Anesthesiology Commons^™

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 …

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 …

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 …

Continuous Subglottic Suctioning Of Intubated Patients In The Icu, Dan Deutsch

Physician Assistant Scholarly Project Posters

Ventilator associated pneumonia (VAP) is a common complication in mechanically ventilated patients. It causes substantial morbidity and mortality, as well as substantial cost to the patients and healthcare systems. One of the major risk factors identified for risk of VAP is the aspiration of secretions from the oropharynx. One intervention aimed at decreasing the incidence of secretion aspiration is an endotracheal tube (ETT) that can be hooked up to suction, providing continuous subglottic suctioning. The purpose of this paper was to explore the use of continuous subglottic suctioning and its effects on the incidence of ventilator-associated pneumonia. Review of literature …

In Children And Elderly Patients, What Are The Effects Of General Anesthesia On Neurological Health Compared With Procedural Sedation?, Taylor G. Caldwell

Theses and Dissertations

Anesthesia has been a necessity in the field of health care since it was discovered in the early to middle 1800s. Before anesthesia, many procedures and surgeries that are now considered an easy fix were life-threatening and patients often chose the inevitable death over the pain of surgery. The idea was stumbled upon when "laughing gas," nitrous oxide, was inhaled and credited in "produc[ing] a state of intoxication during which people became highly amused and insensitive to pain" (Palo Alto, 2013, para. 2). Anesthesia has come an unbelievably long way since the first surgery under anesthesia was performed by Dr. …

The Effect Of An Educational Intervention On The Knowledge And Management Of Ponv Among Anesthesia Providers: A Pilot Study, Eleazar Comprendio, Juan E. Ruan, Mohammad Zyed, Julie Lamoureux, Feliciano Villalba

All Publications

No abstract provided.

Perceptions Of Acupuncture And Acupressure By Anesthesia Providers, Amanda Faircloth

Theses and Dissertations

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure.

METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers …

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 …

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 …

Improving Anesthesia Professional Adherence To Hand Hygiene, Martha E. Seneca

UNF Graduate Theses and Dissertations

Performance of hand hygiene is among the most effective means of preventing healthcare associated infections (HAI) among patients. Deaths resulting from HAIs are one of the top ten leading causes of death in the United States. Any improvement in the frequency of hand hygiene among healthcare professionals may have a direct impact on patient mortality and associated costs. While anesthesia professionals have been found to have low rates of hand hygiene adherence, few targeted studies seeking to improve hand hygiene adherence among this group exist. Studies conducted to improve hand hygiene among health care professionals have reported limited improvement, with …

Increasing Practitioner Knowledge Of Ketamine As An Adjunct Analgesic For Postoperative Pain, Allison Goldfarb

UNF Graduate Theses and Dissertations

Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a …

Anesthesia Safety: Filter Needle Use With Glass Ampules, Debran L. Harmon

UNF Graduate Theses and Dissertations

Glass particle contamination of medication occurs when opening ampules which may cause patient harm. The use of filter needles reduces this risk. Many anesthesia providers use ampules daily, but do not use filter needles when aspirating medications from ampules. In addition, filter needles may not be readily available at the anesthesia medication preparation site. Not using filter needles or having them available for use can increase the risk of patient harm by glass particle contamination. The purpose of this project was to increase anesthesia provider’s knowledge thereby improving compliance with evidence-based standards when preparing medications from ampules. The goal is …

Comparing The Cumulative Pain Patients Experience Waiting For Knee Arthroplasty To Their Postoperative Pain, Eric S. Schwenk, Richard H. Epstein, Md, Cphims, Franklin Dexter

Department of Anesthesiology Faculty Papers

Introduction: Reduction of pain is a major goal of anesthesiologists treating patients undergoing knee arthroplasty. This has been achieved traditionally through the use of regional analgesia. Although these techniques decrease postoperative pain, they inherently do not affect the longstanding pain patients experience as they wait for surgery. Our objectives were to quantify: 1) the decrease in pain achieved by surgical joint replacement; and 2) the decrease in postoperative pain achievable through femoral nerve blocks versus opioids. From a systems-based perspective, we wanted to determine how much reduction in waiting time before surgery would be necessary to achieve an equal cumulative …

Evaluation Of Etoricoxib In Patients Undergoing Total Knee Replacement Surgery In A Double-Blind, Randomized Controlled Trial., Narinder Rawal, Eugene R. Viscusi, Paul M Peloso, Harold S Minkowitz, Liang Chen, Sandhya Shah, Anish Mehta, Denesh K Chitkara, Sean P Curtis, Dimitris A Papanicolaou

Department of Anesthesiology Faculty Papers

BACKGROUND: Optimal postoperative pain management is important to ensure patient comfort and early mobilization.

METHODS: In this double-blind, placebo- and active-controlled, randomized clinical trial, we evaluated postoperative pain following knee replacement in patients receiving placebo, etoricoxib (90 or 120 mg), or ibuprofen 1800 mg daily for 7 days. Patients >=18 years of age who had pain at rest >=5 (0--10 Numerical Rating Scale [NRS]) after unilateral total knee replacement were randomly assigned to placebo (N = 98), etoricoxib 90 mg (N = 224), etoricoxib 120 mg (N = 230), or ibuprofen 1800 mg (N = 224) postoperatively. Co-primary endpoints included …

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.

The Prevalence Of Postoperative Pain In The First 48 Hours Following Day Surgery At A Tertiary Hospital In Nairobi, Gilbert Mwaka, Shariff Thikra, Vitalis Mung’Ayi

Anaesthesiology, East Africa

Background: Day case surgery services are increasing all over the world. The prevalence of postoperative pain after day surgery is found to be high. Little is known about the prevalence of postoperative pain, in Kenya, after day case surgeries.

Objective: To investigate the prevalence of postoperative pain after day surgery at Aga Khan University Hospital (AKUH), Nairobi, to determine the severity/intensity of postoperative pain following day case surgery

Methods: Consecutive sampling was carried out until sample size of one hundred and fifty patients was achieved. The purpose and nature of the study was explained to patients before informed consent was …

Metabolic Syndrome Increases Risk For Pulmonary Embolism After Hip And Knee Arthroplasty., Boris Mraovic, Md, Brian R Hipszer, Md, Richard H. Epstein, Md, Javad Parvizi, Md, Edward C Pequignot, Md, Inna Chervoneva, Md, Jeffrey Joseph, Md

Department of Anesthesiology Faculty Papers

AIM: To investigate whether patients with metabolic syndrome (MetS) undergoing total hip or knee replacement have an increased risk for pulmonary embolism (PE).

METHODS: We studied patients undergoing total hip or total knee replacement from January 2001 to April 2006. The diagnosis of PE was based on a positive finding with a chest CT or a lung scan. Components of MetS were defined as 1) BMI≥30 kg/m(2) , 2) non-fasting preadmission glucose ≥11.1 mmol/L or diagnosis of diabetes, 3) hypertension, and 4) dyslipidemia. MetS was diagnosed if at least three of these components were present.

RESULTS: Of 7282 patients, 107 …

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 …

Medical Errors Related To Look-Alike And Sound-Alike Drugs, Samina Ismail,, Arshad Taqi

Department of Anaesthesia

Despite recent developments in the inventory management, introduction of electronic drug trolleys and cabinets, color coding of the filled syringes and many more interventions, medication errors could not be eliminated. The most common of these are syringe swap and human errors regarding wrong drug administration due to look-alike drug containers or sound-alike names of the drugs belonging to diverse groups. Many of the fatalities, that occur in third world countries due to these causes, go unnoticed and unregistered. This special article complements two special editorials on the same topic by Professor Joseph D. Tobias et al and Professor Robert Stoelting, …