Anesthesiology Commons^™

Manual Trans-Tracheal High Frequency Positive Pressure Ventilation For Left Main Bronchus And Carinal Mass Surgical Resection In A Child, Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid

Department of Anaesthesia

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was …

Ultrasound-Guided Vascular Access: An Evolving Standard Of Care Clinical Practice, Which Is Extremely Under-Utilized In Pakistan, Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai

Department of Anaesthesia

No abstract provided.

Endothelin Signaling In Bone, Jasmin Kristianto, Michael Johnson, Rafia Afzal, Robert D. Blank

Department of Anaesthesia

The endothelin (ET) system includes 3 small peptide hormones and a pair of G-protein-coupled receptors. This review first outlines the ET signaling pathway and ET metabolism. Next, it summarizes the role of ET1 signaling in craniofacial development. Then, it discusses observations relating ET signaling to osteoblastic and other osteosclerotic processes in cancer. Finally, it describes recent work in our laboratory that points to endothelin signaling as an upstream mediator of WNT signaling, promoting bone matrix synthesis and mineralization. It concludes with a statement of some remaining gaps in knowledge and proposals for future research.

Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar

Department of Anaesthesia

No abstract provided.

Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai

Department of Anaesthesia

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and …

Emerging Protagonists In Cancer Metastasis: An Oath Of Allegiance By Platelets, Akbar Shoukat Ali, Arzoo Ajaz, Heeba Hamid

Department of Anaesthesia

No abstract provided.

Physical Manipulation Of Larynx As A Technique For Insertion Of Nasogastric Tube, Sheema Siraj, Mehmood Mian, Fauzia Anis Khan

Department of Anaesthesia

No abstract provided.

Pulmonary Hypertensive Crisis And Its Efficient Management. A Case Report And Literature Review, Karima Karam Khan, Fazal Hameed Khan

Department of Anaesthesia

Perioperative anaesthetic management of patients with pulmonary hypertensive crisis is complex and challenging because of limited window period and treatment options. This case report describes the successful management of a patient with severe valvular heart disease superimposed by severe pulmonary hypertension, who developed pulmonary hypertensive crisis soon after induction of general anaesthesia for cardiac surgery. Pulmonary hypertensive crisis is not a usual phenomenon in these patients, but if it occurs it can be fatal. Anticipatory care of the patient to prevent crisis is the mainstay of treatment, otherwise it adds additional morbidity to such patients. Fortunately our patient survived the …

An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan

Department of Anaesthesia

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke, paraparesis/paraplegia/quadriparesis/or quadriplegia, new …

Multi-Organ Dysfunction Secondary To Yellow Scorpion Sting, Muhammad Faisal Khan, Hameed Ullah

Department of Anaesthesia

Scorpion stings are common in tropical and subtropical regions. The history and clinical manifestation warrant urgent recognition and treatment. The incidence of scorpion stings in Pakistan is not known as there is no published data available in literature. We report our experience of a yellow scorpion sting victim who required intensive care admission after developing multi-organ dysfunction.

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.

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 …

Monitoring Intra-Abdominal Pressure : Should It Be A Routine For Critically Ill?, Madiha Hashmi

Department of Anaesthesia

No abstract provided.

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 …

794 Evaluating Disability In Adult Burn Injury Patients Treated At A Tertiary-Care Burn Unit In Karachi, Pakistan: A Longitudinal Study Using Who Disability Assessment Schedule Ii, Nukhba Zia, Asim Durrani, Safia Awan, Madiha Hashmi, Mazhar Nizam, Asad Latif

Department of Anaesthesia

Background: Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan.
Methods: This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(>18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related …

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 …

Incidence, Outcome And Risk Factors For Sepsis- A Two Year Retrospective Study At Surgical Intensive Care Unit Of A Teaching Hospital In Pakistan, Ali Asghar, Madiha Hashmi, Saima Rashid, Fazal Hameed Khan

Department of Anaesthesia

Background: Sepsis is amongst the leading causes of admission to the intensive care units and is associated with a high mortality. However, data from developing countries is scarse. Aim of conducting this study was to determine the incidence, outcome and risk factors for sepsis on admission to surgical intensive care unit (SICU) of a teaching hospital in Pakistan.
Methods: Two year retrospective observational study included all consecutive adult admissions to the surgical intensive care unit (SICU) of a University Hospital, from January 2012 to December 2013.
Results: Two hundred and twenty-nine patients met the inclusion criteria. Average age of the …

Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital, Mohammad Irfan Akhtar, Hasanat Sharif, Mohammad Hamid, Khalid Samad, Fazal Hameed Khan

Department of Anaesthesia

Background: Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients.
Methods: The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump …

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.

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.

Developing Local Guidelines For Management Of Sepsis In Adults: Sepsis Guidelines For Pakistan (Sgp), Madiha Hashmi, Fazal Hameed Khan, Sarwar Zubairi, S. Tipu Sultan, Saeeda Haider, Sadqa Aftab, Javed Husain, Anwar Ul Haq, Zahid Akhtar Rao, Amin Khuwaja, Syed Farjad Sultan, Zunairah Rais, Roohina Baloch, Naseem Salahuddin, Aslam Khan, Faisal Sultan, Kamran Chima, Amjad Ali, Gohar Ali

Department of Anaesthesia

Background: The purpose of developing ‘Sepsis Guidelines for Pakistan’ (SGP) is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign (SSC) tailored to available resources. These recommendations are not meant to replace the SSC Guidelines.
Methodology: SGP is an initiative of Pakistan Society of Critical Care Medicine (PSCCM). Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committee i.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, …

Job Stress Among Female Residents During Postgraduate Training At A University Hospital In Karachi, Pakistan, Madiha Hashmi, Fauzia A. Khan, Khan S, Ali S. K

Department of Anaesthesia

Background: Postgraduate medical training is a stressful experience for both male and female doctors but previous studies have shown that stress might be more prevalent amongst female residents. Since women make up 70-80% of medical graduates in Pakistan we conducted this study to determine the prevalence of stress among female residents during postgraduate training and identify the most common stressors.

Methodology: All female residents enrolled in postgraduate training programmes at the Aga Khan University meeting the inclusion criteria were recruited and informed written consent was obtained. Job Stress Inventory (JSI) was used to identify symptoms and sources of job stress. …

Perioperative And Acute Care Transesophageal Echocardiography (Toe), Madiha Hashmi

Department of Anaesthesia

In Pakistan perioperative transoesophageal echocardiography (TOE) during cardiac surgery is available in a few centers with reliance on cardiologists and cardiac technicians and its use in noncardiac surgery and intensive care units is very limited. In view of the increasing popularity of TOE based on obvious benefits this review is presented with an aim to evaluate the current indications and potential benefits of using TOE during anesthesia for cardiac and non-cardiac surgery and the intensive care units and compare TOE with pulmonary artery catheter (PAC) and transthoracic echocardiography (TTE) as an hemodynamic monitor in the acute care setting.

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 …

Rare Presentation Of Posterior Reversible Encephalopathy Syndrome (Pres) And Neurogenic Stunned Myocardium In A Patient After Emergency Cesarean Section, Ausaf Ahmed Khan, Khalid Samad, Kashif Munshi, Madiha Hashmi

Department of Anaesthesia

Posterior Reversible Encephalopathy Syndrome (PRES) is clinically characterized by seizures, lethargy, nausea and visual impairment. These findings are thought to be due to vasogenic edema, predominantly in the posterior cerebral hemispheres and are reversible with appropriate management. Neurogenicstunned myocardium is a syndrome of reversible left ventricular dysfunction, associated with excessive sympathetic discharge states like pheochromocytoma, high-grade subarachnoid hemorrhage (SAH), status epilepticus and significant emotional stress. Here, we report a case of PRES and Neurogenic-stunned myocardium occurring simultaneously in a 25 year old primigravida at 34 weeks of gestation with twin pregnancy who presented to the emergency department with eclampsia and …

A Review Of Critical Care Management Of Maternal Sepsis, Madiha Hashmi, Fazal Hameed Khan

Department of Anaesthesia

Sepsis is a leading cause of preventable maternal mortality in developing countries due to poverty, home deliveries by untrained persons in unhygienic conditions, limited access to healthcare facilities and lack of availability of antibiotics. Recent confidential enquiries into maternal deaths from the developed nations have revealed an increase in maternal mortality secondary to genital tract sepsis and provision of suboptimal critical care. Early recognition of critical illness in obstetric patients, involvement of intensive care teams earlier and provision of same standard of critical care to pregnant women as non-pregnant patients while being mindful of the altered maternal physiology and fetal …

Apache Ii Analysis Of A Surgical Intensive Care Unit Population In A Tertiary Care Hospital In Karachi (Pakistan), Madiha Hashmi, Ali Asghar, Saima Rashid, Fazal Hameed Khan, Hameedullah

Department of Anaesthesia

Purpose: Performance of prognostic models deteriorates over time by changes in case-mix and clinical practice. This study was conducted to describe the case-mix of a surgical intensive care unit (SICU) and assess the performance of APACHE II scoring system in this cohort.
Methodology: We analyzed 213adult patients admitted to the surgical intensive care unit (SICU) of Aga Khan University Hospital, from January 2011 to December 2012 and the performance of APACHE II scoring system was assessed in this population.
Results: The mean age of patients was 46.31 years (SD ±18.43), 67.1% patients were male and mean length …

To Compare The Accuracy Of Prayer's Sign And Mallampatti Test In Predicting Difficult Intubation In Diabetic Patients, Mirza Mudassir Ali Baig, Fazal Hameed Khan

Department of Anaesthesia

Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients.
Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was …

Right Ventricular Perforation: A Rare Complication Of Pulmonary Artery Catheterization, Khalid Ahsan, Mohammad Hamid, Saulat H. Fatimi, Ijaz Hidayat

Department of Anaesthesia

A 70 years old male underwent Coronary Artery Bypass and Graft (CABG) surgery. After induction, a Pulmonary Artery Catheter (PAC) was inserted via right IJV with some difficulty in achieving PA tracing. During distal RCA anastomosis, surgeon noticed PAC tip coming out of Right Ventricular (RV) surface. Resistance was felt on trying to pull PAC, so it was left there. Cardiac surgeon then opened the Right Atrium (RA) and pulled out the catheter. Multiple attempts during insertion of PA catheter should always raise the suspicion of PAC tip slipping back into the RV. It should be closely monitored during surgery …