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  Citation statistics : Table of Contents
   2010| January-April  | Volume 4 | Issue 1  
    Online since April 21, 2010

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Ultrasound-guided central venous catheterization in prone position
Khalid Sofi, Samer Arab
January-April 2010, 4(1):28-30
DOI:10.4103/1658-354X.62612  PMID:20668564
Central venous catheterization (CVC) is a commonly performed intraoperative procedure. Traditionally, CVC placement is performed blindly using anatomic landmarks as a guide to vessel position. Real-time ultrasound provides the operator the benefit of visualizing the target vein and the surrounding anatomic structures prior to and during the catheter insertion, thereby minimizing complications and increasing speed of placement. A 22-year-old male underwent open reduction and internal fixation of acetabulum fracture in prone position. Excessive continuous bleeding intraoperatively warranted placement of CVC in right internal jugular vein (IJV), which was not possible in prone position without the help of ultrasound. Best view of right IJV was obtained and CVC was placed using real-time ultrasound without complications. Ultrasound-guided CVC placement can be done in atypical patient positions where traditional anatomic landmark technique has no role. Use of ultrasound not only increases the speed of placement but also reduces complications known with the traditional blind technique.
  10 4,813 380
Procedural sedation analgesia
Saad A Sheta
January-April 2010, 4(1):11-16
DOI:10.4103/1658-354X.62608  PMID:20668560
The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED) usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation) is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.
  9 6,684 938
Effect of tracheostomy on pulmonary mechanics: An observational study
Khalid Sofi, Tariq Wani
January-April 2010, 4(1):2-5
DOI:10.4103/1658-354X.62606  PMID:20668558
Background: This study was undertaken to find out the effect of early tracheostomy on weaning from mechanical ventilation. Pulmonary mechanics and arterial blood gases were assessed before and after tracheostomy in patients with severe head injury (Glasgow coma score < 8) requiring prolonged mechanical ventilation. Patients and Methods: The study included 20 mechanically ventilated patients of either sex between 20 and 45 years of age, who had suffered brain injury due to head trauma during admission (Glasgow coma scores of <8). Mean airway pressure, peak airway pressure, plateau pressure, PaO 2 and PaCO 2 were measured 24 h before and after tracheostomy. Static and dynamic compliances were calculated. Results: Plateau airway pressures were not affected by tracheostomy, but peak airway pressure was reduced (29.90 ± 3.21 cm H 2 O before tracheostomy versus 24.30 ± 1.83 cm H 2 O after tracheostomy, P < 0.001). Dynamic compliance, but not static compliance, was improved by tracheostomy. Tracheostomy did not affect PaCO 2 , but it improved PaO 2 (83.09 ± 5.99 mmHg before versus 90.84 ± 5.61 mmHg after, P ≤ 0.001). Conclusions: The work of breathing through a tracheostomy tube may be less than through an endotracheal tube of same internal diameter.
  5 5,127 590
Diffuse idiopathic skeletal hyperostosis of cervical spine - An unusual cause of difficult flexible fiber optic intubation
Vaibhavi Baxi, Sucheta Gaiwal
January-April 2010, 4(1):17-19
DOI:10.4103/1658-354X.62609  PMID:20668561
This is a report of anterior osteophytes on the cervical vertebra resulting in distortion of the airway and leading to difficulty during intubation. The osteophytes associated with the syndrome of diffuse idiopathic skeletal hyperostosis were at the C2-3 and C6-7, T1 level and resulted in anterior displacement of the pharynx and the trachea respectively.
  4 4,579 246
Cardiac arrest in intensive care unit: Case report and future recommendations
A Mohammad, N Zafar, A Feerick
January-April 2010, 4(1):31-34
DOI:10.4103/1658-354X.62613  PMID:20668565
Initiation of hemofiltration in a patient in septic shock can cause hemodynamic compromise potentially leading to cardiac arrest. We propose that the standard '4Hs and 4Ts' approach to the differential diagnosis of a cardiac arrest should be supplemented in critically ill patients with anaphylaxis and human and technical errors involving drug administration (the 5 th H and T). To illustrate the point, we report a case where norepinephrine infused through a central venous catheter (CVC) was being removed by the central venovenous hemofiltration (CVVH) catheter causing the hemodynamic instability. CVVH has this potential of interfering with the systemic availability of drugs infused via a closely located CVC.
  3 4,510 345
Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine
Chetankumar Raval, Heena Patel, Pranoti Patel, Utpala Kharod
January-April 2010, 4(1):38-41
DOI:10.4103/1658-354X.62616  PMID:20668567
Ankylosing spondylitis (AS) patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed.
  3 3,963 361
Low flow anesthesia: Efficacy and outcome of laryngeal mask airway versus pressure-optimized cuffed-endotracheal tube
Zeinab Ahmed El-Seify, Ahmed Metwally Khattab, Ashraf Shaaban, Dobrila Radojevic, Ivanka Jankovic
January-April 2010, 4(1):6-10
DOI:10.4103/1658-354X.62607  PMID:20668559
Background: Low flow anesthesia can lead to reduction of anesthetic gas and vapor consumption. Laryngeal mask airway (LMA) has proved to be an effective and safe airway device. The aim of this study is to assess the feasibility of laryngeal mask airway during controlled ventilation using low fresh gas flow (1.0 L/min) as compared to endotracheal tube (ETT). Patients and Methods : Fifty nine non-smoking adult patients; ASA I or II, being scheduled for elective surgical procedures, with an expected duration of anesthesia 60 minutes or more, were randomly allocated into two groups - Group I (29 patients) had been ventilated using LMA size 4 for females and 5 for males respectively; and Group II (30 patients) were intubated using ETT. After 10 minutes of high fresh gas flow, the flow was reduced to 1 L/min. Patients were monitored for airway leakage, end-tidal CO 2 (ETCO 2 ), inspiratory and expiratory isoflurane and nitrous oxide fraction concentrations, and postoperative airway-related complications Results : Two patients in the LMA-group developed initial airway leakage (6.9%) versus no patient in ETT-group. Cough and sore throat were significantly higher in ETT patients. There were no evidences of differences between both groups regarding ETCO 2 , uptake of gases, nor difficulty in swallowing. Conclusion : The laryngeal mask airway proved to be effective and safe in establishing an airtight seal during controlled ventilation under low fresh gas flow of 1 L/min, inducing less coughing and sore throat during the immediate postoperative period than did the ETT, with continuous measurement and readjustment of the tube cuff pressure.
  3 5,368 631
Perioperative care of an adolescent with postural orthostatic tachycardia syndrome
Scott Kernan, Joseph D Tobias
January-April 2010, 4(1):23-27
DOI:10.4103/1658-354X.62611  PMID:20668563
Postural orthostatic tachycardia syndrome (POTS) is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.
  2 6,102 316
Ultrasound-guided supraclavicular brachial plexus block in patient with halo device
Mohamed Bilal Delvi
January-April 2010, 4(1):20-22
DOI:10.4103/1658-354X.62610  PMID:20668562
Ultrasound guided regional blocks are on the rise, many institutes are training their staff to master this technique of regional anesthesia. Regional anesthesia in case of an emergency surgery or elective surgery can be the best choice. The case described here is an example - patient with a halo fixation device after motor vehicle accident scheduled for surgery of the extremity. The main aim of management of this case is to achieve a safe anesthesia with minimal interference of the cervical fixation. Supraclavicular brachial plexus block is a good choice for surgeries of the arm and hand and use of an ultrasound to guide the block adds to the safety profile of this versatile block. It has been described as "Spinal of the upper limb". Patients with co-morbidities and injuries to the cervical spine are challenging cases to anesthetize, as regional anesthesia is a very attractive option, failure of the regional block will expose the patient to all adverse sequelae, which were being avoided by planning for a regional anesthesia. Ultrasound has revolutionized the way regional anesthesia is practiced and the proper drug can be placed at the right place in the hands of an experienced anesthesiologist and the block will help in avoiding all the complications of endotracheal anesthesia in these cases.
  1 3,369 277
Severe ovarian hyperstimulation syndrome leading to ICU admission
RK Singh, Sanjay Singhal, Afzal Azim, AK Baronia
January-April 2010, 4(1):35-37
DOI:10.4103/1658-354X.62614  PMID:20668566
Severe ovarian hyperstimulation is a rare complication of ovulation induction therapy. In this report, we are presenting a case of 33-year female, who required intensive care unit admission due to respiratory failure secondary to massive pleural effusion and ascites. With the positive history of in vitro fertilization, the patient was diagnosed to have severe ovarian hyperstimulation syndrome. Besides the medical treatment, abdominal paracentesis for the drainage of massive ascites and tube thoracostomy were performed, resulting in gradual improvement.
  - 3,594 305
SJA, the dream became real
Abdulhamid Al-Saeed
January-April 2010, 4(1):1-1
DOI:10.4103/1658-354X.62605  PMID:20668557
  - 2,098 246