Anesthesiology Commons^™

Electroconvulsive Therapy For A Patient With A Penetrating Ulcer In The Aortic Arch, Andrew Ng, Md, George Hsu, Md, Zvi Grunwald, Md

Department of Anesthesiology Faculty Papers

Case: An 85 year-old male presented with major depressive disorder refractory to medical therapy. A series of eight electroconvulsive therapy (ECT) was planned. Past medical history includes a small penetrating ulcer in the aortic arch, an ascending aortic aneurysm measuring 4.3 x 4.4 cm, atrial fibrillation on anticoagulation and hypertension. Medications include metoprolol, coumadin, simvastatin, alprazolam and venlafaxine.

Intraoperative Point-Of-Care Blood Glucose Values Show Poor Agreement With Central Lab Blood Values, Eric Schwenk, Md, Richard H. Epstein, Md, Cphims, Boris Mraovic, Md

Department of Anesthesiology Faculty Papers

Introduction:

Accuracy of point-of-care (POC) glucose devices compared to central lab values in critically ill patients has come into question, particularly during intensive insulin therapy.

POC devices perform particularly poorly in the hypoglycemic range.

Typically tested under ideal conditions in the lab; intraoperative, real-life data are lacking.

Emergency Airway Management Of A Patient With Tracheal Stenosis, Anwar-Ul-Huda, Muhammad Qamar-Ul-Hoda, Mohammad Sohail Awan

Department of Anaesthesia

We are presenting a case of a 26 year old healthy male, who came with gradual worsening of dyspnoea following prolonged intubation and ventilation, after a road traffic accident five months back. On arrival in ER, he was hypoxaemic with severe respiratory distress. He was transferred to the operation room (OR) for emergency tracheostomy. During the transfer, he was placed in an upright position with oxygen at 15 L/M. In the OR, anaesthesia was induced with sevoflurane gradually. Direct laryngoscopy was done which revealed normal vocal cords. A size 4.00 mm ID endotracheal tube was impossible to pass more than …

Single Lung Ventilation In A Young Child For Repair Of Coarctation Of Aorta, Mohammad Hamid, Mansoor Ahmed Khan, Muneer Amanullah

Department of Anaesthesia

Single lung ventilation in small children is extremely challenging. In this case, a paediatric bronchial blocker was successfully inserted in a 19-month-old child to provide single lung ventilation using a modified insertion technique. It provided excellent working conditions during thoracotomy and our method of insertion may help in reducing the cost.

Anaesthetic Management Of Two Patients With Beta-Thalassaemia Intermedia, Shahnawaz Ali, Fauzia Khan

Department of Anaesthesia

There is paucity of literature regarding the anaesthetic management of patients with thalassaemia intermedia. In this case study, the anaesthetic management and concerns in two children with thalassaemia intermedia aged eleven and nine years undergoing herniotomy and splenectomy respectively is reported. Both children had unanticipated difficulty in airway management and high intraoperative blood pressure trends. These cases are representative of the range of problems seen in children with thalassaemia intermedia.

Anaesthetic Management Of An Infant With Epidermolysis Bullosa Undergoing Inguinal Hernia Repair, Khalid Maudood Siddiqui, Sobia Khan

Department of Anaesthesia

Epidermolysis bullosa is a group of inherited disorders characterized by blistering of the skin as a result of minor trauma. We managed an infant with epidermolysis bullosa undergoing inguinal hernia repair. Anaesthesia was induced with oxygen/nitrous oxide mixture and sevoflurane. Oral tracheal intubation was done with a lubricated laryngoscope blade with KY jelly using atracurium 0.5 mg/kg and fentanyl 0.1 microgm/kg. To avoid frictions on the skin, endotracheal tube was tied with ribbon gauze and fixed around the neck. Pulse-oximetry probe and electrocardiogram electrodes were placed, and then attached to the patient's skin covered with KY jelly. Peripheral venous access …

Inadvertent Respiratory Acidosis Due To Damaged Water Trap Of Capnograph By Isoflurane, Eileen R. Manabat, Md, Richard Berman, Md, Yoogoo Kang, Md

Department of Anesthesiology Faculty Papers

Introduction: A few reports have documented isoflurane leakage causing damage to the water trap in the Drager Apollo anesthesia machine. This case describes an abnormal capnograph tracing yielding falsely normal end-tidal carbon dioxide tension (EtCO2) after breakage of the water trap by isoflurane.

A National Survey Into Desirable Personality Traits In Anaesthesia Trainees In A Developing Country, Fauzia Anis Khan, Fauzia N. Minai

Department of Anaesthesia

OBJECTIVE: To explore personality traits considered to be important in selection of trainees by consultant anaesthetists in a developing country.

METHODS: A questionnaire listing 28 traits was sent to 125 consultant anaesthetists. The raters were asked to mark each trait on a scale of 1 to 10, with one being least desirable and 10 as most desirable. Listing of five most desirable and one least desirable trait was also required.

RESULTS: The response rate was 79%. The most desirable trait was identified as reliability by 40%, followed by honesty 17%, functionality under stress 9%, punctuality 7%, and discipline 4%. The …

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.

Expectations Of Pain Relief Utilizing Epidural Analgesia, Kelly Powell Morris

Nursing Theses and Capstone Projects

This study describes patient expectations and actual pain relief reported by patients experiencing childbirth while utilizing epidural analgesia as their method of choice to reduce the pain associated with childbirth using a quantitative descriptive design. Data were collected using the Expectations of Pain Relief Utilizing Epidural Analgesia Questionnaire. The sample (N=17) consisted of first-time mothers delivering at an acute community hospital who were participants in the county's Nurse-Family Partnership Program. The questionnaire, developed by the researcher, was distributed to participants by their Nurse-Family Partnership Registered Nurse during a routine postpartum home visit during the three month study time span. The …

Hypertonic Saline For Peri-Operative Fluid Management, Vivian Mcalister, Karen E. A. Burns, Tammy Znajda, Brian Church

Surgery Publications

BACKGROUND: Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium.

OBJECTIVES: To determine the benefits and harms of HS versus IS solutions administered to patients undergoing surgery.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library) Issue 1, 2009; MEDLINE (1966 to 2009); EMBASE (1980 to 2009); LILACS (to August 2009) and CINAHL (1982 to 2009) without language restrictions.

SELECTION CRITERIA: We included randomized clinical trials where HS was compared to …

Incidence Of Post Dural Puncture Headache Following Caesarean Section Under Spinal Anaesthesia At The Aga Khan University Hospital, Nairobi, Edna Gisore, Vitalis Mung’Ayi, Sharif T.

Anaesthesiology, East Africa

Background: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist.

Objectives: To examine the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for Caesarean section.

Design: Prospective cohort study.

Subjects: All women who underwent Caesarean sections under spinal anaesthesia and fulfilled the inclusion criteria.

Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya.

Results: …

Conformity To The Surviving Sepsis Campaign International Guidelines Among Physicians In A General Intensive Care Unit In Nairobi, Vitalis Mung’Ayi, R. Karuga

Anaesthesiology, East Africa

Background: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage.

Objectives: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit.

Design: Cross sectional observational study.

Setting: The general intensive care unit, Aga Khan University Hospital, Nairobi.

Subjects: Admitting physicians from all specialties in the general intensive care unit.

Results: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had …