Case Report Open Access

Six Month Quality of Life of Trauma Patients from A Non- Trauma Regional Hospital in Singapore

Shahla Siddiqui, Lim WoanWui and Koh Kwong Fah
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: Introduction: Trauma is a leading cause of mortality and morbidity in Singapore. In our peripheral hospital we have a large trauma load despite being a non level one trauma center. Whilst we have many studies done in the West documenting the quality of life of trauma victims using scoring systems such as the EQ5DTM and GOSE, there is a paucity of literature from this part of the World. Methods: We analyzed the results of 6 months of data collected by our trauma coordinator looking specifially at the EQ5DTM and GOSE scores after 6 months of rehabilitation amongst survivors. Phone interviews were conducted with patients or proxies as respondents. Results: Our scores showed a poor quality of life in 50% of the cohort. An average score of 5-10 was found in 30% of respondents. Only 31% of the patients returned to work, 31% of these were doing the same job as before the trauma and 20% lived in a nursing home. The GOSE (Glasgow outcome score extended) is the most widely used method to describe overall outcome after head injury. Our results showed 63% recovered moderately at 6 months whilst 31% were severely disabled. 20% reported disrupted family relations and only 56% reported resumption of normal life. Discussion: Further large studies are needed to determine similar scores across Singapore and psycho social interventions required to ensure a better prognosis and outcome.

PDF   | Full Text   DOI: 10.23937/2377-4630/1011

Case Report Open Access

What Happens if The Patient Does Not Tell the Truth to His Anesthesiologist?

Alev Oztas, Ezgi Erkilic, Elvin Kesimci, İbrahim Keser and Duran Canatan
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: This is the case report of a young man, whose clinical condition has not been identified properly in the preoperative evaluation. A 27-yr-old man presented with complaints of nasal obstruction. His clinical examination was almost unremarkable, except for indistinct cyanosis at the lips. He denied any symptoms related cardiovascular and respiratory systems. A chest radiograph was normal, as were all laboratory investigations. He had received general anesthesia with persistent low pulse oximetry readings. This led us to investigate him further in the postoperative period and to report Kansas haemoglobin as the fist, benign haemoglobinopathy from Turkish population.

PDF   | Full Text   DOI: 10.23937/2377-4630/1010

Original Article Open Access

Platelet Count and INR Profile after Hepatic Resection in Cirrhotic Patients: Implications for Epidural Analgesia

Siniscalchi A, Gamberini L, Carini A, Laici C, Tassinari S and Faenza S
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: Introduction: Since cirrhotic patients undergoing hepatic resection are at increased risk of developing postoperative coagulopathy, epidural catheter placement in this group of patients is still debated. This retrospective study aimed to evaluate postoperative course of coagulation parameters after surgical hepatic resection in cirrhotic patients and their relation to extent of resection and perioperative risk factors. Methods: Perioperative data from 232 hepatic resections performed in cirrhotic patients were reviewed. We defied postoperative coagulopathy the occurrence of a postoperative platelet count < 100,000/µL and/or INR value ≥ 1.5. Logistic regression was used to assess the association between postoperative coagulopathy and several potential risk factors, while general linear model for repeated measures was used to compare postoperative course of coagulation parameters. Results: 98 patients (42.24%) showed an abnormal coagulation profie at least once during the fist 7 postoperative days. None of the analyzed parameters resulted statistically associated with the development of postoperative coagulopathy. Postoperative INR course was signifiantly different in patients undergoing minor resections with better values, while platelet count was not. Conclusions: Postoperative coagulopathy after hepatic resections is a common issue in cirrhotic patients, which may limit the feasibility of invasive procedures such as epidural catheter placement. Multivariate analysis didn’t show any association between investigated risk factors and postoperative coagulopathy. Postoperative course of coagulation parameters in cirrhotic patients with normal preoperative coagulation tests undergoing minor liver resection seems to be compatible with epidural catheter placement and management.

PDF   | Full Text   DOI: 10.23937/2377-4630/1009

Editorial Open Access

Is Left Ventricular Hypertrophy Early Regression Possible?

Delgado-Baeza Emilio, Quintana-Villamandos Begona
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: It is well established that hypertension is associated with increased cardiovascular morbidity and mortality. Left Ventricular Hypertrophy (LVH) is a relevant problem in patients with hypertension because of its role in long-term severe cardiovascular diseases, including ventricular arrhythmia, congestive heart failure, myocardial infarction, stroke and sudden death. There is a relationship between the regression of LVH and a decreased morbidity and mortality. Treatment to achieve regression of LVH is a goal in clinical practice, however, there are some questions that need to be considered: First, does the regression of LVH guarantee a normal ventricle? Second, in the literature we found that LVH is reversed by antihypertensive therapy, however, is the translation of these findings into clinical practice possible?

PDF   | Full Text   DOI: 10.23937/2377-4630/1008

Case Report Open Access

Airway Management in a Patient with Metatropic Dysplasia: Grossly Abnormal Anatomy Combined with a Low Functional Residual Capacity

Joseph G. Werner, Alberto A. Uribe, Karina Castellon-Larios, Sergio D. Bergese and Matthew P. McKierna
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: Difficult intubation is a constant concern in surgical and critical care settings due to its direct relationship with morbidity and mortality. The incidence reported in literature varies between 0.1% to 13% and reaches 14% in the obese population. The American Society of Anesthesiologists (ASA) defined difficult airway as a situation in which a trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both. They also defined difficult tracheal intubation as an intubation requiring multiple attempts in the presence or absence of tracheal pathology. The complications related to difficult intubation include, but are not limited to: death, hypoxic brain injury, cardiopulmonary arrest, rescue tracheostomy, airway trauma, aspiration, and damage to teeth. Fiber optic intubation and the use of laryngeal mask airways has been a great alternative to manage difficult intubation cases. Different methods and tools have been created and studied to predict a potential difficult intubation case; however, there is not a strong consensus of which one is more used and/or validated.

PDF   | Full Text   DOI: 10.23937/2377-4630/1007

Case Report Open Access

Preemptive Analgesia of Ultrasound - Guided Transversus Abdominis Plane Block Compared with Deep Wound Infiltration in Patients Undergoing Urological Surgery

Karim Omar Elsaeed and Hoda Shokri
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: Background: Transversus abdominus plane (TAP) block is suitable for unilateral urologic surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound (USG) guided TAP block compared with wound infiltration with bupivacaine (0.25%) in patients undergoing urologic surgeries. Methods: In a prospective study, 40 patients undergoing elective unilateral urological surgeries as nephrolithotomy were divided into two groups , The TAP group (n=20) received TAP block with 0.25% bupivacaine (30mL) and infiltration group (n=20) the skin and subcutaneous tissues of the surgical incision and deep muscle layers were infiltrated with 0.25% bupivacaine (50ml). Pethidine 1 mg/kg was given as rescue analgesic at VAS more than 3 at rest and on movement. Total dose of pethidine, VAS at rest and on movement, sedation score and the number of patients experiencing vomiting or pruritis were recorded. Results: Patients of TAP group had significantly lower VAS score, lower pethidine consumption with less incidence of complications as vomiting and pruritis. There was insignificant difference between study groups as regards sedation score. Conlusion: The USG TAP block is easy to perform and more effective as a postoperative analgesic regimen in urologic surgeries with opioid sparing effects and without any complications compared with wound infiltration technique.

PDF   | Full Text   DOI: 10.23937/2377-4630/1006

Research Article Open Access

Intrathecal Dexmedetomidine or Meperidine for Post-spinal Shivering

Mohamed Hamdy Ellakany
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: Background: Shivering occurs frequently during the perioperative period. A prospective, randomized, double-blind study was done to compare between intrathecal dexmedetomidine (5mcg) and intrathecal meperidine (0.2mg/kg) for decreasing the incidence and intensity of shivering after spinal anesthesia for lower abdominal operations. Methods: Seventy five patients scheduled for lower abdominal operations under spinal anesthesia were randomly allocated to three groups. Spinal anesthesia consisted of 12.5 mg hyperbaric bupivacaine 0.5% in addition to dexmedetomidine (5mcg) (group D) or meperidine (0.2 mg/kg) (group M) or, normal saline (group S). Different parameters, including sublingual temperature, sensory block, motor block, incidence and intensity of shivering, sedation score, blood pressure, heart rate, pruritus, nausea, and vomiting was performed at 10 minute intervals. Statistical analysis was carried out using statistical package for social sciences (SPSS) version 15.0 for windows and employing ANOVA and chi-square test with post-hoc comparisons with Bonferroni’s correction. Results: Hypothermia was recorded in 17 patients (68%) in group D, 16 patients (64%) in group M and 18 patients (72%) in group S, while shivering developed in 5 patients (20%) in group D, 6 patients (24%) in group M and 23 patients (92%) in group S, however, pruritus, nausea and vomiting was more common in the meperidine group compared to the other two groups. Conclusion: Intrathecal dexmedetomidine and meperidine lowered the incidence of shivering and increased duration of sensory and motor block during lower abdominal operations. Intrathecal meperidine caused more pruritus, nausea and vomiting than intrathecal dexmedetomidine.

PDF   | Full Text   DOI: 10.23937/2377-4630/1004

Case Report Open Access

Anaesthetic Management in a Patient with Glomus Jugulare Tumour for Ankle Surgery

Monu Yadav, R Gopinath, B Rajesh Kumar, Shibani Padhy, A Anand Ram and Suresh Kumar Chintha
Int J Anesthetic Anesthesiol Volume 1, Issue 2

Abstract: Anaesthesia has special considerations in any case of intracranial space occupying lesions. Not much of literature is available about anaesthetic considerations in a patient with Glomus jugulare tumour requiring surgery for non neurosurgical procedure. Glomus jugulare tumours arise from the glomus body within the adventitia of the jugular bulb. Glomus bodies are histologically similar to carotid bodies. They are composed of epitheloid cells embedded in capillary net work. Occasionally these tumours are capable of secreting catecholamines. We present a known case of Glomus jugulare tumour with right ankle bimalleolar fracture dislocation for open reduction, fibular plating and cancellous screw fixation of medial malleolus.

PDF   | Full Text   DOI: 10.23937/2377-4630/1005

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