxial anesthesia may be delayed or misdiagnosed due to rare occurrence, lack of knowledge, as well as an overlap in clinical presentation with postdural puncture headache (PDPH). Increased awareness of intracranial SDH as a complication of DP may result in earlier recognition and prevention of potentially devastating outcomes. This article reviews the relevant literature on association of neuraxial anesthesia with intracranial SDH formation. \u0000Key words: Intracranial subdural hematoma; Anesthesia, Neuraxial; Anesthesia, Epidural; Combined spinal-epidural; Dural puncture; Anesthesia, spinal; Pregnancy; Postdural puncture headache \u0000Citation: Dhoon TQ, Joshi J, Portnoy D, Rajan GC. Intracranial subdural hematoma: a rare but serious complication following neuraxial anesthesia in obstetric anesthesia. Anaesth. pain intensive care 2021;25(6):828-831: \u0000DOI: 10.35975/apic.v25i6.1719 \u0000Received: August 4, 2021, Reviewed: September 2, 2021, Accepted: October 3, 2021 \u0000 ","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47554742","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":"Shock interpretation and noninvasive hemodynamic monitoring with transthoracic echocardiography in an intensive care unit: a concise review","authors":"Kin-Bong Tang, Chun-Wun Marten Lau, K. Li","doi":"10.35975/apic.v25i6.1713","DOIUrl":"https://doi.org/10.35975/apic.v25i6.1713","url":null,"abstract":"Circulatory failure and shock are common in critically ill patients, and the cause of shock is usually multifactorial. Transthoracic echocardiography is a noninvasive method to determine the contribution of various factors toward a patient’s circulatory failure. Such factors include fluid status, cardiac contractility as well as vasomotor tone. Advances in echocardiographic measurements allow for the accurate estimation of a patient’s loading status and cardiac contractility, which help to guide treatment strategy and monitor treatment response. This article offers an overview of echocardiographic and clinical parameters and aims to incorporate these findings into a methodical approach to the clinical management of shock. \u0000Key words: Transthoracic echocardiogram; Shock; Hemodynamic monitoring; ICU \u0000Citation: Tang KB, Lau CWM, Li KC. Shock interpretation and noninvasive hemodynamic monitoring with transthoracic echocardiography in an intensive care unit: a concise review. Anaesth. pain intensive care 2021;25(6):819–827; \u0000DOI: 10.35975/apic.v25i6.1713 \u0000Received: October 5, 2021; Reviewed: October 10, 202; Accepted: October 25, 2021","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48655480","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}