Anesthesiology Commons^™

Chiral Polarization Scale Of Qcd Vacuum And Spontaneous Chiral Symmetry Breaking, Andrei Alexandru, Ivan Horváth

Anesthesiology Faculty Publications

It has recently been found that dynamics of pure glue QCD supports the low energy band of Dirac modes with local chiral properties qualitatively different from that of a bulk: while bulk modes suppress chirality relative to statistical independence between left and right, the band modes enhance it. The width of such chirally polarized zone – chiral polarization scale Λch – has been shown to be finite in the continuum limit at fixed physical volume. Here we present evidence that Λch remains non–zero also in the infinite volume, and is therefore a dynamical scale in the theory. Our experiments in …

A Randomized Control Trial To Assess The Effect Of Aketamineinfusion On Tourniquet Hypertension During General Anaesthesia In Patients Undergoing Upper And Lower Limb Surgery, Joyce Atieno Ongaya

Master of Medicine in Anaesthesiology

Background: Tourniquet hypertension arising from tourniquet inflation remains of primary concern to the anaesthetist. One drug commonly used to manage tourniquet hypertension is ketamine. Several studies show that ketamine attenuated the blood pressure rise associated with tourniquet inflation. None of the studies carried out examined the effect of ketamine on tourniquet hypertension for a period of more than one hour or an infusion of the same. Objective: To compare the effect of an intravenous infusion of ketamine, versus placebo on tourniquet induced hypertension in patients undergoing upper and lower limb surgery under general anaesthesia Study design: Single blinded Randomized Controlled …

A Randomised Controlled Trial Comparing The Effect Of Adjuvant Intrathecal 2mg Midazolam To 20-Micrograms Fentanyl On Post-Operative Pain For Patients Undergoing Lower Limb Orthopaedic Surgery Under Spinal Anaesthesia, Francis Otieno Codero

Master of Medicine in Anaesthesiology

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. As an intrathecal adjuvant, fentanyl improves the onset and quality of spinal blockade as compared to plain bupivacaine and confers a short duration of postoperative analgesia. However, its use is associated with several adverse effects that range from pruritus to life threatening respiratory depression. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of postoperative analgesia. No studies have been done comparing intrathecal fentanyl …

Effects Of Intravenous Diclofenac On Postoperative Sore Throat In Patients Undergoing Laparoscopic Surgery At Aga Khan University Hospital, Nairobi: A Prospective, Randomized, Double Blind Controlled Trial, Thang'a P., Dorothy Kamya, Vitalis Mung’Ayi

Anaesthesiology, East Africa

Background: Postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated.

Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat.

Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and …

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 …

Perioperative Management Of Interscalene Block In Patients With Lung Disease., Eric S. Schwenk, Kishor Gandhi, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Interscalene nerve block impairs ipsilateral lung function and is relatively contraindicated for patients with lung impairment. We present a case of an 89-year-old female smoker with prior left lung lower lobectomy and mild to moderate lung disease who presented for right shoulder arthroplasty and insisted on regional anesthesia. The patient received a multimodal perioperative regimen that consisted of a continuous interscalene block, acetaminophen, ketorolac, and opioids. Surgery proceeded uneventfully and postoperative analgesia was excellent. Pulmonary physiology and management of these patients will be discussed. A risk/benefit discussion should occur with patients having impaired lung function before performance of interscalene blocks. …

Blended Learning In Anesthesia Education: Current State And Future Model, Jaya Kannan, Viji Kurup

Jandrisevits Faculty Publications

Purpose of review: Educators in anesthesia residency programs across the country are facing a number of challenges as they attempt to integrate blended learning techniques in their curriculum. Compared with the rest of higher education, which has made advances to varying degrees in the adoption of online learning anesthesiology education has been sporadic in the active integration of blended learning. The purpose of this review is to discuss the challenges in anesthesiology education and relevance of the Universal Design for Learning framework in addressing them.

Recent findings: There is a wide chasm between student demand for online education and the …

Root Causes Of Intraoperative Hypoglycemia: A Case Series., Eric S. Schwenk, Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, Richard H. Epstein

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To describe the root causes of intraoperative hypoglycemic events.

DESIGN: Retrospective analysis.

SETTING: Large academic teaching hospital.

MEASUREMENTS: Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.

MAIN RESULTS: Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.

CONCLUSION: Intraoperative hypoglycemia was rare, but often …

Influence Of Body Mass Index And Antibiotic Dose On The Risk Of Surgical Site Infections In Pediatric Clean Orthopedic Surgery., Jeffrey J Cies, Shannon Chan, Jobayer Hossain, B Randall Brenn, M Cecilia Di Pentima

Department of Anesthesiology Faculty Papers

OBJECTIVE: To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients.

PATIENTS AND METHODS: Children between 2 and 19 years of age undergoing clean orthopedic procedures and receiving at least one dose of perioperative antibiotics (cefazolin, vancomycin, or clindamycin) were studied. The retrospective case-controlled study was conducted at the Alfred I. duPont Hospital for Children, a 180-bed tertiary-care academic pediatric hospital in Wilmington, DE. Data were collected from January 1, 2002, to December 31, 2005.

RESULTS: Underweight children had a higher risk for SSIs than overweight and normal-weight children. American Society …

Fiberoptic Intubation In A Paediatric Patient With Severe Temporomandibular Joint (Tmj) Ankylosis, Ali Asghar, Faisal Shamim, Asiyah Aman

Department of Anaesthesia

Craniofacial abnormalities are associated with mandibular hypoplasia, reduced mandibular space with overcrowding of soft tissues and maxillary hypoplasia. Decreased mouth opening and limitation in jaw protrusion are independent predictors of difficult airway in such patients. The relative difficult problem becomes even graver in the paediatric age group because of their small mouth opening and un-cooperativeness. A child with severe temporomandibular joint (TMJ) ankylosis presented with negligible mouth opening and required surgical correction under general anaesthesia. Successful intubation was performed with endotracheal tube size 5.5 mm using an adult 4.3 mm fiberoptic bronchoscope under inhalational as well as topical anaesthesia.

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.

Pain Assessment And Management In Different Wards Of A Tertiary Care Hospital, Anwar Ul Huda, Mohammad Hamid, Saboor Ahmed, Syed Muhammad Baqir, Aysha Almas

Department of Emergency Medicine

OBJECTIVE:

To assess the pain management by medical team, emergency room (ER) team and Acute Pain team in a tertiary care hospital.

METHODS:

The cross-sectional study was done in Medical Ward, Surgical Ward and Emergency Room of Aga Khan University, Karachi, in March-April 2010. The assigned research medical officer visited the three locations every day and selected patients by way of convenient sampling. The study comprised 75 patients; 25 each in three groups. Information was collected on patient's demographics, general characteristics, type of drugs and modalities used. Specific queries about pain were sorted out like adequacy of pain assessment done …

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 …

Unintentional, Paediatric Domestic Injury In A Semi Rural Area Of Karachi., Emaduddin Siddiqui, Kiran Ejaz, Uzma Siddiqui

Department of Emergency Medicine

OBJECTIVE:

To identify the characteristics of unintentional domestic injury in children living in a semi-rural area of Karachi.

METHODS:

This retrospective descriptive study was carried out at a private hospital located at the northern outskirts of Karachi, Pakistan, from January 2005 to January 2007. We enrolled 271 out-patient children of either gender with a positive injury history. A questionnaire inquiring socio-demographic characteristics, timing of injury, monthly variation, injury pattern and factors was filled out. Descriptive analysis and Chi-square test were applied to find out the statistically significant differences.

RESULTS:

Among the 271 patients, the male-to-female ratio was 1.2:1. Fall from …

Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy, Muhammad Shahzad Shamim, S. Ather Enam, Muhammad Zubair Tahir, Mueenullah Khan

Section of Neurosurgery

Objective: To evaluate midazolam as an epidural analgesic in patients undergoing single-level microdiscectomy.
Methods: This prospective case control study was carried out at the Aga Khan University Hospital, Karachi, from January 20 to September 20, 2007, on patients undergoing microdiscectomy. Cases (group A) received midazolam with saline, while controls (group B) received saline only, placed intra-operatively over involved nerve root. Post-operatively, patients were monitored for various variables. Data was analysed using SPSS 13.0 and groups were compared using student's t-test for continuous variables and chi square for categorical variables. P-value <0.05 was considered significant.
Results: Patients in group A ambulated earlier (p = 0.005) …

A Randomised Controlled Trial Comparing Haemodynamic Stability In Elderly Patients Undergoing Spinal Anaesthesia At L5,S1 Versus Spinal Anaesthesia At L3,4 At The Aga Khan University Hospital, Nairobi, Karen Nkatha Mbaya

Master of Medicine in Anaesthesiology

Background: Spinal anaesthesia is a routinely used anaesthetic technique for elderly patients undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia and these include stable haemodynamic variables, less blood loss, less post operative pain, faster recovery time and less post operative confusion. However, despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible …

Influence Of The Menstrual Cycle On The Incidence Of Nausea And Vomiting After Laparoscopic Gynecological Surgery: A Pilot Study., Tatjana Simurina, Boris Mraovic, Neven Skitarelić, Tatjana Andabaka, Zdenko Sonicki

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN: Prospective, observational, blinded study.

SETTING: General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS: 111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS: Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal …