Publisher: Hindawi   (Total: 343 journals)

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Showing 1 - 200 of 343 Journals sorted alphabetically
Abstract and Applied Analysis     Open Access   (Followers: 3, SJR: 0.343, CiteScore: 1)
Active and Passive Electronic Components     Open Access   (Followers: 8, SJR: 0.136, CiteScore: 0)
Advances in Acoustics and Vibration     Open Access   (Followers: 51, SJR: 0.147, CiteScore: 0)
Advances in Aerospace Engineering     Open Access   (Followers: 67)
Advances in Agriculture     Open Access   (Followers: 12)
Advances in Artificial Intelligence     Open Access   (Followers: 22)
Advances in Astronomy     Open Access   (Followers: 51, SJR: 0.257, CiteScore: 1)
Advances in Bioinformatics     Open Access   (Followers: 20, SJR: 0.565, CiteScore: 2)
Advances in Biology     Open Access   (Followers: 11)
Advances in Chemistry     Open Access   (Followers: 35)
Advances in Civil Engineering     Open Access   (Followers: 51, SJR: 0.539, CiteScore: 1)
Advances in Computer Engineering     Open Access   (Followers: 8)
Advances in Condensed Matter Physics     Open Access   (Followers: 11, SJR: 0.315, CiteScore: 1)
Advances in Decision Sciences     Open Access   (Followers: 4, SJR: 0.303, CiteScore: 1)
Advances in Electrical Engineering     Open Access   (Followers: 52)
Advances in Electronics     Open Access   (Followers: 101)
Advances in Emergency Medicine     Open Access   (Followers: 16)
Advances in Endocrinology     Open Access   (Followers: 6)
Advances in Environmental Chemistry     Open Access   (Followers: 10)
Advances in Epidemiology     Open Access   (Followers: 9)
Advances in Fuzzy Systems     Open Access   (Followers: 5, SJR: 0.161, CiteScore: 1)
Advances in Geology     Open Access   (Followers: 19)
Advances in Geriatrics     Open Access   (Followers: 6)
Advances in Hematology     Open Access   (Followers: 13, SJR: 0.661, CiteScore: 2)
Advances in Hepatology     Open Access   (Followers: 3)
Advances in High Energy Physics     Open Access   (Followers: 26, SJR: 0.866, CiteScore: 2)
Advances in Human-Computer Interaction     Open Access   (Followers: 21, SJR: 0.186, CiteScore: 1)
Advances in Materials Science and Engineering     Open Access   (Followers: 31, SJR: 0.315, CiteScore: 1)
Advances in Mathematical Physics     Open Access   (Followers: 9, SJR: 0.218, CiteScore: 1)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Meteorology     Open Access   (Followers: 24, SJR: 0.48, CiteScore: 1)
Advances in Multimedia     Open Access   (Followers: 1, SJR: 0.173, CiteScore: 1)
Advances in Nonlinear Optics     Open Access   (Followers: 7)
Advances in Numerical Analysis     Open Access   (Followers: 9)
Advances in Nursing     Open Access   (Followers: 37)
Advances in Operations Research     Open Access   (Followers: 13, SJR: 0.205, CiteScore: 1)
Advances in Optical Technologies     Open Access   (Followers: 4, SJR: 0.214, CiteScore: 1)
Advances in Optics     Open Access   (Followers: 9)
Advances in OptoElectronics     Open Access   (Followers: 6, SJR: 0.141, CiteScore: 0)
Advances in Orthopedics     Open Access   (Followers: 11, SJR: 0.922, CiteScore: 2)
Advances in Pharmacological and Pharmaceutical Sciences     Open Access   (Followers: 9, SJR: 0.591, CiteScore: 2)
Advances in Physical Chemistry     Open Access   (Followers: 13, SJR: 0.179, CiteScore: 1)
Advances in Polymer Technology     Open Access   (Followers: 14, SJR: 0.299, CiteScore: 1)
Advances in Power Electronics     Open Access   (Followers: 44, SJR: 0.184, CiteScore: 0)
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Public Health     Open Access   (Followers: 28)
Advances in Regenerative Medicine     Open Access   (Followers: 4)
Advances in Software Engineering     Open Access   (Followers: 11)
Advances in Statistics     Open Access   (Followers: 10)
Advances in Toxicology     Open Access   (Followers: 4)
Advances in Tribology     Open Access   (Followers: 15, SJR: 0.265, CiteScore: 1)
Advances in Urology     Open Access   (Followers: 13, SJR: 0.51, CiteScore: 1)
Advances in Virology     Open Access   (Followers: 8, SJR: 0.838, CiteScore: 2)
AIDS Research and Treatment     Open Access   (Followers: 2, SJR: 0.758, CiteScore: 2)
Analytical Cellular Pathology     Open Access   (Followers: 3, SJR: 0.886, CiteScore: 2)
Anatomy Research Intl.     Open Access   (Followers: 4)
Anemia     Open Access   (Followers: 6, SJR: 0.669, CiteScore: 2)
Anesthesiology Research and Practice     Open Access   (Followers: 15, SJR: 0.501, CiteScore: 1)
Applied and Environmental Soil Science     Open Access   (Followers: 20, SJR: 0.451, CiteScore: 1)
Applied Bionics and Biomechanics     Open Access   (Followers: 7, SJR: 0.288, CiteScore: 1)
Applied Computational Intelligence and Soft Computing     Open Access   (Followers: 15)
Archaea     Open Access   (Followers: 4, SJR: 0.852, CiteScore: 2)
Autism Research and Treatment     Open Access   (Followers: 36)
Autoimmune Diseases     Open Access   (Followers: 3, SJR: 0.805, CiteScore: 2)
Behavioural Neurology     Open Access   (Followers: 9, SJR: 0.786, CiteScore: 2)
Biochemistry Research Intl.     Open Access   (Followers: 6, SJR: 0.437, CiteScore: 2)
Bioinorganic Chemistry and Applications     Open Access   (Followers: 11, SJR: 0.419, CiteScore: 2)
BioMed Research Intl.     Open Access   (Followers: 5, SJR: 0.935, CiteScore: 3)
Biotechnology Research Intl.     Open Access   (Followers: 1)
Bone Marrow Research     Open Access   (Followers: 2, SJR: 0.531, CiteScore: 1)
Canadian J. of Gastroenterology & Hepatology     Open Access   (Followers: 4, SJR: 0.867, CiteScore: 1)
Canadian J. of Infectious Diseases and Medical Microbiology     Open Access   (Followers: 8, SJR: 0.548, CiteScore: 1)
Canadian Respiratory J.     Open Access   (Followers: 3, SJR: 0.474, CiteScore: 1)
Cardiology Research and Practice     Open Access   (Followers: 11, SJR: 1.237, CiteScore: 4)
Cardiovascular Therapeutics     Open Access   (Followers: 2, SJR: 1.075, CiteScore: 2)
Case Reports in Anesthesiology     Open Access   (Followers: 11)
Case Reports in Cardiology     Open Access   (Followers: 8, SJR: 0.219, CiteScore: 0)
Case Reports in Critical Care     Open Access   (Followers: 12)
Case Reports in Dentistry     Open Access   (Followers: 8, SJR: 0.229, CiteScore: 0)
Case Reports in Dermatological Medicine     Open Access   (Followers: 2)
Case Reports in Emergency Medicine     Open Access   (Followers: 19)
Case Reports in Endocrinology     Open Access   (Followers: 2, SJR: 0.209, CiteScore: 1)
Case Reports in Gastrointestinal Medicine     Open Access   (Followers: 3)
Case Reports in Genetics     Open Access   (Followers: 2)
Case Reports in Hematology     Open Access   (Followers: 9)
Case Reports in Hepatology     Open Access   (Followers: 2)
Case Reports in Immunology     Open Access   (Followers: 6)
Case Reports in Infectious Diseases     Open Access   (Followers: 6)
Case Reports in Medicine     Open Access   (Followers: 3)
Case Reports in Nephrology     Open Access   (Followers: 5)
Case Reports in Neurological Medicine     Open Access   (Followers: 1)
Case Reports in Obstetrics and Gynecology     Open Access   (Followers: 11)
Case Reports in Oncological Medicine     Open Access   (Followers: 2, SJR: 0.204, CiteScore: 1)
Case Reports in Ophthalmological Medicine     Open Access   (Followers: 3)
Case Reports in Orthopedics     Open Access   (Followers: 6)
Case Reports in Otolaryngology     Open Access   (Followers: 7)
Case Reports in Pathology     Open Access   (Followers: 7)
Case Reports in Pediatrics     Open Access   (Followers: 8)
Case Reports in Psychiatry     Open Access   (Followers: 18)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Case Reports in Radiology     Open Access   (Followers: 12)
Case Reports in Rheumatology     Open Access   (Followers: 10)
Case Reports in Surgery     Open Access   (Followers: 12)
Case Reports in Transplantation     Open Access  
Case Reports in Urology     Open Access   (Followers: 12)
Case Reports in Vascular Medicine     Open Access  
Case Reports in Veterinary Medicine     Open Access   (Followers: 5)
Child Development Research     Open Access   (Followers: 21, SJR: 0.144, CiteScore: 0)
Chinese J. of Engineering     Open Access   (Followers: 2, SJR: 0.114, CiteScore: 0)
Chinese J. of Mathematics     Open Access  
Chromatography Research Intl.     Open Access   (Followers: 5)
Complexity     Hybrid Journal   (Followers: 8, SJR: 0.531, CiteScore: 2)
Computational and Mathematical Methods in Medicine     Open Access   (Followers: 2, SJR: 0.403, CiteScore: 1)
Computational Biology J.     Open Access   (Followers: 7)
Computational Intelligence and Neuroscience     Open Access   (Followers: 15, SJR: 0.326, CiteScore: 1)
Concepts in Magnetic Resonance Part A     Open Access   (Followers: 1, SJR: 0.354, CiteScore: 1)
Concepts in Magnetic Resonance Part B, Magnetic Resonance Engineering     Open Access   (Followers: 1, SJR: 0.26, CiteScore: 1)
Conference Papers in Science     Open Access   (Followers: 2)
Contrast Media & Molecular Imaging     Open Access   (Followers: 2, SJR: 0.842, CiteScore: 3)
Critical Care Research and Practice     Open Access   (Followers: 13, SJR: 0.499, CiteScore: 1)
Current Gerontology and Geriatrics Research     Open Access   (Followers: 10, SJR: 0.512, CiteScore: 2)
Depression Research and Treatment     Open Access   (Followers: 19, SJR: 0.816, CiteScore: 2)
Dermatology Research and Practice     Open Access   (Followers: 4, SJR: 0.806, CiteScore: 2)
Diagnostic and Therapeutic Endoscopy     Open Access   (SJR: 0.201, CiteScore: 1)
Discrete Dynamics in Nature and Society     Open Access   (Followers: 6, SJR: 0.279, CiteScore: 1)
Disease Markers     Open Access   (Followers: 1, SJR: 0.9, CiteScore: 2)
Economics Research Intl.     Open Access   (Followers: 1)
Education Research Intl.     Open Access   (Followers: 19)
Emergency Medicine Intl.     Open Access   (Followers: 9, SJR: 0.298, CiteScore: 1)
Enzyme Research     Open Access   (Followers: 5, SJR: 0.653, CiteScore: 3)
Evidence-based Complementary and Alternative Medicine     Open Access   (Followers: 30, SJR: 0.683, CiteScore: 2)
Game Theory     Open Access   (Followers: 1)
Gastroenterology Research and Practice     Open Access   (Followers: 1, SJR: 0.768, CiteScore: 2)
Genetics Research Intl.     Open Access   (Followers: 1, SJR: 0.61, CiteScore: 2)
Geofluids     Open Access   (Followers: 5, SJR: 0.952, CiteScore: 2)
Hepatitis Research and Treatment     Open Access   (Followers: 6, SJR: 0.389, CiteScore: 2)
Heteroatom Chemistry     Open Access   (Followers: 3, SJR: 0.333, CiteScore: 1)
HPB Surgery     Open Access   (Followers: 9, SJR: 0.824, CiteScore: 2)
Infectious Diseases in Obstetrics and Gynecology     Open Access   (Followers: 5, SJR: 1.27, CiteScore: 2)
Interdisciplinary Perspectives on Infectious Diseases     Open Access   (Followers: 1, SJR: 0.627, CiteScore: 2)
Intl. J. of Aerospace Engineering     Open Access   (Followers: 81, SJR: 0.232, CiteScore: 1)
Intl. J. of Agronomy     Open Access   (Followers: 6, SJR: 0.311, CiteScore: 1)
Intl. J. of Alzheimer's Disease     Open Access   (Followers: 12, SJR: 0.787, CiteScore: 3)
Intl. J. of Analytical Chemistry     Open Access   (Followers: 22, SJR: 0.285, CiteScore: 1)
Intl. J. of Antennas and Propagation     Open Access   (Followers: 13, SJR: 0.233, CiteScore: 1)
Intl. J. of Atmospheric Sciences     Open Access   (Followers: 21)
Intl. J. of Biodiversity     Open Access   (Followers: 3)
Intl. J. of Biomaterials     Open Access   (Followers: 5, SJR: 0.511, CiteScore: 2)
Intl. J. of Biomedical Imaging     Open Access   (Followers: 3, SJR: 0.501, CiteScore: 2)
Intl. J. of Breast Cancer     Open Access   (Followers: 14, SJR: 1.025, CiteScore: 2)
Intl. J. of Cell Biology     Open Access   (Followers: 4, SJR: 1.887, CiteScore: 4)
Intl. J. of Chemical Engineering     Open Access   (Followers: 8, SJR: 0.327, CiteScore: 1)
Intl. J. of Chronic Diseases     Open Access   (Followers: 1)
Intl. J. of Combinatorics     Open Access   (Followers: 1)
Intl. J. of Computer Games Technology     Open Access   (Followers: 10, SJR: 0.287, CiteScore: 2)
Intl. J. of Corrosion     Open Access   (Followers: 11, SJR: 0.194, CiteScore: 1)
Intl. J. of Dentistry     Open Access   (Followers: 8, SJR: 0.649, CiteScore: 2)
Intl. J. of Differential Equations     Open Access   (Followers: 8, SJR: 0.191, CiteScore: 0)
Intl. J. of Digital Multimedia Broadcasting     Open Access   (Followers: 5, SJR: 0.296, CiteScore: 2)
Intl. J. of Electrochemistry     Open Access   (Followers: 10)
Intl. J. of Endocrinology     Open Access   (Followers: 4, SJR: 1.012, CiteScore: 3)
Intl. J. of Engineering Mathematics     Open Access   (Followers: 7)
Intl. J. of Food Science     Open Access   (Followers: 5, SJR: 0.44, CiteScore: 2)
Intl. J. of Forestry Research     Open Access   (Followers: 3, SJR: 0.373, CiteScore: 1)
Intl. J. of Genomics     Open Access   (Followers: 2, SJR: 0.868, CiteScore: 3)
Intl. J. of Geophysics     Open Access   (Followers: 5, SJR: 0.182, CiteScore: 1)
Intl. J. of Hepatology     Open Access   (Followers: 4, SJR: 0.874, CiteScore: 2)
Intl. J. of Hypertension     Open Access   (Followers: 8, SJR: 0.578, CiteScore: 1)
Intl. J. of Inflammation     Open Access   (SJR: 1.264, CiteScore: 3)
Intl. J. of Inorganic Chemistry     Open Access   (Followers: 4)
Intl. J. of Manufacturing Engineering     Open Access   (Followers: 2)
Intl. J. of Mathematics and Mathematical Sciences     Open Access   (Followers: 3, SJR: 0.177, CiteScore: 0)
Intl. J. of Medicinal Chemistry     Open Access   (Followers: 6, SJR: 0.31, CiteScore: 1)
Intl. J. of Metals     Open Access   (Followers: 7)
Intl. J. of Microbiology     Open Access   (Followers: 8, SJR: 0.662, CiteScore: 2)
Intl. J. of Microwave Science and Technology     Open Access   (Followers: 6, SJR: 0.136, CiteScore: 1)
Intl. J. of Navigation and Observation     Open Access   (Followers: 20, SJR: 0.267, CiteScore: 2)
Intl. J. of Nephrology     Open Access   (Followers: 2, SJR: 0.697, CiteScore: 1)
Intl. J. of Oceanography     Open Access   (Followers: 8)
Intl. J. of Optics     Open Access   (Followers: 10, SJR: 0.231, CiteScore: 1)
Intl. J. of Otolaryngology     Open Access   (Followers: 3)
Intl. J. of Partial Differential Equations     Open Access   (Followers: 2)
Intl. J. of Pediatrics     Open Access   (Followers: 6)
Intl. J. of Peptides     Open Access   (Followers: 2, SJR: 0.46, CiteScore: 1)
Intl. J. of Photoenergy     Open Access   (Followers: 3, SJR: 0.341, CiteScore: 1)
Intl. J. of Plant Genomics     Open Access   (Followers: 4, SJR: 0.583, CiteScore: 1)
Intl. J. of Polymer Science     Open Access   (Followers: 28, SJR: 0.298, CiteScore: 1)
Intl. J. of Population Research     Open Access   (Followers: 4)
Intl. J. of Quality, Statistics, and Reliability     Open Access   (Followers: 17)
Intl. J. of Reconfigurable Computing     Open Access   (SJR: 0.123, CiteScore: 1)
Intl. J. of Reproductive Medicine     Open Access   (Followers: 6)
Intl. J. of Rheumatology     Open Access   (Followers: 4, SJR: 0.645, CiteScore: 2)
Intl. J. of Rotating Machinery     Open Access   (Followers: 2, SJR: 0.193, CiteScore: 1)
Intl. J. of Spectroscopy     Open Access   (Followers: 8)
Intl. J. of Stochastic Analysis     Open Access   (Followers: 3, SJR: 0.279, CiteScore: 1)
Intl. J. of Surgical Oncology     Open Access   (Followers: 1, SJR: 0.573, CiteScore: 2)
Intl. J. of Telemedicine and Applications     Open Access   (Followers: 7, SJR: 0.403, CiteScore: 2)
Intl. J. of Vascular Medicine     Open Access   (SJR: 0.782, CiteScore: 2)
Intl. J. of Zoology     Open Access   (Followers: 2, SJR: 0.209, CiteScore: 1)
Intl. Scholarly Research Notices     Open Access   (Followers: 230)

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Similar Journals
Journal Cover
Anesthesiology Research and Practice
Journal Prestige (SJR): 0.501
Citation Impact (citeScore): 1
Number of Followers: 15  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1687-6962 - ISSN (Online) 1687-6970
Published by Hindawi Homepage  [343 journals]
  • Epidural Needle Extension through the Ligamentum Flavum Using the Standard
           versus the CompuFlo®-Assisted Loss of Resistance to Saline Technique: A
           Simulation Study

    • Abstract: Background. The CompuFlo® epidural system has been recently introduced and validated as an objective and sensible tool to detect the epidural space. We aimed to verify whether the high sensitivity of the instrument may help the anesthesiologist to identify the epidural space very early, limiting the extension of the Tuohy needle into the epidural space. Methods. In this prospective, simulation study, we evaluated the Tuohy needle extension through a simulated ligamentum flavum during the epidural procedure performed by 52 expert anesthesiologists by using the CompuFlo® epidural instrument or their standard loss of resistance to saline technique (LORT). Results. The mean (SD) needle extension length was 3.90 (3.71) mm in the standard technique group and 0.68 (0.46) mm in the CompuFlo® group (). The extremely reduced variability of the data in the CompuFlo® group (F test 0.01) made the results obtained with this instrument highly predictable. Conclusions. Puncturing high-resistance material that simulated the ligamentum flavum, the use of CompuFlo® has determined the arrest of the needle more precociously when compared with the traditional LORT.
      PubDate: Tue, 07 Jan 2020 07:35:04 +000
  • Success and Challenge When Returning to Clinical Practice: A Case Series
           in Anesthesiologist Re-Entry

    • Abstract: Introduction. Anesthesiologists returning to clinical practice pose unique challenges for licensing and credentialing boards. Few institutions provide re-education. We describe the physician refresher/re-entry program at our College of Medicine. Methods. We launched the physician re-entry program in 2006. This individualized program re-educates physicians who left clinical practice for any reason and are seeking to return. We report results achieved for 12 anesthesiologists who successfully completed the course between August 2012 and February 2018. Results. Seven men and five women left their practices for various reasons, which included relocation, family or medical reasons, substance use, and burnout. None left practice for medical negligence. Range away from clinical activity was 0–10 years. Five had active licenses. Seven were US graduates and five were international. Nine of 12 achieved their goals. Of the 3 others, 1 did not pursue her goal, another did not obtain a residency, and the other just finished the program. Seven out of 9 (78%) achieved their goal within 1 year of course completion. Discussion. Despite our small sample size, our experience to successfully return inactive physicians to the workforce adds to the scant literature and experience in refreshing inactive physicians. Our trainees return to practice serving communities across the country and are now a pivotal part of the anesthesiology workforce. Thus, this program not only services individual physicians, but the whole community affected by their absence.
      PubDate: Fri, 20 Dec 2019 10:35:05 +000
  • A Five-Year Data Report of Long-Term Central Venous Catheters Focusing on
           Early Complications

    • Abstract: Background. Long-term venous access has become the standard practice for the administration of chemotherapy, fluid therapy, antibiotics, and parenteral nutrition. The most commonly used methods are percutaneous puncture of the subclavian and internal jugular veins using the Seldinger technique or surgical cutdown of the cephalic vein. Methods. This study is based on a quality registry including all long-term central venous catheter insertion procedures performed in patients >18 years at our department during a five-year period. The following data were registered: demographic data, main diagnosis and indications for the procedure, preoperative blood samples, type of catheter, the venous access used, and the procedure time. In addition, procedural and early postoperative complications were registered: unsuccessful procedures, malpositioned catheters, pneumothorax, hematoma complications, infections, nerve injuries, and wound ruptures. The Seldinger technique using anatomical landmarks at the left subclavian vein was the preferred access. Fluoroscopy was not used. Results. One thousand one hundred and one procedures were performed. In eight (0.7%) cases, the insertion of a catheter was not possible, 23 (2.1%) catheters were incorrectly positioned, twelve (1.1%) patients developed pneumothorax, nine (0.8%) developed hematoma, and three (0.27%) developed infection postoperatively. One (0.1%) patient suffered nerve injury, which totally recovered. No wound ruptures were observed. Conclusions. We have a high success rate of first-attempt insertions compared with other published data, as well as an acceptable and low rate of pneumothorax, hematoma, and infections. However, the number of malpositioned catheters was relatively high. This could probably have been avoided with routine use of fluoroscopy during the procedure.
      PubDate: Tue, 10 Dec 2019 05:50:05 +000
  • Effect of Depth of Total Intravenous General Anesthesia on Intraoperative
           Electrically Evoked Compound Action Potentials in Cochlear Implantation

    • Abstract: Purpose. This study aims to compare the effect of the depth of total intravenous anesthesia (TIVA) on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in cochlear implant operations. Methods. Prospectively, a total of 39 patients aged between 1 and 48 years who were scheduled to undergo cochlear implantation surgeries were enrolled in this study. Every patient received both light and deep TIVA during the cochlear implant surgery. The e-ECAP thresholds were obtained during the light and deep TIVA. Results. After comparing the e-ECAP means for each electrode (lead) between the light and deep anesthesia, no significant differences were detected between the light and deep anesthesia. Conclusion. The depth of TIVA may have no significant influence on the e-ECAP thresholds as there was no statistical difference between the light and deep anesthesia.
      PubDate: Sun, 01 Dec 2019 16:05:03 +000
  • Goal-Directed vs Traditional Approach to Intraoperative Fluid Therapy
           during Open Major Bowel Surgery: Is There a Difference'

    • Abstract: Introduction. Optimum perioperative fluid therapy is important to improve the outcome of the surgical patient. This study prospectively compared goal-directed intraoperative fluid therapy with traditional fluid therapy in general surgical patients undergoing open major bowel surgery. Methodology. Patients between 20 and 70 years of age, either gender, ASA I and II, and scheduled for elective open major bowel surgery were included in the study. Patients who underwent laparoscopic and other surgeries were excluded. After routine induction of general anaesthesia, the patients were randomised to either the control group (traditional fluid therapy), the FloTrac group (based on stroke volume variation), or the PVI group (based on pleth variability index). Fluid input and output, recovery characteristics, and complications were noted. Results. 306 patients, with 102 in each group, were enrolled. Five patients (control (1), FloTrac (2), and PVI (2)) were inoperable and were excluded. Demographic data, ASA PS, anaesthetic technique, duration of surgery, and surgical procedures were comparable. The control group received significantly more crystalloids (3200 ml) than the FloTrac (2000 ml) and PVI groups (1875 ml), whereas infusion of colloids was higher in the FloTrac (400–700 ml) and PVI (200–500 ml) groups than in the control group (0–500 ml). The control group had significantly positive net fluid balance intraoperatively (2500 ml, 9 ml/kg/h) compared to the FloTrac (1515 ml, 5.4 ml/kg/h) and PVI (1420 ml, 6 ml/kg/h) groups. Days to ICU stay, HDU stay, return of bowel movement, oral intake, morbidity, duration of hospital stay, and survival rate were comparable. The total number of complications was not different between the three groups. Anastomotic leaks occurred more often in the Control group than in the others, but the numbers were small. Conclusions. Use of goal-directed fluid management, either with FloTrac or pleth variability index results in a lower volume infusion and lower net fluid balance. However, the complication rate is similar to that of traditional fluid therapy. This trial is registered with CTRI/2018/04/013016.
      PubDate: Fri, 29 Nov 2019 08:05:07 +000
  • Comparison of the Effects of Target-Controlled Infusion of Propofol and
           Sevoflurane as Maintenance of Anesthesia on Hemodynamic Profile in Kidney

    • Abstract: Background. Target-controlled infusion (TCI) propofol and sevoflurane are common agents for general anesthesia, including for kidney transplantation procedure. This study compared the effect of TCI propofol and sevoflurane on intraoperative hemodynamic profile in kidney transplant patients. Methods. A single-blinded prospective study was performed in 46 kidney transplant recipients who were randomized into receiving TCI propofol or sevoflurane as anesthetics maintenance. Hemodynamic parameters such as mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) were measured at baseline before induction, postintubation, first surgical incision, every 15 minutes after the first incision, reperfusion, and 15 minutes after reperfusion. Data were analyzed using unpaired t-test, paired t-test, and general linear model. Results. Intraoperative MAP, CI, SVI, and SVRI changes were similar in both groups ( = 0.480, 0.216, 0.086, and 0.054). In comparison to the baseline value, TCI propofol and sevoflurane groups showed significant reductions of MAP at postintubation (;) and during the first surgical incision (;); significant reduction of CI at postintubation (;) and during the first surgical incision (;); significant reduction of SVI at postintubation (;), during the first surgical incision (;), and 15 minutes after reperfusion (;); and significant increasing of SVRI during the first surgical incision (;). The TCI propofol group showed significantly lower SVRI compared to the sevoflurane group postintubation () and during the first surgical incision ().Conclusion. Intraoperative hemodynamic profile was similar between the TCI propofol and sevoflurane group during kidney transplant surgery. The TCI propofol group had higher CI and SVI but showed significantly lower SVRI as compared to the sevoflurane group. The incidence of postanesthesia agitation, postoperative outcome, and complication were not significantly different between the two groups.
      PubDate: Fri, 29 Nov 2019 04:05:10 +000
  • Anesthesia Practice: Review of Perioperative Management of H-Type
           Tracheoesophageal Fistula

    • Abstract: Tracheoesophageal fistula (TEF) is a rare congenital developmental anomaly, affecting 1 in 2500–3000 live births. The H-type TEF, consisting of a fistula between the trachea and a patent esophagus, is one of the rare anatomic subtypes, accounting for 4% of all TEFs. The presentation and perioperative management of neonates with H-type TEFs and all other TEFs are very similar to each other. Patients present with congenital heart disease and other defects and are prone to recurrent aspirations. A barium esophagogram or computed tomography of the chest is a common means to the diagnosis, and surgical repair is carried out through either a cervical approach or a right thoracotomy. During operation, anesthetic management is focused on preventing positive pressure ventilation through the fistula in an attempt to minimize gastric distension. For patients with H-type TEFs, because of the patent esophagus, symptoms are often less severe and nonspecific, resulting in subtle yet important differences in their diagnostic workup and management. This review will cover the finer details in the diagnosis and perioperative anesthetic management of TEF patients and clarify how H-type TEF distinguishes itself from the other anatomic subtypes.
      PubDate: Sun, 03 Nov 2019 00:09:18 +000
  • Risk Factors for Moderate to Severe Pain during the First 24 Hours after
           Laparoscopic Bariatric Surgery While Receiving Intravenous
           Patient-Controlled Analgesia

    • Abstract: Objective. To investigate the incidence of and risk factors for moderate to severe pain during the first 24 hours after laparoscopic bariatric surgery. Materials and Methods. This retrospective study included morbidly obese patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass at a single institution between June 2016 and July 2018. Demographic, clinical, operative, and postoperative pain data from the postanesthesia care unit (PACU) and ward were analyzed. Intravenous patient-controlled analgesia (IV-PCA) was commenced before PACU discharge. Results. Ninety-seven patients were included. The mean age was 38.60 ± 12.27 years, and the mean BMI was 45.04 ± 8.42 kg/m2, and 69% were female. The incidence of moderate to severe pain was 75%. Moderate to severe pain during the first 24 hours was associated with young age, female sex, postoperative administration of NSAIDs, first pain score greater than 3 on arrival at the PACU, and inadequate pain control at PACU discharge. A multivariate analysis revealed that inadequate pain control at PACU discharge was the only factor independently associated with moderate to severe pain during the first 24 hours postoperatively (). From PACU discharge to the end of postoperative day 3, moderate to severe pain at the end of each 24-hour period was a significant predictor of moderate to severe pain in the subsequent 24-hour period (,, and , respectively). Conclusions. Moderate to severe pain was experienced by 75% of patients undergoing laparoscopic bariatric surgery and receiving IV-PCA after PACU discharge. Inadequate pain control at PACU discharge was the only independent risk factor for moderate to severe pain during the first 24 hours postoperatively.
      PubDate: Thu, 03 Oct 2019 04:05:00 +000
  • Effect of Spinal Anesthesia versus General Anesthesia on Blood Glucose
           Concentration in Patients Undergoing Elective Cesarean Section Surgery: A
           Prospective Comparative Study

    • Abstract: Background. This prospective study compared the blood glucose concentration with spinal anesthesia or general anesthesia in patients undergoing elective cesarean section surgery. Methods. In total, 58 pregnant women who underwent elective cesarean section surgery were included in this prospective comparative study. Group S (n = 35) included patients who chose spinal anesthesia, and group G (n = 23) included patients who chose general anesthesia. The patients were allocated to the groups upon patients’ preference. For the group G, the blood glucose concentration (BGC) was obtained 5 minutes before induction, T1, and 5 minutes after induction T2. For the group S, the BGC was obtained immediately before the injection of the local anesthetic agent T1 and 5 minutes after the complete block T2. For both groups, BGC was measured 5 minutes before the end of surgery T3 and 30 minutes after the end of surgery T4. For BGC measurements, we used a blood glucose monitoring system with a lancet device to prick the finger. Results. There was no statistically significant difference in the mean blood glucose concentration between the groups S and G in T1 (78.3 ± 18.2 vs. 74.3 ± 14.7, ) and T2 (79.2 ± 18.3 vs. 84.9 ± 23.7, ). The mean BGC was statistically significantly higher in group G in comparison to group S in the times 5 minutes before (80.2 ± 18.1 vs. 108.4 ± 16.7, ) and 30 minutes after the end of surgery (80.9 ± 17.7 vs. 121.1 ± 17.4, ).Conclusion. There is a much lower increase in blood glucose concentration under spinal anesthesia than under general anesthesia. It is reasonable to suggest that the blood sugar concentration must be intraoperatively monitored in patients undergoing general anesthesia.
      PubDate: Tue, 01 Oct 2019 01:05:12 +000
  • Dimensional Variations of Left-Sided Double-Lumen Endobronchial Tubes

    • Abstract: Background. Tube size selection is critical in ventilating patients’ lungs using double-lumen endobronchial tubes (DLTs). Little information about relevant parameters is readily available from manufacturers. The aim of this study is to provide reference data for relevant dimensions of conventionally available DLTs. Methods. In this study in a benchmark in vitro setup, several dimensional parameters of four sizes of left-sided double-lumen endobronchial tubes from six different manufacturers were assessed, such as distances and diameters of tube shaft, cuff lengths, and diameters as well the angle at the tip. Results. Endobronchial tubes of ostensibly the same size revealed wide variation in measured parameters between brands from different manufacturers. In some parameters, there was an overlap between different sizes from the same manufacturer, i.e., diameters and distances did not increase with increasing nominal endobronchial tube size. The information about dimensions of endobronchial tubes provided by manufacturers’ leaflets is insufficient. Conclusions. Endobronchial tube size selection carries unnecessary uncertainty because clinically relevant parameters are unknown and vary considerably between different manufacturers.
      PubDate: Tue, 24 Sep 2019 05:05:05 +000
  • Emergency Surgery Mortality (ESM) Score to Predict Mortality and Improve
           Patient Care in Emergency Surgery

    • Abstract: Background. Emergency surgery has poor outcomes with high mortality. Numerous studies have reported the risk factors for postoperative death in order to stratify risk and improve perioperative care; nevertheless, a predictive model based upon these risk factors is lacking. Objective. We aimed to identify the risk factors of postoperative mortality and to construct a new model for predicting mortality and improving patient care. Methods. We included adult patients undergoing emergency surgery at Srinagarind Hospital between January 2012 and December 2014. The patients were randomized: 80% to the Training group for model construction and 20% to the Validation group. Patient data were extracted from medical records and then analyzed using univariate and multivariate logistic regression. Results. We recruited 758 patients, and the mortality rate was 14.5%. The Training group comprised 596 patients, and the Validation group comprised 162. Based upon a multivariate analysis in the Training group, we constructed a model to predict postoperative mortality—an Emergency Surgery Mortality (ESM) score based on the coefficient of each risk factor from the multivariate analysis. The ESM score comprised 7 risk factors, i.e., coagulopathy, ASA class 5, bicarbonate 100/min, systolic blood pressure
      PubDate: Mon, 23 Sep 2019 04:05:01 +000
  • Sevoflurane Alleviates Reperfusion Arrhythmia by Ameliorating TDR and
           MAPD90 in Isolated Rat Hearts after Ischemia-Reperfusion

    • Abstract: Objective. To investigate the effect of sevoflurane on the monophasic action potentials (MAPs) in isolated rat hearts after ischemia-reperfusion. Methods. Twenty-four healthy SD male rats, weighing 280–320 g, were randomly divided into three groups after successful preparation of a Langendorff isolated heart perfusion model with a stabilization period perfusion of 15 min with Krebs–Henseleit (K–H) fluid (n = 8): the control group (group A, continuously perfused with K–H fluid for 105 min), the ischemia-reperfusion group (group B, continuously perfused with K–H fluid for 15 min, and then exposed to 60 min of global ischemia induced by Thomas solution followed by 30 min of reperfusion), and the sevoflurane group (group C, K–H fluid contained 1.0 MAC sevoflurane, and other procedures were same as in group B). Heart rate (HR) and MAPs including time course (MAPD50 or MAPD90) of the epicardium (Epi) and endocardium (Endo) were recorded at the time of balance perfusion for 15 min (T0), continuous perfusion for 15 min (T1), reperfusion for 15 min/continuous perfusion for 105 min (T2), and reperfusion for 30 min/continuous perfusion for 120 min (T3), and the transmural dispersion of repolarization (TDR) was calculated. The incidence of arrhythmia, time for restoration of spontaneous heart beat, and duration of arrhythmia were recorded during the period of reperfusion. Results. HR in group B and group C was lower at T2 and T3 than that in group A, while that in group B was significantly lower than that in group A at T2 and T3, and HR in group C was higher than that in group B at T2 and T3 (). There was no difference of TDR in each group at T0 and T1 (), while TDR in group B was increased at T2 and T3 compared with that in group C and group A (). TDR in group C was decreased compared with that in group B at T2 and T3 (), while there was no such difference between group C and group A (). The time for restoration of spontaneous heart beat and duration of arrhythmia in group C were shorter than those in group B (), while cardiac arrhythmia scores in group B were higher than those in group C (). There was no difference of MAPD50 in each group (). The MAPD90 in group B was much longer than that in other groups at T2 and T3 (), while there was no such difference between group C and group A (). The prolonged MAPD90 at T2 and T3 in group B strikingly differed from that at T0 and T1 (). Nevertheless, there was no such difference in other groups at different time points ().Conclusion. Sevoflurane alleviates reperfusion arrhythmia induced by myocardial ischemia-reperfusion through the shortening of MPAD90 in isolated rat hearts.
      PubDate: Sun, 22 Sep 2019 00:06:35 +000
  • Audit on Current Practice of Rapid Sequence Induction and Intubation of

    • Abstract: Background. In patients who are liable to the risk of pulmonary aspiration, airway control is the primary and first concern for the anesthetists both in emergency and elective surgical procedures. Rapid sequence induction is universally required in any occasion of emergent endotracheal intubation needed for unfasted patients or patients’ fasting status is unknown. Methods. institutional-based prospective observational study was conducted from December 2017 to January 2018 in all elective and emergency adult or pediatric patients with a risk of pulmonary aspiration who were operated under general anesthesia with rapid sequence induction and intubation during the audit period. Result. A total of 35 patients were operated during the study period. Of these, 31 (88.57%) patients were adults and 4 (11.43%) patients were pediatrics. Most of the patients were emergency (29 (82.857%)), and the rest were elective (6 (17.142%)). Conclusion. Most anesthetists were good at preparing all available monitoring and drugs, making sure that IV line is well-functioning, preparing suction with a suction machine, preoxygenation, application of cricoid pressure, and checking the position of the ETT after intubation was performed. Preparing difficult airway equipment during planning of rapid sequence induction and intubation, giving roles and told to proceed their assigned role for the team, attempt to ventilate with a small tidal volume, and routine use of bougie or stylet to increase the chance of success of intubation needed improvement.
      PubDate: Sun, 22 Sep 2019 00:06:33 +000
  • Compuflo®-Assisted Training vs Conventional Training for the
           Identification of the Ligamentum Flavum with an Epidural Simulator: A
           Brief Report

    • Abstract: The ability of recognizing the ligamentum flavum is the first, crucial, important skill to teach novices when they are learning the epidural technique. The aim of this preliminary prospective study was to evaluate whether the Compuflo® Epidural instrument may help inexperienced trainees to better identify the ligamentum flavum during an epidural simulator training session. Compuflo® reduced the total number of attempts to identify the ligamentum flavum and increased three fold the chance to identify it at the first attempt during a simulator-assisted training module, making this identification easier for inexperienced trainees. This trial is registered with NCT03812926.
      PubDate: Thu, 12 Sep 2019 13:05:02 +000
  • Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio
           University Hospital of Lomé in Togo

    • Abstract: Introduction. Severe pediatric traumatic brain injury (pTBI) is a leading cause of disability and death in children worldwide. Children victims of pTBI are admitted to the Sylvanus Olympio University Hospital (SOUH) at the multipurpose Intensive Care Unit (ICU). We aimed in this study to describe the epidemiologic characteristics and outcomes of pTBI patients admitted in this ICU. Patients and Methods. This study was conducted at the ICU of SOUH of Lome. It was a retrospective study based on patients’ records from 0 to 15 years old admitted during the period from 1 January 2012 to 30 June 2018 (5 years and 6 months). Results. We recorded 91 pTBI included in the study. The mean age was 7.7 ± 4.3 years. The male predominated with 67.0%. Road traffic accidents were the most common cause (79.1%), followed by falls (19.8%). The average pediatric Glasgow Coma Scale (pGCS) was 6.6 ± 1.4, with a mean Injury Severity Score (ISS) of 23.1 ± 8.4. The most common brain injuries found in the CT scan were brain edema (72.9%), skull fracture (69.5%), and brain contusion (55.9%). The average duration under mechanical ventilation was 2.1 ± 2.9 days, and the mean ICU stay was 4.9 ± 4.4 days. Overall mortality was 31.9% (29 cases). Factors significantly associated () with death were hypotension (51.7%), anemia (43.1%), hyperthermia (46.7%), GCS  20 (48.9%). Conclusion. pTBI mortality remains high in SOUH ICU. Factors associated with mortality were secondary systemic insults, worse GCS  20.
      PubDate: Thu, 01 Aug 2019 01:05:24 +000
  • Are Anesthesiology Providers Good Guessers' Heart Rate and Oxygen
           Saturation Estimation in a Simulation Setting

    • Abstract: Background. Anesthesia providers may need to interpret the output of vital sign monitors based on auditory cues, in the context of multitasking in the operating room. This study aims to evaluate the ability of different anesthesia providers to estimate heart rate and oxygen saturation in a simulation setting. Methods. Sixty anesthesia providers (residents, nurse anesthetics, and anesthesiologists) were studied. Four scenarios were arranged in a simulation context. Two baseline scenarios with and without waveform visual aid, and two scenarios with variation of heart rate and/or oxygen saturation were used to assess the accuracy of the estimation made by the participants. Results. When the accurate threshold for the heart rate was set at less than 5 beats per minute, the providers only had a correct estimation at two baseline settings with visual aids ( and 0.2237). Anesthesia providers tend to underestimate the heart rate when it increases. Providers failed to accurately estimate oxygen saturation with or without visual aid ( and 0.0105, respectively). Change in recording settings significantly affected the accuracy of heart rate estimation (), and different experience levels affected the estimation accuracy ().Conclusion. The ability of anesthesia providers with different levels of experience to assess baseline and variations of heart rate and oxygen saturation is unsatisfactory, especially when oxygen desaturation and bradycardia coexist, and when the subject has less years of experience.
      PubDate: Sun, 21 Jul 2019 09:05:11 +000
  • Magnitude and Associated Factors of Awareness with Recall under General
           Anesthesia in Amhara Regional State Referral Hospitals, 2018

    • Abstract: Introduction. Awareness with recall of intraoperative events is an infrequent but potentially devastating complication of general anesthesia, with a reported incidence of 0.1-0.2% in low-risk patients. Higher incidence is expected in resource-limited operation room setups and in high-risk patients. Awareness can result in significant distress to patients and long-term psychological consequences, including symptoms associated with posttraumatic stress disorder, anxiety, night mares, night terror, dissatisfaction with surgical service, and sometimes even suicide. Objective. To assess the magnitude and associated factors of awareness with recall under general anesthesia in Amhara regional state referral hospitals. Method. An institution-based cross-sectional study was conducted on 1065 patients who underwent surgery under general anesthesia from January 1 to June 30, 2018. The study participants were selected by systematic random sampling from 4 referral hospitals. The modified Brice questionnaire was used to detect awareness under general anesthesia. Interviewer-administered structured questionnaire and chart review were employed. Data with complete information were entered in to SPSS version 20 computer software. Descriptive statics and bivariate and multivariable analysis were computed. A P-value less than 0.2 was used to select candidate variables for multivariable logistic regression. A P-value less than 0.05 was used to declare statistical significance. Result. 1065 patients were included in the study which makes the response rate of 90.7%. The magnitude of awareness with recall under general anesthesia was found to be 8.2% of which 4.9%, 2.6%, and 0.7% of patients reported hearing voice, pain, and sensation of breathing tube, respectively. Lack of premedication was the only significantly associated factor for awareness with recall under general anesthesia (AOR = 3.014, 95% CI (1.201 to 7.565)). Conclusion and Recommendation. Our study showed higher magnitude of awareness with recall under general anesthesia. Lack of premedication was the only associated factor with awareness with recall under general anesthesia. Anesthetists should give emphasis to prevent the possibility of awareness under general anesthesia by providing premedication. Cohort studies should be done including the consequences of awareness with recall under general anesthesia.
      PubDate: Sun, 07 Jul 2019 08:05:22 +000
  • Anesthesia Workspace Cleanliness and Safety: Implementation of a Novel
           Syringe Bracket Using 3D Printing Techniques

    • Abstract: Purpose. Wide variability persists in the preparation and storage of common anesthetic medications despite the recognition of anesthesia workspace standardization as a national quality improvement priority. Syringe contamination and medication swaps continue to pose significant hazards to patient safety. Methods. We assessed differences in practice related to the availability of commonly prepared anesthetic medications. Using baseline provider surveys (n = 87) and anesthesia workspace audits (n = 80), we designed a custom syringe organization device using 3D printing techniques to serve as a cognitive aid and organizational tool. We iteratively tested and then deployed this device in all 60 operating rooms at a single institution, and then, repeated postintervention surveys (n = 79) and workspace audits (n = 75) one year after introduction. Results. Implementation was associated with significant improvements in provider-reported medication availability during coverage and handoff situations (43.7% versus 76.2% reporting 95% confidence preintervention versus postintervention, ). This was substantiated by audits of the anesthesia workspace which demonstrated reduced variability in the location () and availability () of key medications. Provider confidence in the cleanliness of syringes was also improved (). A high degree of acceptance and compliance with the intervention was reported, with 80.4% of syringes observed to be stored in the device one year after implementation and approximately 95% of respondents reporting positive measures of usability and convenience. Conclusion. Use of a simple organizational device for syringes in the anesthesia workspace has numerous safety benefits. 3D printing offers improvements in adaptability and affordability compared with prior approaches.
      PubDate: Mon, 01 Jul 2019 01:05:10 +000
  • Labor Epidural Analgesia to Cesarean Section Anesthetic Conversion
           Failure: A National Survey

    • Abstract: Background. If conversion of labor epidural analgesia to cesarean delivery anesthesia fails, the anesthesiologist can be confronted with a challenging clinical dilemma. Optimal management of a failed epidural top up continues to be debated in the absence of best practice guidelines. Method. All members of the Obstetric Anaesthetists’ Association in the United Kingdom were emailed an online survey in May 2017. It obtained information on factors influencing the decision to utilize an existing labor epidural for cesarean section and, if epidural top up resulted in no objective sensory block, bilateral T10 sensory block, or unilateral T6 sensory block, factors influencing the management and selection of anesthetic technique. Differences in management options between respondents were compared using the chi-squared test. Results. We received 710 survey questionnaires with an overall response rate of 41%. Most respondents (89%) would consider topping up an existing labor epidural for a category-one cesarean section. In evaluating whether or not to top up an existing labor epidural, the factors influencing decision-making were how effective the epidural had been for labor pain (99%), category of cesarean section (73%), and dermatomal level of blockade (61%). In the setting of a failed epidural top up, the most influential factors determining further anesthetic management were the category of cesarean section (92%), dermatomal level of blockade (78%), and the assessment of maternal airway. Spinal anesthesia was commonly preferred if an epidural top up resulted in no objective sensory block (74%), bilateral T10 sensory block (57%), or unilateral T6 sensory block (45%). If the sensory block level was higher or unilateral, then a lower dose of intrathecal local anesthetic was selected and alternative options such as combined-spinal epidural and general anesthesia were increasingly favored. Discussion. Our survey revealed variations in the clinical management of a failed epidural top up for cesarean delivery, suggesting guidelines to aid decision-making are needed.
      PubDate: Sun, 02 Jun 2019 12:05:33 +000
  • Subparalyzing Doses of Rocuronium Reduce Muscular Endurance without
           Detectable Effect on Single Twitch Height in Awake Subjects

    • Abstract: Purpose. To test the hypothesis that a low-dose rocuronium acts mainly by means of reducing muscular endurance rather than by reducing momentary force. Methods. In a randomized placebo-controlled double-blinded study, eight healthy volunteers were studied in two sets of experiments. In the first set, the subjects made a sustained maximum effort with the dominant hand for 80 seconds while squeezing an electronic handgrip dynamometer at three minutes after intravenous administration of placebo, 0.04 or 0.08 mg/kg rocuronium. Handgrip force at initiation of testing (maximum handgrip force) and after 60 seconds was evaluated. In the second set, the ulnar nerve of the subjects was electrically stimulated every tenth second for at least 10 and a maximum of 30 minutes following the administration of placebo and 0.08 mg/kg rocuronium. Single twitch height of the adductor pollicis muscle was recorded. Results. There was no significant difference in the effect on maximum handgrip force at time 0 between the three different doses of rocuronium. As compared with placebo, handgrip force after 0.08 mg/kg rocuronium was reduced to approximately a third at 60 seconds (214 N (120–278) vs. 69 (30–166); ), whereas only a slight reduction was seen after 0.04 mg/kg (187 (124–256); ). Based on these results, the sustained handgrip force after 0.2 mg/kg at 60 seconds was calculated to be 1.27% (95% CI [0.40, 4.03]) of the maximum force of placebo. No effect on single twitch height after 0.08 mg/kg rocuronium at four minutes after drug administration could be detected. Conclusions. Subparalyzing doses of rocuronium show a distinct effect on muscular endurance as opposed to momentary force. The findings support the hypothesis that low doses of rocuronium act mainly by reducing muscular endurance, thereby facilitating, for example, tracheal intubation.
      PubDate: Thu, 02 May 2019 00:09:27 +000
  • Predictive Values of Preoperative Tests for Difficult Laryngoscopy and
           Intubation in Adult Patients at Tikur Anbessa Specialized Hospital

    • Abstract: Introduction. The significance of difficult or failed tracheal intubation following induction is a well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia, the incidence of difficult tracheal intubation has been estimated at 1.5%–8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally, in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia, there are no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guidelines for preoperative tests. The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia-related morbidity and mortality. Objective. The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1 to March 30, 2016. Study Design. A facility-based cross-sectional study design was used. Result. In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5%, respectively. 33.3% of patients with difficult laryngoscopy were found to be difficult for intubation. Mallampati test, interincisor distance, and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation. We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessment.
      PubDate: Mon, 01 Apr 2019 09:05:49 +000
  • Differentiating False Loss of Resistance from True Loss of Resistance
           While Performing the Epidural Block with the CompuFlo® Epidural

    • Abstract: Background. The occurrence of false losses of resistance may be one of the reasons for inadequate or failed epidural block. A CompuFlo® epidural instrument has been introduced to measure the pressure of human tissues in real time at the orifice of a needle and has been used as a tool to identify the epidural space. The aim of this study was to investigate the sensitivity and the specificity of the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance encountered during the epidural space identification procedure. Method. We performed epidural block with the CompuFlo® epidural instrument in 120 healthy women who requested labor epidural analgesia. The epidural needle was considered to have reached the epidural space when an increase in pressure (accompanied by an increase in the pitch of the audible tone) was followed by a sudden and sustained drop in pressure for more than 5 seconds accompanied by a sudden decrease in the pitch of the audible tone, resulting in the formation of a low and stable pressure plateau. We evaluate the sensitivity, specificity, and positive and negative predictive values of the ability of CompuFlo® recordings to correctly identify the true LOR from the false LOR. Results. The drop in pressure associated with the epidural space identification was significantly greater than that recorded after the false loss of resistance (73% vs 33%) (). The sensitivity was 0.83, and the AUC was 0.82. Discussion. We have confirmed the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance and established its specificity and sensitivity. Conclusion. An easier identification of dubious losses of resistance during the epidural procedure is essential to reduce the number of epidural attempts and/or needle reinsertions with the potential of a reduced risk of accidental dural puncture especially in difficult cases or when the procedure is performed by trainees.
      PubDate: Sun, 03 Feb 2019 00:00:00 +000
  • The Difficult Airway Trolley: A Narrative Review and Practical Guide

    • Abstract: Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.
      PubDate: Sun, 27 Jan 2019 12:05:20 +000
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Heriot-Watt University
Edinburgh, EH14 4AS, UK
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