Research and Innovation in Anesthesia

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2020 | January-June | Volume 5 | Issue 1

Original Article

Priti S Devalkar, Priti Devalkar, Sweta V Salgaonkar, Mansi Badve

Audit of Anesthetic Management of Parturients with Cardiac Diseases Posted for Obstetric Procedures in a Tertiary Care Hospital

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Anesthesia, Cardiac monitoring, Cardiac parturients, Labor analgesia

PDF  |  DOI: 10.5005/jp-journals-10049-0069  |  Open Access |  How to cite  | 

Abstract

The obstetric patient with heart disease challenges the anesthesiologists’ skills. Pregnancy and labor due to hemodynamic burden and the hypercoagulable state compromise an already stressed cardiovascular system. In developed countries, congenital heart disease (CHD) is the most common cause whereas in developing countries, still rheumatic heart disease remains the major concern. Results: Over a period of 6 months, we encountered 30 patients with cardiac disease posted for different obstetric procedures. Anesthesia management was decided according to severity and pathophysiology of cardiac lesion and urgency of procedure. In this article, we have mentioned our experience with cardiac parturients with CHD, rheumatic heart disease, peripartum cardiomyopathy, and Takayasu arteritis. Conclusion: Effective management of obstetric patient with cardiac disease includes antepartum counseling, risk stratification, an optimization, monitoring and tailored anesthesia plan for labor, delivery, and obstetric procedure, and intensive care unit care in the immediate postpartum period.

Original Article

Sarika S Naik, Chaitra Venkategowda, Narasimha Reddy, Sudhir M Naik

Combined Nerve Block and Topical Anesthesia: An Effective Alternate to General Anesthesia in Hybrid Balloon Sinuplasty Procedures

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:4] [Pages No:6 - 9]

Keywords: Hybrid balloon sinuplasty, Infraorbital nerve block, Maxillary nerve block

PDF  |  DOI: 10.5005/jp-journals-10049-0080  |  Open Access |  How to cite  | 

Abstract

Background/objectives: Hybrid balloon sinuplasty (BSP) is recommended for chronic rhinosinusitis without polyposis. Standalone BSP is an office-based procedure under local anesthesia. Materials and methods: We report a randomized study of patients operated with hybrid BSP under local and topical anesthesia in one group and the other group done under general anesthesia. Results: In the comparative analysis, local anesthesia hybrid procedures were more economical with equal symptoms improvement. Conclusion: The hybrid BSP procedure not only reduces the obstruction of chronic rhinosinusitis but also as a hybrid procedure addresses turbinates and deviated nasal septums. As such a complex procedure is done under local anesthesia while reducing the costs of hospitalization.

CASE REPORT

Aparna A Ruparel, Shilpa Kanakam, Raghbirsingh Gehdoo, Shruti Hazari, Azra Z Kakroo, Dhirav H Shah

Anesthesia Management for Electrophysiological Neuromonitoring in a Patient of a Spinal Tumor Excision at Lumbar Level: A Case Report

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:3] [Pages No:10 - 12]

Keywords: Somatosensory and motor-evoked potential, Spinal tumor, Total intravenous anesthesia

PDF  |  DOI: 10.5005/jp-journals-10049-0068  |  Open Access |  How to cite  | 

Abstract

This is a case report of a 40-year-old ASA1 patient posted for intradural extramedullary tumor at the level of the L2–L3 spine. The patient was operated for the same and the tumor was resected. Postoperatively after 36 hours, the patient complained of loss of bladder sensation associated with urinary retention. Surgical, urological, and radiological findings were suggestive of the mass effect (remnant tumor or clot) at the site of the previous surgery. A decision was taken to perform a re-exploration at the site with the use of electrophysiological monitoring including somatosensory evoked potential (SSEP) and motor-evoked potential (MEP). The surgery was performed completely under total intravenous sedation with the use of midazolam, fentanyl, and propofol. The remnant mass was resected and the patient regained sensory functions in the postoperative period. Hence, this case report highlights the use of total intravenous sedation for somatosensory and motor-evoked potential monitoring in major neurosurgeries.

CASE REPORT

Apeksha A Gala, Naina Dalvi

Anesthesia Management of a Child with Duchenne's Muscular Dystrophy Posted for Skin Grafting

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:2] [Pages No:13 - 14]

Keywords: Caudal anesthesia, Duchenne\'s muscular dystrophy, Skin grafting

PDF  |  DOI: 10.5005/jp-journals-10049-0079  |  Open Access |  How to cite  | 

Abstract

Children with neuromuscular diseases may often present for anesthesia either as a part of a diagnostic procedure or surgery relating to their underlying disorder or for incidental surgery. The diagnosis may be clear from either a family history or from the clinical and pathological features. We managed to successfully anesthetize an 8-year-old male child who was a known case of Duchenne\'s muscular dystrophy and was posted for skin grafting surgery of his right lower limb. We would like to emphasize here the benefits of regional anesthesia, in such cases, (caudal in this case) which to a great extent reduces the requirement of general anesthetics used in the procedure, apart from giving adequate analgesia to the patients.

CASE REPORT

Amruta V Hippalgaonkar, Chaitanya V Bokil

Adrenal Cyst: An Incidental Finding!

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:3] [Pages No:15 - 17]

Keywords: Laparoscopy,Adrenal cyst, General anesthesia

PDF  |  DOI: 10.5005/jp-journals-10049-0083  |  Open Access |  How to cite  | 

Abstract

Adrenal cysts are rare, mostly silent clinically and their management remains controversial. Herein, we report a case of adrenal cyst in a young female who was incidentally found to have a cystic lesion of either suprarenal or pancreatic origin by abdominal ultrasonography during workup for her left abdominal pain radiating to back and leg. The computed tomography (CT) revealed a large thin-walled cystic lesion, enhanced on the left suprarenal gland, with eccentric calcification, causing mass effect on the pancreas and left kidney. Laparoscopic surgical exploration was performed and the cystic adrenal mass was excised. The histopathologic diagnosis was mesothelioma. Thus, we discuss the diagnosis and management of adrenal cyst and briefly review the literature.

CASE REPORT

Saloni K Shah

Anticipated Difficult Airway Management with McGrath Mac Videolaryngoscope for a Case of Pyriform Fossa Carcinoma: A Case Report

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:3] [Pages No:18 - 20]

Keywords: Anticipated difficult airway, Awake intubation, McGrath Mac videolaryngoscopy, Pyriform fossa carcinoma

PDF  |  DOI: 10.5005/jp-journals-10049-0085  |  Open Access |  How to cite  | 

Abstract

Pyriform fossa carcinoma is usually an exophytic squamous cell carcinoma which may lead to a change in the anatomy and pathophysiology of the airway. Total laryngectomy is required in such cases. Airway management is challenging for such patients from both surgical and anesthesiologist\'s perspective during anesthesia induction. These patients usually present in the advanced stages affecting the surrounding structures, requiring a definite surgical intervention. Management of the difficult airway during the perioperative period is also a difficult task. We are reporting here anesthesia management of a case of right pyriform fossa carcinoma with glottic extension that was posted for total laryngectomy with partial pharyngectomy, right hemithyroidectomy, and bilateral modified radical neck dissection as the lymph nodes were involved. A difficult airway situation was anticipated as a soft tissue growth was crossing the midline covering the glottic opening, involving the aryepiglottic fold and vocal cords as shown on the CT scan.

SHORT COMMUNICATION

Tural Alekberli, Fidan R Alekberli, Chloé Mimouni, Abu A Muhammed

Smart-anesthesia Application with Artificial Intelligence for a Preoperative Evaluation of Patients

[Year:2020] [Month:January-June] [Volume:5] [Number:1] [Pages:2] [Pages No:21 - 22]

Keywords: Preoperative evaluation,Anesthesia assessment, Artificial intelligence, Innovation in anesthesia

PDF  |  DOI: 10.5005/jp-journals-10049-0078  |  Open Access |  How to cite  | 

Abstract

Anesthesiology is a dynamic specialty of medicine that fosters continuous improvements in anesthetic care for patients undergoing surgical procedures. The preoperative (pre-op) evaluation of a patient is vital for reasonable and acceptable patient care. Inadequate pre-op patient preparation causes medical, organizational, economic, and emotional problems to patients and professionals. There are no standards for the level of knowledge and skills of an anesthesiologist worldwide; the difference is more dramatic, especially in a country without proper residency education. It can be life-threatening, especially during urgent cases where resident anesthesiologists evaluate patients frequently at the bedside before the procedure. Smart-anesthesia project is an innovative online preoperative anesthesia evaluation application (App), uses artificial intelligence (AI), gives perioperative anesthesia recommendations. The app is available for smartphone/tablet/laptop and compatible with android/IOS/windows, which is useful for elective/urgent procedures. A printable assessment document with an anesthesia recommendation list is available. Compatible with ICD-11 codes to avoid terminology and grammar-related issues. Minimal handwriting for maximal automation. Rapid screening and assessment of patients with a user-friendly interface. Safe practice of anesthesiology with recommendations by analyzing data with updated American Society of Anesthesiologists (ASA) guidelines. An automatic ASA scoring will be available. A universal preoperative assessment tool that connects anesthesiologists around the world with a common language for safer anesthesia practice.

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