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Anaesthesia, Pain & Intensive Care
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ISSN (Print) 1607-8322 - ISSN (Online) 2220-5799
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  • Published - Data Science and its Application in Anaesthesiology

    • Authors: Shemila Abbasi, Usama Ahmed, Fauzia Anis Khan
      Abstract: Electronic health records have resulted in improvement in all aspects of health care. Anaesthesia Information Management System is a specialized form of electronic health record system that records the events taking place during the perioperative phase such as procedures, physiologic changes and medications administration. Based on anaesthetic data many databases have been developed internationally for quality improvement in anaesthesiology and to know the research outcomes. At an individual clinical level, big anaesthesia data is not yet present, unless waveforms and continuous numerical data of intraoperative physiologic variables is recorded. Though the initiative for big data has taken up by some health care institutions in the health data management but our country is still far behind in this field.  
      PubDate: 2022-02-14
      DOI: 10.35975/apic.v26i1.1742
      Issue No: Vol. 26, No. 1 (2022)
       
  • Data science and its application in anesthesiology

    • Authors: Shemila Abbasi, Usama Ahmed, Fauzia Anis Khan
      Pages: 1 - 3
      Abstract: Electronic health records have brought about vast improvement in all aspects of healthcare. ‘Anesthesia Information Management System’ is a specialized form of electronic health record system that is used to record all of the events taking place during the perioperative period, such as clinical procedures performed, physiologic changes that may happen and the medications administered. Based on anesthetic data many databases have been developed internationally for quality improvement in anesthesiology and to know the research outcomes. At an individual clinical level, big anesthesia data is not yet present, unless waveforms and continuous numerical data of intraoperative physiologic variables is recorded. Though the initiative for big data has taken up by some healthcare institutions in the health data management but our country is still far behind in this field. This editorial is aimed to highlight the necessity of this system and to draw the attention of the concerned authorities to plan provision of electronic record keeping in operating rooms. Key words: Electronic Health Records; Data; Data Science; Anesthesiology Citation: Abbasi S, Ahmed U, Khan FA. Data science and its application in anesthesiology. Anaesth. pain intensive care 2021;26(1):1–3;
      DOI : 10.35975/apic.v26i1.1757 Received: January 11, 2022, Accepted: January 14, 2022
      PubDate: 2022-02-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Anesthesia without opioids

    • Authors: Mohsin Nazir Butt, Asma Faraz, Maheen Fazal
      Pages: 4 - 7
      Abstract: Summary Opium was the first opioids with sedative and analgesic effects, so was readily adopted by the surgical doctors to be used during surgeries. Later on its natural alkaloid, morphine, was extensively used, till synthetic alkaloids were introduced in the clinical practice. Now many non-narcotic analgesic drugs have been synthesized and proven to be devoid of serious side effects, commonly associated with the opioid use. There have been some staunch advocates of non-narcotic based anesthesia, who claim that the side effects of the opioids outweigh their benefits in the anesthesia. This editorial throws some light on the current and the future trends in analgesic use in anesthesia. Key words: Opioids; Analgesics; Non-opioid analgesics; Perioperative pain; Side effects Citation: Butt MN, Faraz A, Fazal M. Anesthesia without opioids (Editorial). Anaesth. pain intensive care 2021;26(1):4–7;
      DOI : 10.35975/apic.v26i1.1758 Received: January 10, 2022, Accepted: January 12, 2022
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Effect of three different doses of intrathecal dexmedetomidine on
           subarachnoid block: a prospective randomized double-blind trial

    • Authors: Ashita Mowar, Vishwadeep Singh, Akhilesh Pahade, Geeta Karki
      Pages: 8 - 13
      Abstract: Background: Dexmedetomidine has increasingly been used in regional anesthesia as an adjuvant, but there is still no consensus on the optimum dose when it is used intrathecally. We conducted this study to elucidate the dose-response relation between three different doses of intrathecal dexmedetomidine (2.5, 5, or 10 µg) as an adjuvant to 0.5% hyperbaric bupivacaine in patients undergoing elective lower abdominal and lower limb surgeries. Methodology: 90 patients, aged 18-60 y, were randomized into three groups of 30 patients each. Group A received 0.5% hyperbaric bupivacaine 12.5 mg (2.5 ml) with 2.5 µg dexmedetomidine, Group B received 5 µg dexmedetomidine with bupivacaine, and Group C received 10 µg dexmedetomidine with bupivacaine. Duration of the spinal sensory blockade (primary outcome), onset of the blockade, time to rescue analgesia, level of sedation, duration of motor blockade, comparison of hemodynamic variables and complications, if any were assessed. Results: There was a significant dose dependent prolongation of sensory block; Group A - 250.67 ± 51.39, Group B - 286 ± 52.76, and Group C - 351.00 ± 47.00 min; (p < 0.001), motor block; Group A - 255.53 ± 44.25, Group B - 312 ± 29.64, and Group C - 361.4 ± 16.14 min (p < 0.001). Time to two segment regression was 132.33 ± 48.29, 148.77 ± 48.89, 171.57 ± 25.46 min (p = 0.002) and time for rescue analgesia was 351.33 ± 101.19, 472.00 ± 24.41, 738.00 ± 67.79 min (p < 0.001). VAS was significantly low in Group C (p < 0.05). Intergroup hemodynamic parameters were comparable (p > 0.05) without any appreciable side effects. Conclusion: Spinal dexmedetomidine increases the sensory and motor block durations as well as time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner, when used with hyperbaric bupivacaine. Abbreviations: IT - Intrathecal; ITD - Intrathecal Dexmedetomidine; SAB - Subarachnoid Block; VAS - Visual Analogue Scale; BMI - Body Mass Index; NIBP - Non-Invasive Blood Pressure; RSS - Ramsay Sedation Score; TSSR - Two segment sensory regression; ANOVA - Analysis of Variance; OSB - Onset of sensory block, TSSRT - Two segment sensory regression time; Duration of sensory blockade; OMB - Onset of motor block; DMB - Duration of motor blockade Key words: Dexmedetomidine; Bupivacaine; Anesthesia, Spinal; Dexmedetomidine; Post-operative analgesia Citation: Mowar A, Singh V, Pahade A, Karki G. Effect of three different doses of intrathecal dexmedetomidine on subarachnoid block: a prospective randomized double-blind trial. Anaesth. pain intensive care 2021;26(1):8–13;
      DOI : 10.35975/apic.v26i1.1759 Received: July 24, 2021, Reviewed: November 18, 2021, Accepted: November 28, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Bispectral index monitoring in spinal anesthesia with sedation can prevent
           dexmedetomidine related bradycardia: a randomized clinical trial

    • Authors: Jiwook Kim, Hui Young Kim, Minsu Yun, Jeongyeop Lee, Joo-Duck Kim, Donghee Kang
      Pages: 14 - 19
      Abstract: Background: An unintentional large dose of dexmedetomidine during sedation can lead to increased side effects such as bradycardia and hypotension. We investigated whether the frequency of bradycardia in patients undergoing surgery under spinal anesthesia and sedation with dexmedetomidine was effected if bispectral index (BIS) was used to monitor the sedation. Methodology: Fifty patients between 20 and 60 y of age, who underwent spinal anesthesia, were included in this study. The patients were divided into two groups (control and BIS groups). Patients in the control group were administered a loading dose of 1 μg/kg dexmedetomidine for the first 10 min without BIS monitoring, followed by a maintenance dose of 0.2 μg/kg/h. Patients in the BIS group received a loading dose of 1 μg/kg dexmedetomidine for the first 10 min. The maintenance dose in this group was administered at the discretion of the anesthesiologist to maintain the BIS score between 50 and 70. The baseline heart rate (HR), lowest HR, and the difference between baseline and the lowest HR were calculated. Results: The baseline HR was 74.4 ± 11.0 beats per minute (bpm) and 80.9 ± 16.0 bpm, in the control and BIS groups respectively (p = 0.098). The difference between the baseline and lowest HR in the control and BIS groups was 19.4 ± 7.6 bpm and 25.5 ± 8.8 bpm, respectively (p = 0.011). Low baseline HR was positively correlated with a reduced lowest HR. Conclusions: The frequency of bradycardia during sedation with dexmedetomidine decreased with BIS monitoring. Patients with a low baseline HR were more likely to develop bradycardia during sedation with dexmedetomidine. Therefore, BIS monitoring may be helpful in patients with low baseline HR. Key words: Bispectral index monitor; Dexmedetomidine; heart rate; spinal anesthesia Citation: Kim J, Kim HY, Yun M, Lee J, Kim JD, Kang D. Bispectral index monitoring during sedation with dexmedetomidine in spinal anesthesia prevents bradycardia: a randomized clinical trial. Anaesth. pain intensive care 2021;26(1):14-19 ;
      DOI : 10.35975/apic.v26i1.1760
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Effect of retrograde autologous priming on lactate and hemoglobin levels
           of adult patients undergoing coronary artery bypass grafting

    • Authors: Mehwish Naseer, Rehana Feroze, Muhammad Adnan Akram, Fakhar -e- Fayaz
      Pages: 20 - 24
      Abstract: Background:   Reduced hemoglobin, excessive transfusions and raised lactate levels are important determinants of patient outcome after cardiopulmonary bypass. Many strategies have been studied for optimum management of these parameters. In this study, we evaluated the impact of retrograde autologous priming (RAP) method on hemoglobin and lactate levels in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass. Methodology: This prospective randomized controlled trial was conducted at Army Cardiac Centre, CMH, Lahore, from January 01, 2021 to June 30, 2021. After approval of institutional ethical committee and taking informed consent from patients, 272 patients undergoing CABG were enrolled. Patients with ages less than 18 y, LVEF ≤ 20%, emergency operations, repeat operations, valvular or combined procedures, recent myocardial infarction, with preoperative lactate levels of more than 2 mmol/L and Hb of less than 9 gm/dL and other preoperative systemic diseases or infection were excluded.  Patients were divided into two groups. Group A received conventional priming of bypass circuit with ringer lactate, and Group B received RAP with patient’s own blood. Hb and lactate levels were measured in arterial blood gases before induction and upon weaning from bypass. Results: The demographic features of both groups were identical, Group A patients had significantly high levels of lactate (3.76 ± 0.81 vs. 2.64 ± 0.47 mmol/L, P < 0.01). Hb levels of patients in RAP (RAP) (Group B) were significantly better (9 ± 0.31 vs. 7.9 ± 0.39 gm/dL, P < 0.01) than Group A. Conclusion: Our study concludes that when compared with crystalloid priming, retrograde autologous priming technique is associated with reduced lactate levels and better hemoglobin levels after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting. Abbreviations: CABG - Coronary artery bypass grafting; CPB - cardiopulmonary bypass; LVEF – Left ventricular ejection fraction; Hb – Hemoglobin; RAP – Retrograde autologous priming; FFP - Fresh frozen plasma; Key words: cardiopulmonary bypass; coronary artery bypass grafting; lactate levels, retrograde autologous priming. Citation: Naseer M, Feroze R, Akram MA, Fakhar-e-Fayaz. Effect of retrograde autologous priming on lactate and hemoglobin levels of adult patients undergoing coronary artery bypass grafting. Anaesth. pain intensive care 2022;26(1):20–24  
      DOI : 10.35975/apic.v26i1.1761 Received: October 4, 2021, Reviewed: November 14, 2021,, Accepted: January 19, 2022
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Ultrasound-guided interscalene block is effective for anesthesia and
           postoperative analgesia for clavicle fracture surgery

    • Authors: Dedi Susila, Ristiawan Muji Laksono
      Pages: 25 - 30
      Abstract: Background & Objective: General anesthesia is commonly used during clavicular fracture surgery; however, it has been associated with hemodynamic fluctuations, airway and respiratory problems, stress response, and postoperative nausea and vomiting. We assessed the effectiveness and side effects of ultrasound-guided interscalene block when used for anesthesia and postoperative analgesia for clavicle fracture surgery. Methodology: This study was conducted on 48 patients who were planned for clavicle fracture surgery. Patients were given premedication with midazolam 0.05 mg/kg and pethidine 0.5-1 mg/kg intramuscularly. Patients received ultrasound-guided interscalene block using nerve stimulator and 0.5% ropivacaine 30 ml or bupivacaine 0.375%. Postoperatively, almost all patients received non-steroidal anti-inflammatory drugs (NSAIDs) (COX–1 or COX–2). Postoperative pain was evaluated using a visual analog scale (VAS) at 12, 24, 36, and 48 h postoperatively. Patients received a rescue dose of intravenous fentanyl when the VAS > 4. Block was successful if the surgery was completed without shifting to general anesthesia. The data was analyzed using the T-test and Man Whitney-test using SPSS 20. Result: 95.83% of patients received a successful block. The mean pre-operative VAS was 3.48 ± 1.27 and significantly decreased in the post-operative period; 1.48 ± 0.77 (12 h post-op), 1.79 ± 1.05 (24 h post-op), 1.21 ± 0.41 (36 h postop), and 1.04 ± 0.20 (48 h postoperative) (p=0.000). The preoperative and postoperative mean arterial pressure (MAP) and pulse rate of the patients remained stable. There was no incidence of nausea, vomiting, or other complications. Conclusion: Ultrasound-guided interscalene block is effective and safe as an anesthetic and for postoperative analgesia in clavicle fracture surgery. Key words: Clavicular fracture; Interscalene block; Analgesia; Anesthesia Cittion: Susila D, Laksono RM. Ultrasound-guided interscalene block is effective for anesthesia and postoperative analgesia for clavicle fracture surgery. Anaesth. pain intensive care 2021;26(1):25–30
      DOI : 10.35975/apic.v26i1.1762 Received: May 6, 2921, Reviewed: November 5, 2021, Accepted: December 21, 2021                                                 
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Comparing the effectiveness of static stretching and proprioceptive
           neuromuscular facilitation stretching in treating delayed onset muscle
           soreness in calf muscles of runners

    • Authors: M. Ammar Ahmad Sohail, Ramesha Tahir, Ayesha Maqbool, Sana Hanif, Osama Saeed
      Pages: 31 - 38
      Abstract: Objectives: To evaluate the comparative effectiveness of proprioceptive neuromuscular facilitation (PNF) and static stretching in relieving pain, increasing range of motion and improving functional disability in runners suffering from calf muscle delayed onset muscle soreness (DOMS). Methodology: In this randomized controlled trial a sample size of 48 patients was taken from various gymnasiums of Faisalabad which were randomly allocated into 3 groups. Group A (n=16) received static stretching, Group B (n=16) received PNF stretching and Group C (n=16) received no intervention being the passive control group. Patients’ pain, range of motion (ROM) and lower extremity functional scale (LEFS) were assessed every 24 h after onset of DOMS for 5 days. Results: No significant difference of age was observed between all groups. Significant improvement was demonstrated in all outcome measures across 5 days of treatment in subjects of all 3 groups with p < 0.05 by using Repeated Measures analysis of variance (ANOVA). Results of one–way ANOVA demonstrated significant improvement in all outcome measures including pain, range of motion and lower extremity functional scale. But most significant improvement was observed in the PNF group. Conclusion: PNF stretching has proved to be relatively more effective than static stretching in reducing pain and improving range of motion and lower extremity functional scale scores in runners suffering from calf muscle DOMS. Abbreviations: PNF - proprioceptive neuromuscular facilitation; DOMS - delayed onset muscle soreness; ROM - range of motion; LEFS - lower extremity functional scale; OTS - overtraining syndrome; EAMS - exercise associated muscle cramp; EIMD - exercise induced muscle damage; NPRS - numerical pain rating scale; HSD - "honestly significant difference”; GTO - Golgi Tendon Organs Key words: Muscle soreness; Myalgia; Muscular cramp; Proprioceptive neuromuscular facilitation; PNF; Stretching; Muscle stretching exercise; Static active stretching Citation: Sohail MAA, Tahir R, Maqbool A, Hanif S, Saeed O. Comparing the effectiveness of static stretching and proprioceptive neuromuscular facilitation stretching in treating delayed onset muscle soreness in calf muscles of runners. Anaesth. pain intensive care 2021;26(1):31-38.
      DOI : 10.35975/apic.v26i1.1763 Received: February 20, 2021, Reviewed: November 20, 2021, Accepted: November 22, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Comparison of intrathecal fentanyl and buprenorphine as adjuvants to
           bupivacaine in gynecological surgery

    • Authors: Yashpal Singh, Adarsh Kumar Yadav, Vijeta Bajpai, Priyanka Diwedi, Shekhar Verma, Ravi Kumar Verma
      Pages: 39 - 43
      Abstract: Background & Objective: Hyperbaric bupivacaine is the most commonly used local anesthetic for spinal anesthesia, alone or in combination with various adjuvants. Opioids are frequently used for their rapid onset and intense block characteristics. Fentanyl is the preferred intrathecal opioids with rapid onset of action but has a shorter duration of action. Buprenorphine is a mixed agonist-antagonist with high affinity at both mu and kappa opioid receptors. We compared administration of buprenorphine with fentanyl as adjuvants with intrathecal hyperbaric bupivacaine in gynecological surgeries. Methodology: After Institutional Ethical Committee approval and written informed consent, 60 patients aged 18–65 y, scheduled for lower abdominal gynecological surgery, were divided into two equal groups; Group F to receive 0.5% hyperbaric bupivacaine 2.5 ml with fentanyl 25 µg intrathecal and Group B to receive 0.5% hyperbaric bupivacaine 2.5 ml with buprenorphine 75 µg intrathecal. Block characteristics and associated side effects were compared between two groups. The data was analyzed using Chi square test and Fisher’s exact test. For comparing two group of mean, independent student’s t test was used. P-value < 0.05 was considered as statistically significant. Results: The mean onset of sensory and motor block was significantly earlier in Group F than Group B (p < 0.001). Mean duration of sensory block was significantly prolonged in Group B compared to Group F (p < 0.05). Whereas, the duration of motor was comparable in both of the groups (p > 0.05). Duration of analgesia was significantly prolonged in Group B than Group F (p < 0.001). Conclusion: We conclude that when a longer duration of postoperative pain relief is needed, buprenorphine can be a suitable drug to be used with intrathecal hyperbaric bupivacaine for gynecological surgeries because of prolonged duration of action. Key words: Spinal anesthesia; Fentanyl; Buprenorphine; Bupivacaine Citation: Singh Y, Yadav AK, Vijeta Bajpai, Diwedi P, Verma S, Verma RK. Comparison of intrathecal fentanyl and buprenorphine as adjuvants to bupivacaine in gynecological surgery. Anaesth. pain intensive care 2021;26(1):39-43.
      DOI : 10.35975/apic.v26i1.1764
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Effect of lidocaine infusion compared to dexmedetomidine infusion on
           proinflammatory cytokines and stress response in pelvi–abdominal cancer
           surgeries: a randomized clinical trial

    • Authors: Mohamed Mahmoud Hassan, Emad Gerges Saleh, Norma Osama Abdalla, Noha Hassan Radwan, Ekramy Mansour Abdelghfar
      Pages: 44 - 52
      Abstract: Background & Objectives: Stress response to extensive surgeries in cancer patients results in an imbalance between the pro-inflammatory and anti-inflammatory cytokines, besides activating an inflammatory cascade. We investigated the comparative effects of intravenous infusion of dexmedetomidine and lidocaine on proinflammatory cytokines and the stress reaction. Methodology: A prospective randomized double blind trial was performed in National Cancer Institute. 54 patients scheduled for pelvi–abdominal cancer surgery under general anesthesia were randomly allocated to three equal groups. Lidocaine group: patients received 1.5 mg/kg loading dose of lidocaine followed by 1.5 mg/kg/h infusion; Dexmedetomidine group: received a loading dose of dexmedetomidine 1 µg/kg followed by infusion of 0.5 µg/kg/h; or Saline group: received 50 ml of normal saline followed by infusion at a rate of 10 ml/h till the end of the surgery. The primary outcome was a postoperative target level of IL–6 after 24 h. Results: Immediate and 24 h postoperative IL–6 and TNFα were significantly lower in both dexmedetomidine and lidocaine groups compared to the control group (P < 0.001). Dexmedetomidine group had a significantly lower IL–6 and TNFα levels compared to lidocaine group at immediate postoperative and 24 h postoperative period (P < 0.001). Dexmedetomidine and lidocaine groups had a significantly lower lactate and insulin levels compared to the control group immediately postoperatively as well as 24 h postoperatively (P < 0.001). The dexmedetomidine group had a significantly lower lactate levels compared to the lidocaine group immediately postoperatively only. The lidocaine group had lower insulin level than the control group regarding immediate postoperative period only. Conclusion: Intraoperative infusion of dexmedetomidine or lidocaine, both attenuate the postoperative levels of proinflammatory cytokines and stress response in patients undergoing pelvi–abdominal cancer surgeries. Clinical trial registration: The study was registered at clinicaltrials.gov (NCT 04148599). Key words: Lidocaine; Dexmedetomidine; Interleukins; Tumor necrosis factor-α; Stress response; Pelvi–abdominal cancer; Surgery Abbreviations: TNF - Tumor necrosis factor; IL – Interleukins; Citation: Hassan MM, Saleh RG, Abdalla NO, Radwan NH, Abdelghfar EM. Effect of lidocaine infusion compared to dexmedetomidine infusion on proinflammatory cytokines and stress response in pelvi–abdominal cancer surgeries: a randomized clinical trial. Anaesth. pain intensive care 2021;26 (1):44-52.
      DOI : 10.35975/apic.v26i1.1765 Received: February 15, 2021, Reviewed: December 02, 2021, Accepted: December 05, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Prognostic significance of non-thyroidal illness syndrome in sepsis and
           septic shock cases: a systematic review and meta-analysis

    • Authors: Rio Wironegoro, Nabila Ananda Kloping, Andro Pramana Witarto, David Nugraha, Niwanda Yogiswara, Kevin Luke, Yudhistira Pradnyan Kloping, Maulydia Maulydia, Soebagijo Adi
      Pages: 54 - 62
      Abstract: Background: This study aimed to assess non-thyroidal illness syndrome (NTIS) as a prognostic determinant in patients with sepsis, severe sepsis, and septic shock by evaluating thyroid hormone (TH) levels. Methodology: A systematic search was performed through electronic databases including PubMed, Embase, Scopus, and Medline. Following medical subject headings (MeSH) and free-text terms: "euthyroid sick syndrome" or "Euthyroid Sick Syndromes" or "non–thyroidal illness syndrome" or "non–thyroidal illness syndrome" or "sick euthyroid syndrome" or "low T3 syndrome" or "low tri-iodothyronine syndrome" AND "sepsis" or "septic shock" or "systemic inflammatory response syndrome" or "septicemia" or "bacteremia". Boolean operators’ combinations were applied to broaden and narrow the search results. Investigators independently reviewed the search results. For the purpose of the meta-analysis each thyroid hormone level was converted into the same unit: nmol/L for T3, T4 and rT3; μIU/mL for TSH; and pmol/L for fT3 and fT4. Statistical analysis was performed using Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC. Results: A total of 843 patients from 9 studies were included in this analysis. In septic patients, the lowest effect size of thyroid function parameter was TSH (g = 2.05; 95% CI = 1.56-2.54), while T3, fT3, and fT4 had the lowest effect size in severe septic patients (g [95%CI]: 0.83 [0.22-1.44]; 1.92 [0.57-3.27]; 1.00 [0.87-1.13]). Patients with septic shock had the highest effect size of TSH (g = 2.08; 95% CI = 1.54-2.61) and fT4 (g = 9.26; 95% CI = 0.98-17.53). Meanwhile, the lowest was T4 (g = 65.60; 95% CI = 64.63-66.57) and rT3 (g = 0.29; 95% CI = 0.24-0.34). A lower effect size of T3 (g = 0.83; 95% CI = 0.76-0.91), T4 (g = 59.48; 95% CI = 57.92-61.04), fT3 (g = 2.25; 95% CI = 1.83-2.66), and fT4 (g = 9.19; 95% CI = 1.56-16.81) were found in non-survivor groups. Conclusion: Thyroid hormone levels differ according to the severity of sepsis in septic patients. Non-thyroidal illness syndrome is a prognostic factor in septic patients and is associated with the risk of the mortality. Abbreviations: ESS - Euthyroid Sick Syndrome; NTIS - Non-Thyroidal Illness Syndrome; Tg - Thyroglobulin Key words: Non-thyroidal illness syndrome; Euthyroid sick syndrome; Sepsis; Septic shock; Prognosis Citation: Wironegoro R, Kloping NA, Witarto AP, Nugraha D, Yogiswara N, Luke K, KlopingYP, Maulydia M, Adi S. Prognostic significance of non-thyroidal illness syndrome in sepsis and septic shock cases: a systematic review and meta-analysis. Anaesth. pain intensive care 2021;26(1):54-62.
      DOI : 10.35975/apic.v26i1.1768 Received: July 16, 2021, Reviewed: December 15, 2021, Accepted: December 28, 2021
      PubDate: 2022-07-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Safety and efficacy of LMA Supreme™ vs. LMA ProSeal™ for ambulatory
           surgeries in adult patients

    • Authors: Amanjot Singh, Jaskirat Kaur, Sarvjeet Kaur, Kewal Krishan Gupta
      Pages: 63 - 68
      Abstract: Background & objectives: The laryngeal mask airway Supreme™ (LMA-S) is a new, single-use, supraglottic device that combines the functionality of the ProSeal™ and Fastrach™ airways. Till now, there have been conflicting results regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme™ vs. the LMA ProSeal™, which is the major determinant of effective ventilation and airway protection during LMA use. We compared the safety and efficacy of the LMA ProSeal™ vs. the LMA Supreme™ in ambulatory surgeries. Methodology: In this prospective, comparative trial, eighty adult patients undergoing elective surgery, were randomly allocated to one of the two groups: Group LMA–P (LMA ProSeal™ group) and Group LMA–S (LMA Supreme™ group) of 40 patients each. OLP, insertion times, number of insertion attempts, ease of insertion and pharyngolaryngeal morbidity were assessed. Statistical analysis was performed using SPSS version 21.0 software using Student’s t-test and Chi-square test. P < 0.05 was considered to be statistically significant. Results: Oropharyngeal leak pressure in Group LMA–P (26.65 ± 1.59 cmH2O) was comparable to Group LMA–S (26.08 ± 1.67 cmH2O) and both provided adequate seal and effective ventilation. The mean effective airway time was significantly less in Group LMA–S as compared to Group LMA–P (14.80 ± 1.24 sec and 17.80 ± 1.47 sec) respectively. Mean number of successful insertion attempts, hemodynamic response and pharyngolaryngeal morbidity were comparable in both the groups. Conclusion: Both LMA Supreme™ and LMA ProSeal™ are equally efficacious and safe for maintaining airway and ventilation in paralyzed patients. However, LMA Supreme™ is easier to insert with shorter effective airway time than LMA ProSeal™. Abbreviations: SAD - Supraglottic airway device; ETI - Endotracheal intubation; LMA - Laryngeal mask airways; PPV - Positive pressure ventilation; OLP - oropharyngeal leak pressure Key words: LMA ProSeal™, LMA Supreme™, Oropharyngeal leak pressure; Airway; Aieway management Citation: Singh A, Kaur J, Kaur S, Gupta KK. Safety and efficacy of LMA Supreme™ vs. LMA ProSeal™ for ambulatory surgeries in adult patients. Anaesth. pain intensive care 2021;26(1):63-68.
      DOI : 10.35975/apic.v26i1.1769 Received: June 02, 2021, Reviewed: December 13, 2021, Accepted: December 15, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • An online study of knowledge and practices of local anesthetic systemic
           toxicity among doctors in Sri Lanka

    • Authors: B. M. Munasinghe, Nishanthan Subramaniam, Nimalan Srisothinathan, B. D. W. Jayamanne
      Pages: 69 - 74
      Abstract: Background: Inadvertent over-dosage or intravascular injections may still lead to systemic toxicity. Local anesthetic systemic toxicity (LAST) could be potentially life threatening. This study focused on the current knowledge and practices in use of LA by the doctors in Sri Lanka and their ability to detect and manage an event of LAST. Methodology: A descriptive cross-sectional study was conducted among doctors in Sri Lanka using an online self-administered questionnaire based on AAGBI guidelines (2010). Descriptive statistics were analyzed by cross-tabulations and presented as numbers and percentages using IBM-SPSS 25. Results: The response rate was 60% out of 600 doctors. Majority were males (58%) while 45% of the respondents were anesthetists. Ultrasound was used by 47.4% during specific LA use. The majority (74%) considered total body weight for dose calculations. Around 50% of the respondents identified bupivacaine as the most cardiotoxic. The majority (77%) utilized some form of monitoring and were knowledgeable on identification, prevention and initial management of LAST. Approximately 45% identified Intralipid (ILE) as the definitive treatment of LAST, out of which, 66.8% knew the correct dose, 77.2% and 26.5%, the availability and the location of the stored drug, respectively. Conclusion: The basic knowledge about LAST was satisfactory among the respondents. A statistically significant difference on knowledge on maximum safe doses of LA, ILE in established LAST, its dosage and the availability was identified between anesthetists and non-anesthesia doctors; and postgraduate trainees and the rest of the doctors. Overall, significant lapses were noted with regard to the use of total body weight for dose calculations, use of ultrasound during LA administration and dosage, availability and storage of the definitive therapy and ILE. Abbreviations: LA - Local anesthetics; LAST - Local anesthetic systemic toxicity; ILE - Intralipid Key words: Local Anesthetic Systemic Toxicity; LAST, cardiac toxicity, Intralipid Citation: Munasinghe BM, Subramaniam N, Srisothinathan N, Jayamanne BDW. An online study of knowledge and practices of local anesthetic systemic toxicity among doctors in Sri Lanka. Anaesth. pain intensive care 2022;26(1):69-74.
      DOI : 10.35975/apic.v26i1.1770 Received: August 27, 2021, Reviewed: October 05, 2021, Accepted: October 10, 2021
      PubDate: 2022-02-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • A randomized controlled trial to study the effect of a pediatric
           anesthesia comic information leaflet on preoperative anxiety in children

    • Authors: Malavika M. Kulkarni, Shwetha Pradeep, Madhu Rao, Muralidhar M. Kulkarni
      Pages: 75 - 80
      Abstract: Background & Objective: Preoperative anxiety among children may at times be very cumbersome for the anesthesiologist, as an anxious child cannot be expected to be very cooperative. Anxiety may interfere into vascular excess and smooth induction of anesthesia. This study was conducted to assess the efficacy of ‘pediatric anesthesia comic information’ leaflet in reducing preoperative anxiety and to obtain parents feedback on its utility. Methodology: It was a prospective single blinded randomized controlled trial among 150 children, aged 6-12 y, undergoing elective surgery in a tertiary-care hospital. Test group (Group T) was given a comic leaflet along with oral information while control group (Group C) received only oral information. Preoperative anxiety was measured using Modified Yale Preoperative Anxiety Scale (m-YPAS) at three time intervals along with feedback from parents on the comic’s utility. Data was analyzed using SPSS version 21.0 with Chi-square, independent t and Mann Whitney tests applied to interpret the results. Results: Pre-operative anxiety on the day prior to surgery (T1) was 25.75 ± 5.52 and 26.61 ± 7.77 compared to baseline (T0) score of 25.8 ± 6.1 and 26.6 ± 8.0 in group T and C respectively. The mean scores in the holding area (T2) was 38.87 ± 14.20 and 41.35 ± 16.40 in Group T and C respectively. The p value of change in the preoperative anxiety scores T0-T1 was 0.2, and T0-T2 was 0.24 with no significant decrease in preoperative anxiety in intervention compared to the control group (p > 0.05). Conclusion: Our results show that comic leaflet, given pre-operatively in addition to standard oral information had no additional effect on reducing anxiety in children undergoing surgery. However, the parents of the study subjects found the comic leaflet to be informative and it needs to be explored further in future research. Key words: Anesthesia; Preoperative anxiety; Pediatrics; Surgery; Comic leaflet Citation: Kulkarni MM, Pradeep S, Rao M, Kulkarni MM. A randomized controlled trial to study the effect of a pediatric anesthesia comic information leaflet on preoperative anxiety in children. Anaesth. pain intensive care 2021;26(1):75-80.
      DOI : 10.35975/apic.v26i1.1771 Received: June 27, 2021, Reviewed: September 28, 2021, Accepted: November 17, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • A comparative randomized study of awareness during two anesthetic
           induction techniques in old aged patients using isolated forearm technique
           

    • Authors: Tamer Hamed Ibrahim, Ahmed H. Ayoub, Ibrahim Mohamed Ibrahim, Mohamed Abdulmohsen Abdulnaiem Ismaiel, Raham Hasan Mostafa
      Pages: 81 - 88
      Abstract: Background & Objective: Awareness under anesthesia is defined as intraoperative consciousness and/or postoperative recall of surgical events. The isolated forearm technique (IFT) is a technique that has the ability to assess consciousness of the external world through a verbal command during general anesthesia. It provides live information about the presence of consciousness. We compared inhalational induction technique versus intravenous induction technique regarding awareness during laryngoscopy and intubation in elderly patients. Design: A prospective, randomized trial Methodology: A total of 50 patients scheduled for elective surgery under general anesthesia; aged 60 to 80 years were recruited. Patients were randomized into either Group A (inhalational induction group) or Group B (total intravenous induction group). Awareness reaction using IFT technique was observed during laryngoscopy and intubation phase to identify awareness incidence. A patient was considered a responder if IFT score > 2. Results: At laryngoscopy and intubation phase, 32% of cases had an awareness reaction in intravenous induction group (Group B): While in the inhalational induction group (Group A), only 8% of cases had an awareness reaction. Additionally, none of the patients, suffered from postoperative explicit recall as detected by modified Brice questionnaire (MBQ). Conclusions: On the basis of the results of our study, we conclude that intravenous induction of general anesthesia may subject old aged patients to a higher incidence of awareness when compared to inhalational induction technique. Trial Registration: NCT05019560 Abbreviations: TIVA - Total intravenous anesthesia; IFT - Isolated forearm technique; MBQ - Modified Brice questionnaire; BISTM -Bispectral Index™; ETAC - End-tidal anesthetic concentration; MAC – Minimum alveolar concentration Key words: Awareness; The modified Brice questionnaire; Elderly patients; Isolated forearm technique; Sevoflurane; TIVA Citation: Ibrahim TH, Ayoub AH, Ibrahim IM, Ismaiel MAA, Mostafa RH. A comparative randomized study of awareness during two anesthetic induction techniques in old aged patients using isolated forearm technique. Anaesth. pain intensive care 2022;26(1):81-88.
      DOI : 10.35975/apic.v26i1.1772 Received: November 14, 2021, Reviewed: December 18, 2021, Accepted: December 22, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Remote monitoring of COVID–19 patients using home pulse oximetry and
           virtual platform: an observational study

    • Authors: AKM Akhtaruzzaman, Md Mostafa Kamal, Monira Parveen, Marziur Rabbi, Rajib Dhali, Md Shafiqul Islam, Dilip Kumar Bhowmick
      Pages: 89 - 95
      Abstract: Background: The coronavirus disease (COVID–19) is a global health problem with ever-increasing attributed deaths. Patients with COVID–19 may deteriorate rapidly, and their continuous monitoring is necessary. Monitoring and providing care beyond the traditional face-to-face model is a new chapter in the history of medicine. It consists of remote monitoring and management using virtual platform as a critical component in the ever-changing environment of this deadly pandemic. We evaluated the impact of remote monitoring of the patients at their residences after being infected with SARS-COV-2 virtually. Methodology: This observational study was conducted among patients with symptoms of COVID–19 attending in the Fever Clinic between January and March 2021. The study was set to continue for the duration of the pandemic. Access to pulse oximeter and virtual platform was given to the enrolled patients. The participants were monitored in a remote monitoring platform at home and during the hospital stay. The primary outcome measures included number of recovery i.e. discharged from remote home monitoring and/or hospital and escalation of management such as hospitalization or transfer to the ICU facilities. Duration of hospital stay, patient experience and satisfaction, and barriers to use the virtual platform were included in the secondary outcome measures. Results: A total of twenty patients (median age 45 y, male to female ratio 65:35) were included. The median duration of monitoring was 10 days (IQR 8-12 days). Out of twenty patients, 3 (15%) patients needed hospitalization and were recognized in time by the team. The duration of hospital stay was 4 days median (IQR 3-6 days). All patients were discharged from this service safely; no death was reported. Ninety percent of the studied population were satisfied and felt reassured by this remote monitoring service. Conclusion: Early recognition of deterioration and prompt management through remote monitoring model increases the chances of survival of patients, and reduces the morbidity. Such remote monitoring model can be applied for future outbreaks of pandemics. Key words: COVID–19; Remote monitoring; Pulse oximetry; Emerging technologies; Virtual platform; Likert’s scale; Satisfaction. Citation: Akhtaruzzaman AKM, Kamal MM, Parveen M, Rabbi M, Dhali R, Islam MS, Bhowmick DK Remote monitoring of COVID–19 patient using home pulse oximetry and virtual platform: an observational study. Anaesth. pain intensive care 2022;26(1):89-95.
      DOI : 10.35975/apic.v26i1.1773 Received: December 14, 2021, Reviewed: January 16, 2022, Accepted: January 22, 2022
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Stimulation of acupoint P6 before induction of anesthesia to prevent
           postoperative nausea and vomiting; a randomized control trial

    • Authors: Saman Hamid, Mohsin Nazir Butt, Azhar Rehman, Gauhar Afshan
      Pages: 96 - 101
      Abstract: Background & Aims: Laparoscopic surgery has been associated with troublesome postoperative nausea and vomiting (PONV) in patients. Various regimens have been tried by the anesthesiologist to prevent PONV in laparoscopic cholecystectomy (LapChole). The primary objective of this study was to determine the role of stimulation of acupoint P6 for this purpose in patients undergoing LapChole at our institution.  Methodology: A randomized clinical trial was conducted at the Aga Khan University Hospital, Karachi, Pakistan. The research setting took place at the Post Anesthesia Care Unit (PACU) of the hospital. A total of 84 participants undergoing LapChole, ASA Status I or II, were enrolled and randomly allocated into two groups: 41 in control and 43 in the intervention group. In the intervention group, a commercially available band – PressureRight™ was applied at the wrist and the beads were placed exactly at P6 point. In the control group, the band was applied at the wrist with the beads placed on the dorsal surface. In both groups, acupressure band was applied before the induction of anesthesia in the waiting area of the operating room and continued during the intraoperative period and six hours postoperatively. Measurements: Postoperatively, patients were monitored for postoperative nausea and vomiting at the time of arrival in post anesthesia care unit [PACU], after half hour, three hour and six hours postoperatively using numerical pain scale [NPS] from 1-10 [1=none, 2-5=mild, 6-7=moderate, 8-10=severe] for PONV separately. Main Results: The results of PONV in PACU, at 30 minutes, three hours and six hours postoperatively showed an insignificant difference in intervention and control group. The frequencies of mild to moderate PONV were gradually reduced in both groups but the reduction was more pronounced in the control group than in the intervention group. There were no reported events of severe PONV at three hours and six hours postoperatively in both groups. The use of rescue antiemetics was statistically insignificant between the two groups [P = 0.744]. Conclusions: Our study reports that acupressure at Neiguan P6 point starting before the induction of anesthesia till 6 hours postoperative has no significant role in preventing PONV in patients undergoing laparoscopic cholecystectomy. Rescue antiemetics were required in both groups with a similar frequency. Key words: Acupoint P6; Acupressure; PONV; Laparoscopic cholecystectomy; Antiemetics; Randomized Clinical Trial Ethical approval: AKU No. 5365-ane-ERC-18, dated July 17, 2018 Citation: Hamid S, Butt MN, Rehman A, Afshan G. Stimulation of acupoint P6 before induction of anesthesia to prevent postoperative nausea and vomiting; a randomized control trial. Anaesth. pain intensive care 2022;26(1):96-101.
      DOI : 10.35975/apic.v26i1.1774 Received: August 6, 2021, Reviewed: October 22, 2012, Accepted: December 15, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Comparison of propofol and ketofol for sedation in patients undergoing
           shoulder surgery with interscalene and suprascapular nerve blocks

    • Authors: Yasemin Akcaalan, Mehmet Sahap, Handan Gulec, Eyup Horasanli, Mahmut Ugurlu, Serhat Akcaalan
      Pages: 102 - 109
      Abstract: Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset. Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service. Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p < 0.05). Significant higher mean values of hemodynamic findings in the ketofol  group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p < 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p < 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p < 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p > 0.05). Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation. Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109.
      DOI : 10.35975/apic.v26i1.1775 Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Status of artificial intelligence in Pakistan and its implications in
           anesthesiology

    • Authors: Muhammad Imran Khan
      Pages: 110 - 114
      Abstract: Artificial intelligence (AI) refers to the technology that enables machine-based intelligent behavior. This descriptive article gives an overview of the implementation of artificial intelligence in the following disciplines within the field of clinical medicine: Anesthesiology, Cardiology, Pulmonology, Endocrinology, Nephrology, Gastroenterology, Neurology, Histopathology, and Radiology. In this article, we will discuss the employment of artificial intelligence in anesthesiology and provide an analysis of the several areas in which it is being utilized. We will also evaluate the current status of AI and its future in Pakistan. The importance of this manuscript is to highlight the benefits of artificial intelligence so that the benefits can be realized in Pakistan. Key words: Artificial intelligence; Anesthesiology; Clinical medicine; Endocrinology; Gastroenterology; Histopathology; Nephrology; Neurology; Pakistan; Radiology Citation: Khan MI. Status of artificial intelligence in Pakistan and its implications in anesthesiology. Anaesth. pain intensive care 2021;26(1):110-114.
      DOI : 10.35975/apic.v26i1.1776 Received: September 12, 2021, Reviewed: November 24, 2021, Accepted: December 10, 2021
      PubDate: 2022-07-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Systemic thrombolysis and anticoagulation in postpartum patient with acute
           respiratory distress syndrome, COVID-19 and acute pulmonary embolism: a
           case report

    • Authors: Samuel Hotma Rotua, Dwisetyo Gusti Arilaksono, Shinta Vera Hutajulu
      Pages: 115 - 118
      Abstract: COVID-19 has a wide spectrum of clinical presentations, from asymptomatic cases to severe respiratory distress, multi-organ dysfunction, and death. Pulmonary embolism (PE) is the most feared and severe complication of venous thromboembolism (VTE). We present a case of a 25-year-old nonsmoker pregnant woman (gravida 2, no history of abortion/miscarriage), who underwent an elective cesarean section at 39 weeks of gestation after uneventful pregnancy. She exhibit clinical presentation of pulmonary embolism (PE) overlapping with severe COVID-19 pneumonia. The diagnosis was made based upon severe oxygen desaturation, McConnel sign finding on POCUS and elevated D-dimer level (34.19 µg/mL). Alteplase and low-molecular-weight heparin were used, which resulted in rapid clinical improvement. We should be warned about high or extremely elevated D-dimer levels and severe oxygen desaturation, as markers of severe COVID-19 pneumonia in patients with high clinical suspicion of PE. Thrombolysis could be an effective and safe therapy for PE in ARDS secondary to COVID-19. Furthermore, we underline that POCUS, despite its inherent limitations, could be a flexible diagnostic and management tool in refractory ARDS due to COVID-19. Key words: COVID-19; SARS-CoV-2; Pulmonary Embolism; Thrombolysis; Postpartum; POCUS Abbreviations: ARDS - Acute respiratory distress syndrome; PE - Pulmonary embolism; VTE - Venous thromboembolism; BPM – Beats per minute Citation: Rotua SH, Arilaksono DG, Hutajulu SV. Systemic thrombolysis and anticoagulation in postpartum patient with acute respiratory distress syndrome, COVID-19 and acute pulmonary embolism: a case report. Anaesth. pain intensive care 2022;26(1):115-118.
      DOI : 10.35975/apic.v26i1.1777 Received: September 13, 2021, Reviewed: November 06, 2021, Accepted: November 10, 2021
      PubDate: 2022-02-07
      Issue No: Vol. 26, No. 1 (2022)
       
  • Difficult airway management in Apert syndrome for maxillofacial
           reconstruction: a case report

    • Authors: Purwoko Purwoko, Andre Azhar, Septian Adi Permana
      Pages: 119 - 122
      Abstract: Apert syndrome (AS) is an autosomal dominant disease associated with several craniofacial and limb deformities. Craniofacial deformities in AS patients requiring surgery are usually associated with difficult airway management. We report a case of a 21-year-old male patient, ASA III, with AS, who had a mandibular fracture and reconstruction was planned. The patient had all the features of AS. He had no comorbidities such as hypertension and diabetes mellitus. Awake intubation with fiberoptic bronchoscope was planned. In these patients with AS, intravenous access might also be difficult due to limb deformities. Some surgical procedures make intravenous access even more difficult. Rarely, if intravenous access is judged to be mandatory in an emergency, intraosseous or intramuscular access may be an alternative. Abbreviations: AS - Apert syndrome; ED - emergency department; MSCT - Multislice Computerized Tomography Key words: Apert syndrome; Acrocephalosyndactylia / diagnostic imaging; Acrocephalosyndactylia / pathology; Syndactyly / pathology; Maxillofacial reconstruction, Airway management Citation: Purwoko P, Azhar A, Permana SA. Difficult airway management in Apert syndrome for maxillofacial reconstruction: a case report. Anaesth. pain intensive care 2021;26(1):119-122.
      DOI : 10.35975/apic.v26i1.1781 Received: October 27, 2021, Reviewed: November 11, 2021, Accepted: November 14, 2021
      PubDate: 2022-04-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Extreme physical exhaustion leading to hypokalemic periodic paralysis- a
           case report

    • Authors: Monjuri Borkotokey, Kaustuv Dutta
      Pages: 123 - 125
      Abstract: Sudden onset limb weakness in a young individual requires a thorough evaluation and prompt diagnosis. Delay in treatment awaiting CT scan reports or laboratory investigations can lead to complications. Our case report stresses upon the clinicians to consider hypokalemic periodic paralysis in the differential diagnosis in evaluating such patients. Classical ECG changes and blood gas analysis can effectively diagnose hypokalemia and institute gradual correction of the electrolyte abnormality. In a very rare incident, our patient developed hypokalemia after strenuous exercise. Key words: Hypokalemic periodic paralysis; Hypokalemia; Flaccid paralysis; Exhaustion Citation: Borkotokey M, Dutta K. Extreme physical exhaustion leading to hypokalemic periodic paralysis- a case report. Anaesth. pain intensive care 2022;26(1):123-125.
      DOI : 10.35975/apic.v26i1.1782 Received: November 30, 2021, Reviewed: December 25, 2021,, Accepted December 27, 2021
      PubDate: 2022-04-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Injection of local anesthetic lateral to vertebral transverse process
           instead of conventional method for interscalene block in difficult cases
           with poor view

    • Authors: Reza Heidarifar, Seyyed Mohammadreza Amini, Sarah Lotfi, Abbas Ahmadi
      Pages: 126 - 127
      Abstract: Ultrasound guided (USG) peripheral nerve block techniques have become increasingly popular in regional anesthesia in the recent few years. USG interscalene brachial plexus block provides effective analgesia after a variety of of surgeries and have been shown to reduce opioid consumption, decrease postoperative nausea and vomiting (PONV), improve patient satisfaction, and decrease recovery room length of stay.1 Regardless of all of these advantages, there have been some complications associated with this technique. The most important complication is the phrenic nerve block. Therefore, impaired respiratory function is considered a relative contraindication to interscalene plexus block. It has been shown to cause ipsilateral hemidiaphragmatic paresis almost always due to phrenic nerve block.2, 3 Key words: Nerve Block/methods; Anesthetics, Local; Peripheral Nerves / diagnostic imaging; Ultrasonography, Interventional / methods  Citation: Heidarifar R, Amini SM, Lotfi S, Ahmadi A. Injection of local anesthetic lateral to vertebral transverse process instead of conventional method for interscalene block in difficult cases with poor view. Anaesth. pain intensive care 2021;26(1):126-127.
      DOI : 10.35975/apic.v26i1.1783
      PubDate: 2022-04-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Successful airway management in a patient with left parapharyngeal and
           retropharyngeal abscess with mediastinal extension during COVID-19
           pandemic

    • Authors: Muhamad Rafiqi Hehsan, Wan Fadzlina Wan Muhd Shukeri, Raman S RM Subramaniam Chettiar, Huda Zainal Abidin
      Pages: 128 - 129
      Abstract: Acute airway compromise caused by a deep neck space abscess significantly contributes to the morbidity and mortality, and it requires quick identification and rapid treatment.1 Parapharyngeal and retropharyngeal abscesses affect 2.64 persons out of 100,000 population. The incidence in males and females is 3.34 and 1.94 per 100,000 people, respectively.2 Of note, the abscess might increase the patient’s susceptibility to COVID-19 infection. In order to limit COVID-19 transmission in such patients, an advanced treatment plan is required.3 We share the anesthetic airway management of a high-risk airway case during the current COVID-19 pandemic. Key words: airway management; COVID-19; abscess, parapharyngeal; abscess, retropharyngeal; video-assisted thoracoscopy; Surgery, thoracic Citation: Hehsan MR, Shukeri WFWM, Chettiar RSRMS, Abidin HZ. Successful airway management in a patient with left parapharyngeal and retropharyngeal abscess with mediastinal extension during COVID-19 pandemic. Anaesth. pain intensive care 2021;26(1):128-129.
      DOI : 10.35975/apic.v26i1.1784
      PubDate: 2022-04-02
      Issue No: Vol. 26, No. 1 (2022)
       
  • Professor Sajid Usman Kaul

    • Authors: Liaqat Ali, Arshad Taqi
      Pages: 130 - 132
      Abstract: Prof. Sajid Usman Kaul touched many lives during his lifetime, significant among them a group of anesthetists he recruited, nurtured, and empowered to take over when he passed the baton. Prof. Kaul became the pioneer of corporate anesthesia and pain services in Pakistan when he established Kaul Associates (Pvt) Ltd.
      PubDate: 2022-04-02
      DOI: 10.35975/apic.v26i1.1785
      Issue No: Vol. 26, No. 1 (2022)
       
 
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