<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-oper...<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.展开更多
The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Its rapid spread has put a strain on healthcare systems globally. Singapore ranked the highest in terms of reported cases outside of Chin...The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Its rapid spread has put a strain on healthcare systems globally. Singapore ranked the highest in terms of reported cases outside of China in the first few weeks of this outbreak. The management of a patient with COVID-19 in the Operating Theatre (OT) presents a unique set of challenges to the Anaesthetist. Delivery of timely and quality care must be upheld while reducing the risk of transmission to healthcare staff and other patients. This article describes our Anaesthesia Unit’s experiences and challenges in instituting our pandemic plans. The authors hope that the sharing of our experience and practical approach would be useful to other Anaesthesia Units worldwide.展开更多
Background: Hypnosis monitoring has been shown to reduce the incidence of awareness. A-line ARX-IndexTM (AAI) derived from auditory evoked potentials (AEP) represents as a numerical variable depth of anaesthesia. Obje...Background: Hypnosis monitoring has been shown to reduce the incidence of awareness. A-line ARX-IndexTM (AAI) derived from auditory evoked potentials (AEP) represents as a numerical variable depth of anaesthesia. Objectives: To study the efficacy of AEP as an indicator of anaesthetic depth and monitor intraoperative awareness in neurosurgical patients by using the AAI scale. Design: Prospective cohort study is used. Setting: The study is in Neurosurgical centre of Tertiary care hospital. Participants: Neurosurgical patients requiring general anaesthesia with duration of surgery between 90 - 150 minutes were enrolled for the study. Intervention: Patients in Group 1 (control) were monitored by conventional methods. Patients in Group 2 (study) underwent intraoperative monitoring by using the AEP monitor. Primary outcome: To study the efficacy of AEP monitoring and AAI index for monitoring the depth of anaesthesia and reducing the incidence of awareness. Results: There was no significant difference in the intraoperative haemodynamic responses measured between the two study groups (p > 0.5). There was no significant difference in the identification of intraoperative awareness by using conventional parameters between the two groups (p > 0.5). There was also a significantly faster time to recovery for patients in Group 2 (p < 0.05). Conclusion: Hypnosis monitoring using AEP monitor/AAI in neurosurgical patients under general anaesthesia did not show any significant difference in haemodynamic response and intraoperative awareness but had significant lower consumption of volatile anaesthetic with cost sparing effect and a faster recovery time as compared to conventional monitoring.展开更多
Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respirat...Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respiratory complications. While regional anaesthetic techniques are often performed as adjuncts to general anaesthesia, there is less data on breast operations being done solely under regional anaesthesia. We herein describe a patient with Swyer-James-MacLeod Syndrome who underwent breast lesion wide excision under combined paravertebral and pectoral nerves block, supplemented with propofol infusion for sedation. Choice of blocks was decided upon based on knowledge on the anatomy. Sole regional anaesthetic techniques have been the safest approach in some circumstances and should always be considered in patients who are of high risk under general anaesthesia.展开更多
Perioperative airway management in patients with oro-facial cancers who has undergone chemo/or radiotherapy poses a great challenge to the anaesthesiologist. These challenges are mainly due to either a mass in the ora...Perioperative airway management in patients with oro-facial cancers who has undergone chemo/or radiotherapy poses a great challenge to the anaesthesiologist. These challenges are mainly due to either a mass in the oral cavity or a limited mouth opening making intubation difficult or a major facial defect making mask ventilation difficult. We present our first time experience in a 27-year-old man with a malignant lymphoma of the right cheek who had undergone chemotherapy and needed plastic surgery to restore the face.展开更多
Arrhythmogenic right ventricular dysplasia(ARVD) is an inherited heart muscle disease.Myocyte apoptosis and fibro-fatty scar tissue predisposes patients to malignant ventricular arrhythmias.Patients may present to var...Arrhythmogenic right ventricular dysplasia(ARVD) is an inherited heart muscle disease.Myocyte apoptosis and fibro-fatty scar tissue predisposes patients to malignant ventricular arrhythmias.Patients may present to variety of surgical procedures with diagnosed ARVD.Surgical insult,catecholamine surge and physiological disturbance can be hazardous on the vulnerable myocardium and may result in life-threatening ventricular tachycardia or sudden cardiac death in the perioperative period.Anaesthetists have particular role in perioperative management of this patient population,meticulous perioperative planning,close haemodynamic monitoring and maintenance of physiological stability throughout helps to avoid devastating perioperative loss.展开更多
Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The a...Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.展开更多
Background: Chronic exposure to inhaled anaesthetic agents poses an occupational hazard related to the practice of anaesthesia. Therefore, this study sought to find out the perception of anaesthesia providers on expos...Background: Chronic exposure to inhaled anaesthetic agents poses an occupational hazard related to the practice of anaesthesia. Therefore, this study sought to find out the perception of anaesthesia providers on exposure to inhalational anaesthetics, evaluate their knowledge on the effects of chronic exposure and strategies to reduce chronic exposure to operating room inhalational anaesthetic agents. Method: This cross-sectional survey was conducted by administering a self-administered questionnaire to 71 anaesthesia providers in Ghana who attended the annual refresher course of the faculty of Anaesthesia, West African College of Surgeons, in 2016. Data collected were analysed and presented as frequencies and percentages. Results: Halothane and isoflurane were the most frequently used inhalational agents by the respondents. Majority (90.1%) of the respondents perceived they are exposed to inhalational anaesthetics in their working environment. Majority of the anaesthetic providers cited poorly functioning scavenging systems (28.2%) and use of paediatric Ayre’s T-piece (28.2%) as sources of exposure to inhalational anaesthetics. All respondents admitted making attempts to reduce their exposure to inhalational anaesthetics. Majority of the respondents mentioned teratogenicity (77.5%) and hepatotoxicity (67.6%) as effects of chronic exposure to inhaled anaesthetic agents. Conclusion: Anaesthesia providers in Ghana perceived they are chronically exposed to inhalational anaesthetic agents in their work environment. They are aware of the sources of inhalational anaesthetic agent exposure, associated health risks and strategies required to reduce chronic exposure to inhaled anaesthetic agents.展开更多
Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation ...Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.展开更多
In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physio...In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physiology, end organs effects, procedural related factors should all be part of the specific anaesthetic plan tailored for each patient individually. The different anaesthetic techniques applied, and procedure related complications are evaluated. Anaesthetic management, procedural related difficulties, pharmacologic aspects, and possible associated complications are reviewed.展开更多
Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progre...Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.展开更多
Objective： To observe the effect of general anaesthesia with combination of acupuncture [ conducted with Han＇s acupoint nerve stimulator （HANS） applied] and enflurane in radical operation of laryngocarcinoma （LC...Objective： To observe the effect of general anaesthesia with combination of acupuncture [ conducted with Han＇s acupoint nerve stimulator （HANS） applied] and enflurane in radical operation of laryngocarcinoma （LC）. Methods： Sixty patients with LC of grade Ⅰ -Ⅱ, classified according to the standard of American Society of Anesthesiologists （ASA）, were assigned by randomizing number table to the control group and the tested group, 30 patients in each group. The control group received anaesthesia with enflurane alone for inducing and maintaining; the tested group was anaesthetized with enflurane like that given to the control group but also received additionally needling stimulation conducted by HANS. The dosage of enflurane used, the minimum effective concentration of enflurane in alveolar air （MACEnf） and the changes of heart rate （HR） as well as blood pressure （BP） in patients at different time points in the operational process were observed. Results： As compared with those in the control group, in the tested group, both the MACEnf and the dosage of enflurane were reduced, with the difference between the two groups significant （ P〈0.01 ）. The changes of HR and BP among different time points in the tested group were slight, and as compared with those in the control group at the corresponding time points, the difference was significant （ P〈 0. 05 or P〈0.01）. Conclusion： General anaesthesia with combination of enflurane and needling conducted by HANS applied in radical operation of LC has definite effect with less complication. Needling could be cooperated with narcotics, and so it could be taken as an auxiliary measure of anaesthesia for radical operation of LC.展开更多
Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageou...Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.展开更多
BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making ...BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.展开更多
Delayed neurocognitive recovery following anesthesia and surgery is a common complication in older adult patients.Synapses are fundamental to cognitive function.The activity of synapses heavily depends on the energy s...Delayed neurocognitive recovery following anesthesia and surgery is a common complication in older adult patients.Synapses are fundamental to cognitive function.The activity of synapses heavily depends on the energy supplied by synaptic mitochondria,which are significantly influenced by oxidative stress.Sirtuin 3 is a histone deacetylase located in the mitochondrial matrix that plays a pivotal role in regulating mitochondrial function.However,it remains unclear whether and how sirtuin 3 is involved in the development of delayed cognitive recovery.Therefore,in this study,we investigated the potential role of sirtuin 3 in synapses during delayed neurocognitive recovery.Our results showed that anesthesia and surgery induced cognitive impairment in mice and reduced sirtuin 3 protein expression.Overexpression of sirtuin 3 inhibited opening of the mitochondrial permeability transition pore by reducing acetylation of K166 on cyclophilin D and also rescued cognitive impairment.Aged mice carrying the cyclophilin D-K166R mutation exhibited significantly reduced cognitive impairment.Similarly,administering the mitochondrial permeability transition pore blocker,cyclosporine A,effectively alleviated the decline in synaptic mitochondrial function and cognitive impairment caused by anesthesia and surgery in aged mice.These results indicate that the sirtuin 3/cyclophilin D-K166/mPTP signaling pathway in hippocampal synaptic mitochondria is involved in delayed neurocognitive recovery of aged mice,suggesting this pathway could serve as a potential target for treatment.展开更多
文摘<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (B中央人民政府), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.
文摘The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Its rapid spread has put a strain on healthcare systems globally. Singapore ranked the highest in terms of reported cases outside of China in the first few weeks of this outbreak. The management of a patient with COVID-19 in the Operating Theatre (OT) presents a unique set of challenges to the Anaesthetist. Delivery of timely and quality care must be upheld while reducing the risk of transmission to healthcare staff and other patients. This article describes our Anaesthesia Unit’s experiences and challenges in instituting our pandemic plans. The authors hope that the sharing of our experience and practical approach would be useful to other Anaesthesia Units worldwide.
文摘Background: Hypnosis monitoring has been shown to reduce the incidence of awareness. A-line ARX-IndexTM (AAI) derived from auditory evoked potentials (AEP) represents as a numerical variable depth of anaesthesia. Objectives: To study the efficacy of AEP as an indicator of anaesthetic depth and monitor intraoperative awareness in neurosurgical patients by using the AAI scale. Design: Prospective cohort study is used. Setting: The study is in Neurosurgical centre of Tertiary care hospital. Participants: Neurosurgical patients requiring general anaesthesia with duration of surgery between 90 - 150 minutes were enrolled for the study. Intervention: Patients in Group 1 (control) were monitored by conventional methods. Patients in Group 2 (study) underwent intraoperative monitoring by using the AEP monitor. Primary outcome: To study the efficacy of AEP monitoring and AAI index for monitoring the depth of anaesthesia and reducing the incidence of awareness. Results: There was no significant difference in the intraoperative haemodynamic responses measured between the two study groups (p > 0.5). There was no significant difference in the identification of intraoperative awareness by using conventional parameters between the two groups (p > 0.5). There was also a significantly faster time to recovery for patients in Group 2 (p < 0.05). Conclusion: Hypnosis monitoring using AEP monitor/AAI in neurosurgical patients under general anaesthesia did not show any significant difference in haemodynamic response and intraoperative awareness but had significant lower consumption of volatile anaesthetic with cost sparing effect and a faster recovery time as compared to conventional monitoring.
文摘Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respiratory complications. While regional anaesthetic techniques are often performed as adjuncts to general anaesthesia, there is less data on breast operations being done solely under regional anaesthesia. We herein describe a patient with Swyer-James-MacLeod Syndrome who underwent breast lesion wide excision under combined paravertebral and pectoral nerves block, supplemented with propofol infusion for sedation. Choice of blocks was decided upon based on knowledge on the anatomy. Sole regional anaesthetic techniques have been the safest approach in some circumstances and should always be considered in patients who are of high risk under general anaesthesia.
文摘Perioperative airway management in patients with oro-facial cancers who has undergone chemo/or radiotherapy poses a great challenge to the anaesthesiologist. These challenges are mainly due to either a mass in the oral cavity or a limited mouth opening making intubation difficult or a major facial defect making mask ventilation difficult. We present our first time experience in a 27-year-old man with a malignant lymphoma of the right cheek who had undergone chemotherapy and needed plastic surgery to restore the face.
文摘Arrhythmogenic right ventricular dysplasia(ARVD) is an inherited heart muscle disease.Myocyte apoptosis and fibro-fatty scar tissue predisposes patients to malignant ventricular arrhythmias.Patients may present to variety of surgical procedures with diagnosed ARVD.Surgical insult,catecholamine surge and physiological disturbance can be hazardous on the vulnerable myocardium and may result in life-threatening ventricular tachycardia or sudden cardiac death in the perioperative period.Anaesthetists have particular role in perioperative management of this patient population,meticulous perioperative planning,close haemodynamic monitoring and maintenance of physiological stability throughout helps to avoid devastating perioperative loss.
文摘Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.
文摘Background: Chronic exposure to inhaled anaesthetic agents poses an occupational hazard related to the practice of anaesthesia. Therefore, this study sought to find out the perception of anaesthesia providers on exposure to inhalational anaesthetics, evaluate their knowledge on the effects of chronic exposure and strategies to reduce chronic exposure to operating room inhalational anaesthetic agents. Method: This cross-sectional survey was conducted by administering a self-administered questionnaire to 71 anaesthesia providers in Ghana who attended the annual refresher course of the faculty of Anaesthesia, West African College of Surgeons, in 2016. Data collected were analysed and presented as frequencies and percentages. Results: Halothane and isoflurane were the most frequently used inhalational agents by the respondents. Majority (90.1%) of the respondents perceived they are exposed to inhalational anaesthetics in their working environment. Majority of the anaesthetic providers cited poorly functioning scavenging systems (28.2%) and use of paediatric Ayre’s T-piece (28.2%) as sources of exposure to inhalational anaesthetics. All respondents admitted making attempts to reduce their exposure to inhalational anaesthetics. Majority of the respondents mentioned teratogenicity (77.5%) and hepatotoxicity (67.6%) as effects of chronic exposure to inhaled anaesthetic agents. Conclusion: Anaesthesia providers in Ghana perceived they are chronically exposed to inhalational anaesthetic agents in their work environment. They are aware of the sources of inhalational anaesthetic agent exposure, associated health risks and strategies required to reduce chronic exposure to inhaled anaesthetic agents.
文摘Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.
文摘In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physiology, end organs effects, procedural related factors should all be part of the specific anaesthetic plan tailored for each patient individually. The different anaesthetic techniques applied, and procedure related complications are evaluated. Anaesthetic management, procedural related difficulties, pharmacologic aspects, and possible associated complications are reviewed.
文摘Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.
文摘Objective： To observe the effect of general anaesthesia with combination of acupuncture [ conducted with Han＇s acupoint nerve stimulator （HANS） applied] and enflurane in radical operation of laryngocarcinoma （LC）. Methods： Sixty patients with LC of grade Ⅰ -Ⅱ, classified according to the standard of American Society of Anesthesiologists （ASA）, were assigned by randomizing number table to the control group and the tested group, 30 patients in each group. The control group received anaesthesia with enflurane alone for inducing and maintaining; the tested group was anaesthetized with enflurane like that given to the control group but also received additionally needling stimulation conducted by HANS. The dosage of enflurane used, the minimum effective concentration of enflurane in alveolar air （MACEnf） and the changes of heart rate （HR） as well as blood pressure （BP） in patients at different time points in the operational process were observed. Results： As compared with those in the control group, in the tested group, both the MACEnf and the dosage of enflurane were reduced, with the difference between the two groups significant （ P〈0.01 ）. The changes of HR and BP among different time points in the tested group were slight, and as compared with those in the control group at the corresponding time points, the difference was significant （ P〈 0. 05 or P〈0.01）. Conclusion： General anaesthesia with combination of enflurane and needling conducted by HANS applied in radical operation of LC has definite effect with less complication. Needling could be cooperated with narcotics, and so it could be taken as an auxiliary measure of anaesthesia for radical operation of LC.
文摘Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.
文摘BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.
基金supported by the National Natural Science Foundation of China,Nos.81701040(to HM),82071180(to HM),82271206(to TL),82171191(to YW),82371211(to YW)the Natural Science Foundation of Beijing,No.7212023(to HM)Key Subject of the Natural Science Foundation ofJiangsu Province for Colleges and Universities,No.23KJA320009(to YW).
文摘Delayed neurocognitive recovery following anesthesia and surgery is a common complication in older adult patients.Synapses are fundamental to cognitive function.The activity of synapses heavily depends on the energy supplied by synaptic mitochondria,which are significantly influenced by oxidative stress.Sirtuin 3 is a histone deacetylase located in the mitochondrial matrix that plays a pivotal role in regulating mitochondrial function.However,it remains unclear whether and how sirtuin 3 is involved in the development of delayed cognitive recovery.Therefore,in this study,we investigated the potential role of sirtuin 3 in synapses during delayed neurocognitive recovery.Our results showed that anesthesia and surgery induced cognitive impairment in mice and reduced sirtuin 3 protein expression.Overexpression of sirtuin 3 inhibited opening of the mitochondrial permeability transition pore by reducing acetylation of K166 on cyclophilin D and also rescued cognitive impairment.Aged mice carrying the cyclophilin D-K166R mutation exhibited significantly reduced cognitive impairment.Similarly,administering the mitochondrial permeability transition pore blocker,cyclosporine A,effectively alleviated the decline in synaptic mitochondrial function and cognitive impairment caused by anesthesia and surgery in aged mice.These results indicate that the sirtuin 3/cyclophilin D-K166/mPTP signaling pathway in hippocampal synaptic mitochondria is involved in delayed neurocognitive recovery of aged mice,suggesting this pathway could serve as a potential target for treatment.
