Anesthesiology Commons^™

Is Current Evidence That Avoidance Of Inhalation Agents And Opioids May Decrease Metastasis Strong Enough For Crnas To Show A Willingness To Change Practice?, Michael Wesley Tillman

Doctoral Projects

Metastasis following the surgical resection of primary site breast cancer is a medical issue, which plagues mastectomy patients. The intention of this project was to synthesize current literature in order to make a presentation and disseminate it to Certified Registered Nurse Anesthetists (CRNAs) in southern Mississippi and assess the providers' willingness to change practice. CRNAs took part in a Qualtrics survey after viewing a PowerPoint presentation of evidence regarding anesthesia and metastasis. The presentation illustrated the anesthetic techniques and pharmacological agents utilized, which either mitigate or potentiate a patient's risk for metastasis. The survey assessed for a willingness to change …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Awareness Regarding Application Of Endotracheal Tube (Ett) Cuff Pressure Measuring Gauge In Anesthesia Practice; Acritical Step To Avoid Postintubation Tracheal Stenosis In Critically Ill Patients On Prolonged Mechanical Ventilator, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Renal Stress Testing In The Assessment Of Kidney Disease, Lakhmir S. Chawla, Claudio Ronco

Anesthesiology and Critical Care Medicine Faculty Publications

As part of human evolutionary development, many human organ systems have innate mechanisms to adapt to increased “work demand” or stress. This reserve capacity can be informative and is used commonly in cardiology to assess cardiac function (e.g., treadmill test). Similarly, the kidney possesses reserve capacity, which can be demonstrated in at least 2 of the following renal domains: glomerular and tubular. When appropriate stimulants are used, healthy patients with intact kidneys can significantly increase their glomerular filtration rate and their tubular secretion. This approach has been used to develop diagnostics for the assessment of renal function. This article reviews …

Comparison Of Spinal Anesthesia Dosage Based On Height And Weight Versus Height Alone In Patients Undergoing Elective Cesarean Section, Khalid Maudood Siddiqui, Muhammad Asghar Ali, Hameed Ullah

Department of Anaesthesia

Background: Spinal anesthesia with bupivacaine, typically used for elective and emergency cesarean section, is associated with a significant incidence of hypotension resulting from sympathetic blockade. A variety of dosing regimens have been used to administer spinal anesthesia for cesarean section. The objective of this study was to compare the incidence of hypotension following two different fixed dosing regimens.Methods: This was a randomized double-blind clinical trial with a two-sided design, 5% significance level and 80% power. After approval of the hospital ethics review committee, 60 patients were divided randomly into two groups. In one group, the local anesthetic dose was adjusted …

Effects Of Bupivacaine Infiltration On Postoperative Tramadol Consumption In Elective Day Care Unilateral Inguinal Hernia Repair, Rehan Muhammad Qureshi, Fauzia Anis Khan

Department of Anaesthesia

Objective: To determine the difference in analgesic requirement in terms of mean postoperative narcotic consumption and mean postoperative pain score in patients undergoing unilateral inguinal hernia repair with or without bupivacaine infiltration as day-care patients.Methods: The randomised controlled trial was conducted at Aga Khan University Hospital, Karachi, from June to December 2011, and comprised patients who were randomly divided into groups A and B. Tramadol 1.5 mgkg-1 was used as intraoperative analgesia. At the time of closure of surgical incision, 20ml of bupivacaine 0.25% plain was infiltrated in the subcutaneous tissue sub-facially and in the deeper layers along the incision …

Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital, Syed Shabbir Ahmed, Mohammad Irfan Akhtar, Rehana Kamal

Department of Anaesthesia

Background: Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients.Methods: A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

Role Of Acute Pain Service In Optimizing Postoperative Pain Relief In A Tertiary Care Teaching Hospital, Aliya Ahmed, Muhammad Yasir

Department of Anaesthesia

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects.Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19.Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required …

Track Extubation In Pediatric Congenital Heart Disease Open Heart Surgical Patients In Pakistan, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Anesthesia For Deep Brain Stimulation In Traumatic Brain Injury-Induced Hemidystonia., Jill M Jani, Chima O Oluigbo, Srijaya K Reddy

Anesthesiology and Critical Care Medicine Faculty Publications

Deep brain stimulation in an awake patient presents several unique challenges to the anesthesiologist. It is important to understand the various stages of the procedure and the complexities of anesthetic management in order to have a successful surgical outcome and provide a safe environment for the patient.

Anaesthetic Consideration In A Cannabis Addict, Karima Karam, Shemila Abbasi, Fauzia Anis Khan

Department of Anaesthesia

This case report describes the anaesthetic management of a patient addicted to Bhang(cannabis) for 20 years. Cannabis use has implication in the anaesthetic management of a patient because of its effects on the cardiovascular system, respiratory system, and central nervous system and its interaction with anaesthetic drugs.

Anesthesia For Cardiac Catheterization Procedures, A Hamid

Department of Anaesthesia

Anesthesiologist's involvement for the purpose of diagnostic and interventional procedures in cardiac catheterization laboratory has been evolving particularly since last two decades. Catheterization laboratory environment poses certain challenges for the anesthesiologist including unfamiliar remote location, exposure to radiation, limited help from colleagues and communication with cardiologists. Anesthesiologists working in catheterization laboratory are required to have adequate knowledge of the environment, personnel, fluoroscope, echocardiography and type of radio contrast dye during the procedure. Anyone who is exposed to radiation environment is expected to protect himself from the exposure and must also wear a dosimeter for cumulative exposure tracing.There is no ideal …

Cardiac Arrest In A Child Following Cranioplasty, Asma Abdus Salam, Fauzia Anis Khan

Department of Anaesthesia

Craniofacial surgery in paediatric patients is associated with several complications, including severe bleeding and venous air embolism. We present a case of an 18 months, 10 kilogramme weight child who had cardiac arrest after completion of surgery, but before extubation. Possibility of both haemorrhage and venous air embolism is discussed.

Airway Management In A Patient With Bullous Pemphigoid, Mohammad Yasir, Fauzia Anis Khan

Department of Anaesthesia

Airway management in patients with pemphigoid lesions has anaesthetic implications. We report a case of a 23 years old female with bullous pemphigoid who presented with laryngeal stenosis and critical airway narrowing. The airway was initially managed with jet ventilation. Anaesthesia was maintained with propofol infusion and ventilation was performed by introducing a size 10 French gauge suction catheter through the stenotic laryngeal orifice. Thirty minutes into anaesthesia, she developed subcutaneous emphysema and decreased air entry on right side of the chest but remained hemodynamically stable. The airway was further managed by tracheostomy. This case report highlights complications that can …

Comparison Of Hemodynamic Response To Tracheal Intubation With Macintosh And Mccoy Laryngoscopes, Mehtab A. Haidry, Fauzia A. Khan

Department of Anaesthesia

Background: Use of McCoy blade laryngoscope avoids the lifting force in the vallecula and theoretically should lead to a lower hemodynamic response related to laryngoscopy and tracheal intubation. The available literature on the topic is conflicting.MATERIALS AND Methods: We studied the hemodynamic response to laryngoscopy and tracheal intubation in 60 ASA 1 AND 2 adult patients using either Macintosh or McCoy laryngoscopes. The change in systolic, diastolic, mean arterial pressure, and heart rate (HR) was observed for 10 min post intubation. Arrhythmias and ST changes were also observed.Results: The maximum change in HR was 18.7% in the Macintosh and 7.7% …

Induction Position For Spinal Anaesthesia: Sitting Versus Lateral Position, Khurrum Shahzad, Gauhar Afshan

Department of Anaesthesia

Objective: To compare the effect of induction position on block characteristics (sensory and motor nerves) and haemodynamic stability in elderly patients with isobaric bupivacaine. Patient comfort was also looked at.Methods: The randomized single blinded study was conducted at the Aga Khan University Hospital, Karachi, from September 2007 to August 2008. A total of 70 patients aged >60 years of both genders were included. Spinal anaesthesia was performed either in sitting or lateral position according to random allocation. Assessments of sensory, motor block and heart rate, systolic and diastolic blood pressure were recorded for 20 minutes. SPSS 16 was used for …

Pharmacological Agents For Preventing Morbidity Associated With The Haemodynamic Response To Tracheal Intubation, Fauzia A. Khan, Hameed Ullah

Department of Anaesthesia

Background: Several drugs have been used in attenuating or obliterating the response associated with laryngoscopy and tracheal intubation. These changes are of little concern in relatively healthy patients but can lead to morbidity and mortality in the high risk patient population.Objectives: The primary objective of this review was to determine the effectiveness of pharmacological agents in preventing the morbidity and mortality resulting from the haemodynamic changes in response to laryngoscopy and tracheal intubation in adult patients aged 18 years and above who were undergoing elective surgery in the operating room setting.SEARCH Methods: We searched the Cochrane Central Register of Controlled …

Anaesthetic Management Of A Young Patient With Homocystinuria, Ali Asghar, Faiza Mazhar Ali

Department of Anaesthesia

Homocystinuria is a rare autosomal recessive genetic disease. It is caused by a deficiency in cystathionine-b-synthase leading to a defect in methionine metabolism. High levels of plasma homocysteine are associated with vascular injury via mechanisms of oxidative damage, vascular smooth muscle proliferation, promotion of platelet activation and aggregation,and disruption of normal procoagulant-anticoagulant balance favouring thrombosis. This is a case of 8 years old boy, a known case of homocystinuria, who was scheduled for bilateral lensectomy and intraocular lens placement. The major anaesthetic considerations include the development of thromboembolism, need to avoid nitrous oxide in balanced anaesthesia regimen and hypoglycaemia.

Anaesthetic Management Of Neonatal Primary Hyperparathyroidism, Anwar-Ul-Huda, Sanam Dost Mohammad, Tauseef Ahmed

Department of Anaesthesia

Neonatal primary hyperparathyroidism (NPHP) is a rare disease that presents in the first 6 months of life. It is almost invariably fatal unless a prompt diagnosis is made and urgent surgical intervention is instituted. Patients with hyperparathyroidism require special preoperative considerations. They require proper work-up from cardiac, renal and neurological point of view, correction of intravenous volume and electrolytes irregularities. We are presenting a case of an infant who started to have cyanosis and lethargy at 21st day of life. Initial diagnosis of pneumonia was made but later on diagnosed as hyperparathyroidism. He was planned for parathyroidectomy under general anaesthesia. …

Comparison Of Upper Lip Bite Test With Mallampati Test In The Prediction Of Difficult Intubation At A Tertiary Care Hospital Of Pakistan, Muhammad Asghar Ali, Muhammad Qamar-Ul-Hoda, Khalid Samad

Department of Anaesthesia

Objective: To determine the accuracy of the Upper lip bite test and Mallampati test in predicting difficult endotracheal intubation.Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, a tertiary care facility in Karachi, Pakistan. Between June 1,2007 and May 31, 2008, 324 adult patients undergoing elective surgeries requiring general anaesthesia with endotracheal intubations were enrolled. Pre-operatively upper lip bite test and Mallampati test were performed for the assessment of airway by a specifically trained observer. Laryngoscopic view was rated by using Cormack and Lehane laryngoscopic grading once the patient was fully anaesthetised using standard anaesthesia technique. Completed …

Spinal Anaesthesia For Caesarean Section: Plain Vs Hyperbaric Bupivacaine, Gurmukh Das Punshi, Gauhar Afshan

Department of Anaesthesia

Objective: To compare the clinical characteristics of sensory and motor block as well as haemodynamic stability using plain and hyperbaric bupivacaine in spinal anaesthesia for caesarean section.Methods: Two equal groups were formed from a total of 60 patients who were enrolled in this prospective randomised double-blinded study that was done at tertiary care hospital in Karach, during 2005 to 2006. Equal volume of plain and hyperbaric bupivacaine 10 mg with 25 mcg of fentanyl was used for spinal anaesthesia in the two groups that were formed on the basis of random allocation. Characteristics of sensory and motor block, episodes of …

Spontaneous Intracranial Hypotension In A Patient With Marfan's Syndrome Treated With Epidural Blood Patch--A Case Report, Samad Khalid, Punshi Gurmukh Das, Hamid Mohammad, Ullah Hameed

Department of Anaesthesia

Spontaneous intracranial hypotension (SIH) is a well-defined clinical entity that is frequently misdiagnosed. We are reporting a case of 38 years old male who presented with severe headache and an episode of generalized tonic-clonic seizure. He was managed successfully with an epidural blood patch. Understanding of the characteristics, symptomatology, evaluation, treatment options, and prognosis is discussed.

Are We Anesthesiologists, Aware About The Incidence Of Muscle Stiffness Associated With Remifentanil?, Gauhar Afshan

Department of Anaesthesia

No abstract provided.

Laryngeal Mask Airway Insertion Anaesthesia And Insertion Techniques, Abdul Monem, Fauzia A. Khan

Department of Anaesthesia

Laryngeal Mask Airway has gained wide acceptance for routine airway management, difficult airway and in emergency situations. The classical method of insertion was recommended by Dr Brain. Over the years various induction and insertion techniques have been described with variable results. Combination of induction agents with narcotics, with or without small dose muscle relaxants has been found to be very effective. There is less also lesser incidence of mucosal trauma with partially inflated cuff. Insertion with cuff facing laterally or backwards and rotating it forwards into position has also been described. A review of various options and their advantages and …

Audit Of An Acute Pain Service In A Tertiary Care Hospital In A Developing Country, Muhammad Qamarul Hoda, Mohammad Hamid, Fauzia Anis Khan

Department of Anaesthesia

The first anaesthesia based acute pain service (APS) was introduced in Pakistan at the Aga Khan University Hospital in July 2001, with the aim of patient safety and satisfaction. The American Society of Anesthesiologist task force guidelines were used for the introduction of APS. APS has managed 6810 patients during four and half years period. Common analgesic techniques used, were intravenous infusion (50%), patient controlled intravenous analgesia (18%) and epidural infusions (30%). Common reported side effects were nausea and vomiting with intravenous infusion (10%) and PCIA (10%) while motor block was noticed with epidural infusion (29%). This article aims to …

Comparison Of Two Sedation Techniques In Patients Undergoing Surgical Procedures Under Regional Anaesthesia, Aliya Ahmed, Fauzia Anis Khan, Aziza Hussain

Department of Anaesthesia

Objective: Intraoperative comfort and patient satisfaction during surgical procedures under regional anaesthesia can be improved with the use of supplemental intravenous sedation. The authors conducted a study to compare two sedation techniques for surgical procedures performed under regional anaesthesia, i.e., midazolam and pethidine combination compared with midazolam and tramadol combination.Methods: Forty adult American Society of Anaesthesiologists (ASA) grade 1-111 patients, aged between 40-65 years undergoing surgery under regional anaesthesia (sub-arachnoid block) were included. The patients were randomly divided into two groups. All patients received standardized premedication, intraoperative monitoring and oxygen therapy. Group A patients received midazolam 0.03 mg/kg followed by …

Epidural Anaesthesia During Labour For A Patient With Congenital Complete Heart Block: A Case Report, Abdul Monem, Ursula Chohan, Mohammed Ali

Department of Anaesthesia

We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only …

Role Of Stellate Ganglion Block In Post Cabg Sympathetically Mediated Chest Pain, Mueen Ullah Khan, Imtiaz Ahmed

Department of Anaesthesia

Acute chest pain is a common presentation in emergency. After clinical assessment undiagnosed chest pain can become a difficult problem. Sympathetically mediated chest pain is a rare presentation, as it is similar to that of secondary hyperalgesia in the intact skin surrounding an injury site. We are reporting a case of a 62 years old man who presented with atypical chest pain four months after coronary artery bypass grafting (CABG). On investigation no new change was noticed than previous evaluation. On chronic pain assessment he was having hyperalgesia to light touch in addition to the spontaneous chest pain. He was …

Arterial To End-Tidal Carbon Dioxide Difference In Neurosurgical Patients Undergoing Craniotomy: A Review Of Practice, Fauzia Anis Khan, Mueenullah Khan, Shemila Abbasi

Department of Anaesthesia

Objective: To see if PETCO2 reflects PaCO2 with acceptable accuracy.Methods: In this audit the.anaesthetic chart of fifty consecutive patients, age 12 years and above undergoing craniotomy for intracranial pathology, were reviewed.Results: The difference between end tidal carbon dioxide (ETCO2) value corresponding to the time of taking the arterial sample and the PaCO2 was calculated. The mean end tidal CO2 was 29.3 +/- 2.8 and the mean PaCO2 was 32.63 +/- 4.5. The mean difference between the two values was calculated as 4.09 +/- 3.0. The regression coefficient was 0.496, which showed a moderate association. A wide variability was observed in …