Anesthesiology Commons^™

Corticosteroid Therapy For Sepsis: A Clinical Practice Guideline, Francois Lamontagne, Bram Rochwerg, Lyubov Lytvyn, Gordon H. Guyatt, Morten Hylander Møller, Djillali Annane, Michelle E. Kho, Neill K J Adhikari, Flavia Machado, Madiha Hashmi

Department of Anaesthesia

No abstract provided.

Effect Of Two Techniques Of Parental Interaction On Children's Anxiety At Induction Of General Anaesthesia - A Randomized Trial, Alia Hussain, Fauzia Khan

Department of Anaesthesia

Objective: Several non-pharmacological techniques, such as parental presence and behavioral preparation, are used to decrease children's anxiety at anaesthesia induction. We compared the mean anxiety score in children at the time of anaesthesia induction with two different physical techniques of parental interaction and a control group with no parent present. The secondary objective was to determine the face mask acceptance during induction.
Methods: This study recruited 123 ASA I & II children, aged 1 to 8 years, undergoing day care surgery, who were randomly allocated to three groups. Children either went to the operating room (OR) alone (Gp C), or …

Representation Of South Asian Countries In Five High-Impact Anesthesia Journals, Mohammad Irfan Akhtar, Karima Karam Khan, F. Khan

Department of Anaesthesia

Context: The South Asian region is comprised of eight countries, i.e., Pakistan, India, Bangladesh, Sri Lanka, Afghanistan, Bhutan, Nepal, and Maldives. There is dearth of literature documenting anesthesia research in this region.
Aim: The aim of this audit was to look at research productivity in the region by examining the volume and the type of anesthesia publication in five high-index anesthesia journals.
Settings and Design: The study design was a survey of literature in the top five high-impact anesthesiology journals carried out at a tertiary care hospital.
Materials and Methods: The journal citation report 2016 was accessed to identify the …

Other Clinical Applications Of Videolaryngoscopy Besides Intubation, Faisal Shamim, Marium Nafis, Mubasher Ikram

Department of Anaesthesia

No abstract provided.

Glioblastoma Multiforme Involving Conus Medullaris In A Child, Muhammad Atif Mansha, Agha Muhammad Hammad Khan, Ahmed Nadeem Abbasi, Mohammad Usman Ali, Naureen Mushtaq, Maria Tariq, Asmara Waheed

Department of Radiation Oncology

Primary spinal cord glioblastoma multiforme involving the conus medullaris is an uncommon entity with poor outcomes. An aggressive multimodality treatment approach has been used, but prognosis remains same. There are no guidelines for the treatment of patients with spinal glioblastoma multiforme (GBM). We highlight the case of a child diagnosed with conal GBM. He was treated with definitive surgery followed by adjuvant concurrent chemoradiation. After completion of treatment, he showed a temporary symptomatic improvement, but later on his condition deteriorated. We elaborate the stepwise treatment approach employed in this patient.

Misplaced Central Venous Catheter In Carotid Artery During Emergency Surgery For The Total Correction Of Tetralogy Of Fallot Of An Adolescent Boy, Shabbir Ahmed, Faisal Junejo, Fazal Wahab Khan

Department of Anaesthesia

Ultrasound-guided central venous cannulation is now considered as the standard of care, and this has largely replaced blind central venous cannulation using anatomical landmarks. We are reporting a case of inadvertent placement of central venous catheter in the right common carotid artery with the use of ultrasound guidance during emergency surgery for the total correction of Tetralogy of Fallot (ToF). This patient luckily had a favourable outcome despite this inadvertent catheter placement which was not recognised even after completion of surgery .The patient also received drug infusions of inotropes and vasopressors through this malplaced central line into the aorta. The …

Pre-Anaesthetic Assessment Of Intracranial Pressure Using Optic Nerve Sheath Diameter In Patients Scheduled For Elective Tumour Craniotomy, Faraz Shafiq, Muhammad Asghar Ali, Fauzia Khan

Department of Anaesthesia

Background: The objective of study was to determine the pre-anaesthetic status of intracranial pressure (ICP), using ultrasonographic measurement of optic nerve sheath diameter (ONSD) inpatient scheduled for elective tumour craniotomy. The secondary objective was to compare the diagnostic accuracy of ONSD guided rise in ICP with clinical and radiographic parameters. This is prospective observational study, conducted at single neurosurgical theatre of The Aga Khan University over a period of one year.
Methods: After getting ethical approval and informed consent patient fulfilling inclusion criteria and planned for elective tumour craniotomy were enrolled in study. The clinical and radiographic signs predicting the …

Ultrasound-Guided Peripheral Nerve Blocks In High-Risk Patients, Requiring Lower Limb (Above And Below Knee) Amputation, Faisal Shamim, Malika Hameed, Nadeem Ahmed Siddiqui, Shemila Abbasi

Department of Anaesthesia

A case series of five high-risk patients with lower limb ischemia, sepsis, altered coagulation, and multi-organ dysfunction requiring emergent or urgent lower limb amputation is presented. Use of peripheral nerve blocks for below and above knee amputations is quite uncommon which provides better hemodynamic stability and pain management, especially in the very sick patients. The surgeries were successfully carried out under ultrasound-guided combined femoral and sciatic nerve blocks. All five patients obtained adequate level of block at the area of amputation. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. Combined …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Practice Of Ventilation In Middle-Income Countries (Provent-Imic): Rationale And Protocol For A Prospective International Multicentre Observational Study In Intensive Care Units In Asia, Luigi Pisani, Anna Geke Algera, Ary Serpa Neto, Areef Ahsan, Abigail Beane, Kaweesak Chittawatanarat, Abul Faiz, Rashan Haniffa, Reza Hashemian, Madiha Hashmi

Department of Anaesthesia

Introduction: Current evidence on epidemiology and outcomes of invasively mechanically ventilated intensive care unit (ICU) patients is predominantly gathered in resource-rich settings. Patient casemix and patterns of critical illnesses, and probably also ventilation practices are likely to be different in resource-limited settings. We aim to investigate the epidemiological characteristics, ventilation practices and clinical outcomes of patients receiving mechanical ventilation in ICUs in Asia.
Methods and Analysis: PRoVENT-iMIC (study of PRactice of VENTilation in Middle-Income Countries) is an international multicentre observational study to be undertaken in approximately 60 ICUs in 11 Asian countries. Consecutive patients aged 18 years or older who …

Palliative Surgical Gastrostomy Under Ultrasound‑Guided Bilateral Rectus Sheath Blocks In A Head And Neck Cancer Patient, Saima Rashid, Faisal Shamim,, Maha Khan, Robyna Khan

Department of Anaesthesia

No abstract provided.

Factors Affecting Reintubations After Cardiac And Thoracic Surgeries In Cardiac Intensive Care Unit Of A Tertiary Care Hospital, Khalid Maudood Siddiqui, Khalid Samad, Faisal Jonejo, Muhammad Faisal Khan, Khalid Ahsan Khalid Ahsan

Department of Anaesthesia

Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.
Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation …

Occupational Exposure To Hiv In A Developing Country: Assessing Knowledge And Attitude Of Healthcare Professional Before And After An Awareness Symposium, Samina Ismail, Safia Awan, Rubaba Naeem, Sarfraz Siddiqui, Badar Afzal, Bushra Jamil, Uzma Rahim Khan

Department of Anaesthesia

Objective: Health care providers (HCPs) are at risk of occupational exposure to HIV infection. In developing world these exposure occur due to general lack of awareness, education and structured training of HCPs. The objective of the study was to asses if continuing medical education symposium can be used as an effective educational tool to improve attitude, awareness and knowledge regarding occupational exposure to HIV infection. This quasi-experimental study was conducted among HCPs from Karachi, Pakistan. After assessing the baseline knowledge, awareness, and attitude by means of pretest; HCPs were reassessed with posttest after an education symposium on occupational exposure to …

Haemodynamic Assessment And Support In Sepsis And Septic Shock In Resource-Limited Settings, David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W. Dünser, Arjen M. Dondorp, Marcus J. Schultz, Global Intensive Care Working Group†, Of The European Society Of Intensive Care Medicine (Esicm) And The Mahidol Oxford Tropical Medicine Research Unit (Moru) In Bangkok, Thailand

Anaesthesiology, East Africa

Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking.

Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind.

Results: We suggest using capillary refill time, skin mottling scores and skin temperature gradients; suggest …

Bladder Distension As A Cause Of Abdominal Compartment Syndrome, Muhammad Yasir, Muhammad Qamarul Hoda, Tauseef Ahmed

Department of Anaesthesia

Abdominal compartment syndrome (ACS) is increasingly identified in critically ill patient and its harmful effects are well documented. The disparity among the pressure, volume in abdominal cavity and its contents, results in ACS. The actual incidence of ACS is not known. However, it has been observed predominantly in patients with severe blunt and penetrating abdominal trauma, ruptured abdominal aortic aneurysms, retro- and intra-peritoneal hemorrhage, pneumoperitoneum, neoplasm, pancreatitis, ascites and multiple bone fracture. We present a case of 40-year female who underwent emergency cesarean section and developed abdominal compartment syndrome due to urinary bladder distension secondary to blockade of urinary catheter …

Analgesic Effect Of Bilateral Subcostal Tap Block After Laparoscopic Cholecystectomy, Karima Karam Khan, Robyna Irshad Khan

Department of Anaesthesia

Background: Pain after laparoscopic cholecystectomy is mild to moderate in intensity. Several modalities are employed for achieving safe and effective postoperative analgesia, the benefits of which adds to the early recovery of the patients. As a part of multimodal analgesia, various approaches of Transversus abdominis plane (TAP) block has been used for management of parietal and incisional components of pain after laparoscopic cholecystectomy. This study was designed to compare the analgesic efficacy of two different approaches of ultrasound guided TAP block, i.e., Subcostal-TAP block technique with ultrasound guided Posterior-TAP block for postoperative pain management in patients undergoing laparoscopic cholecystectomy under …

Fluid Choice During Perioperative Care In Children: A Survey Of Present‑Day Proposing Practice By Anesthesiologists In A Intertiary Care Hospital, Muhammad Faisal Khan, Khalid Maudood Siddiqui, Ali Asghar

Department of Anaesthesia

Background: Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists.

Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the

current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital.

Methods: After obtaining approval from the Departmental Research Review Committee, a survey form including questions

was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed.

Results: Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in

this survey. Majority of …

A Randomized Control Trial Comparing Train Of Four Ratio > 0.9 To Clinical Assessment Of Return Of Neuromuscular Function Before Endotracheal Extubation On Critical Respiratory Events In Adult Patients Undergoing Elective Surgery At A Tertiary Hospital In Nairobi, Isaac Adembesa, Vitalis Mung’Ayi, Zul Premji, Dorothy Kamya

Anaesthesiology, East Africa

Background: There is increasing evidence that the incidence of postoperative residual paresis after using neuromuscular blockers ranges from 24 to 50% in post anaesthesia care unit (PACU) and is associated with postoperative complications such as critical respiratory events as evidenced by hypoxia, hypoventilation and upper airway obstruction. Quantitative neuromuscular monitoring (such as the assessment of Train of four (TOF) ratio) and reversal of neuromuscular blockers has been shown to reduce postoperative residual paresis. There are very few outcome studies on effect of residual paresis in PACU. There is a paucity of published randomized controlled trials investigating whether using a TOF …

A Reliable Alternative Of Fiberoptic Bronchoscope Inunanticipated Difficult Airway: Flexible Fiberoptic Cystoscope, Muhammad Sohaib, Khalid Maudood Siddiqui, Muhammad Faisal Khan

Department of Anaesthesia

No abstract provided.

Pediatric Critical Incidents Reported Over 15 Years At A Tertiary Care Teaching Hospital Of A Developing Country, Shemila Abbasi, Fauzia Anis Khan, Sobia Khan

Department of Anaesthesia

Background and Aims: The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Material and Methods: Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University …

Intravenous Lidocaine And Postextubation Laryngospasm, Muhammad Faisal Khan, Ullah Saleem

Department of Anaesthesia

No abstract provided.

Is Homocystinuria A Real Challenge For Anesthetist? Are We Making A Difference?, Muhammad Umar Slote, Karima Karam Khan,, Ausaf Ahmed Khan, Mohsin Nazir Butt

Department of Anaesthesia

No abstract provided.

Comparison Between Intravenous Boluses Versus Infusion Of Tranexamic Acid (Txa) To Reduce Bleeding In Paediatric Cyanotic Congenital Heart Disease (Chd) Surgeries, Faisal Junejo, Mohammad Irfan Akhtar, Mohammad Hamid, Syed Shabbir Ahmed, Fauzia Minai, Muneer Amanullah

Department of Anaesthesia

Objective: To compare the intravenous boluses and intravenous continuous infusion of tranexamic acid (TXA) to reduce postoperative bleeding in cyanotic congenital heart disease surgeries. Study Design: Single-blinded randomised clinical trial. Place and Duration of Study: Anaesthesia Department, The Aga Khan University Hospital, Karachi, from July 2016 to April 2017.
Methodology: Sixty patients of cyanotic congenital heart disease, undergoing either palliative or corrective surgery involving cardiopulmonary bypass (CPB), were recruited. These 60 patients were divided randomly into two groups. The infusion group received intravenous infusion of TXA at 5 mg/kg/hour while the bolus group received three intravenous boluses of 10 mg/kg …

Urinary Retention In Unilateral Total Knee Arthroplasty: Comparison Between Continuous Epidural Analgesia And Single-Shot Femoral Nerve Block, Ausaf Ahmed Khan, Robyna Irshad Khan

Department of Anaesthesia

Objective: To compare the frequency of urinary retention and requirement of bladder catheterization in patients undergoing total knee arthroplasty while receiving either continuous epidural analgesia or single-shot femoral nerve block.
Study design: Randomized controlled study.
Place and duration of study: Operating Rooms of Aga Khan University Hospital, Karachi, from January 2014 to January 2015.
Methodology: Patients were randomized in two groups of 30 each, i.e. epidural group (group E) or femoral nerve block group (group F). Baseline parameters were recorded. Postoperatively, patients were followed for upto 24 hours to collect the data regarding urinary retention. Final outcome was taken at …

Dealing A Neonate With Charge Syndrome: Anaesthesia Perspective Of Perioperative Care, Khalid M Siddiqui, Muhammad Ali Asghar, Amjad Nadeem

Department of Anaesthesia

CHARGE syndrome is a condition that can disturb numerous areas of human body. As an abbreviation CHARGE stands for: coloboma, heart defects, atresia choanae, and retardation of growth, genital, and ear abnormalities. The configuration of malformations differs among individuals with this disorder, and the various health issues can be life-threatening during infancy and childhood. Affected individuals typically have several main features or a combination of major and minor appearances. Here we are presenting a case report of a neonate with CHARGE syndrome who underwent successful repair of choanal atresia under general anaesthesia with invasive monitoring.

Anaesthetic Management Of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach, Faraz Shafiq, Fahad Salim, Ather Enam, Jai Parkash, Mohammad Faheem

Department of Anaesthesia

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length …

Anaesthetic Management Of Nesidioblastosis In Two Infants, Muhammad Saad Yousuf, Mohsin Nazir, Fauzia Khan

Department of Anaesthesia

Nesidioblastosis is the most common cause of non-transient, recurrent and persistent hypoglycaemia in neonates and infants. It is a disorder of diffuse proliferation of beta cells of the pancreas leading to hyperinsulinemia and hypoglycaemia. The main aim is to prevent the severe episodes of hypoglycaemia which can cause damage to the brain and/or mental retardation. In this case report we present two cases of nesidioblastosis and their perioperative anaesthetic course for near-total pancreatectomy. First case was a 7 months old female who had repeated episodes of convulsions since birth. Second case was a 4-month-old female child who again presented with …

Response To Comment On Mohammad Hamid Et Al (J Pak Med Assoc 67: 1019; 2017) - Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif

Section of General Surgery

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health …

Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Mohammad Hamid, Mohammad Irfan Akhtar, Hamid Iqil Naqvi, Khalid Ahsan

Department of Anaesthesia

Objective: To observe the incidence and pattern of thrombocytopenia in cardiac surgery patients.
Methods: This prospective, cohort study was conducted at the Aga Khan University Hospital, Karachi, from November 2014 to April 2015, and comprised adult cardiac patients. Patients with platelet count less than 150,000 x 109/L, history of malignancy, immune thrombocytopenic purpura and on chemo or radiotherapy were excluded. All information including demographics, platelet count, heparin doses, total cardiopulmonary bypass time, cross-clamp time, blood products transfused, any thromboembolic complication and the presence of infection were recorded on a pre-designed proforma. SPSS 19 was used for data analysis..
Results: Of …