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   2022| January-March  | Volume 16 | Issue 1  
    Online since January 4, 2022

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Unexpected aortic tear: Nightmare for the anesthesiologist
Priyanka Sethi, BD Vaishnavi, Manbir Kaur, Tanvi Meshram
January-March 2022, 16(1):140-142
  5,602 70 -
Anesthetic management of a 2-day old neonate with double outlet right ventricle associated with anorectal malformation posted for emergency colostomy surgery
Manbir Kaur, Priyanka Sethi, Pradeep Bhatia
January-March 2022, 16(1):142-143
  5,570 83 -
Comment on article 'Fixed dilated pupils following laparoscopic urological procedure: Steep trendelenburg position was the cause'
Summit Dev Bloria
January-March 2022, 16(1):139-140
  5,478 68 -
Intraoperative nociception monitoring gadgets- present status
Manish K Tiwary, Ashok Lal, Rasathurai Kajenthiran, Abhijit S Nair
January-March 2022, 16(1):133-135
  5,410 73 -
American Board of Anesthesiology and Accountability (or lack of): What the rest of the world can learn?
Basavana Goudra
January-March 2022, 16(1):1-3
  3,580 140 -

January-March 2022, 16(1):144-144
  2,695 142 -
Artificial intelligence and anesthesia: A narrative review
Madhavi Singh, Gita Nath
January-March 2022, 16(1):86-93
Rapid advances in Artificial Intelligence (AI) have led to diagnostic, therapeutic, and intervention-based applications in the field of medicine. Today, there is a deep chasm between AI-based research articles and their translation to clinical anesthesia, which needs to be addressed. Machine learning (ML), the most widely applied arm of AI in medicine, confers the ability to analyze large volumes of data, find associations, and predict outcomes with ongoing learning by the computer. It involves algorithm creation, testing and analyses with the ability to perform cognitive functions including association between variables, pattern recognition, and prediction of outcomes. AI-supported closed loops have been designed for pharmacological maintenance of anesthesia and hemodynamic management. Mechanical robots can perform dexterity and skill-based tasks such as intubation and regional blocks with precision, whereas clinical-decision support systems in crisis situations may augment the role of the clinician. The possibilities are boundless, yet widespread adoption of AI is still far from the ground reality. Patient-related “Big Data” collection, validation, transfer, and testing are under ethical scrutiny. For this narrative review, we conducted a PubMed search in 2020-21 and retrieved articles related to AI and anesthesia. After careful consideration of the content, we prepared the review to highlight the growing importance of AI in anesthesia. Awareness and understanding of the basics of AI are the first steps to be undertaken by clinicians. In this narrative review, we have discussed salient features of ongoing AI research related to anesthesia and perioperative care.
  1,464 244 1
An algorithm for management of failed ultrasound-guided peripheral nerve blocks
Harshraj Bhendale, Jagannathan Balavenkatasubramanian, Tuhin Mistry, Kartik Sonawane
January-March 2022, 16(1):131-133
  1,528 87 -
Ultrasonographic evaluation of incidence of diaphragmatic paralysis following different volumes of supraclavicular brachial plexus block- A prospective randomized double blinded study
J Edward Johnson, Shabila Daniel
January-March 2022, 16(1):58-64
Background: Ipsilateral diaphragmatic paralysis occurs following supraclavicular blocks such as interscalene blocks, supposedly attributable to the backward diffusion of the local anesthetic (LA) inside the neural sheath. Hence, we have made an attempt to assess diaphragmatic paralysis with ultrasonogram (US) following different volumes of supraclavicular brachial plexus blocks (SCB). Aim: To compare the incidence of diaphragmatic paralysis with different volumes of supraclavicular brachial plexus block using ultrasonogram. Methods: Sixty patients with American Society of Anesthesiologists (ASA) Physical Status I and II were randomized to receive 20, 25, or 30 mL of 0.375% bupivacaine in a double-blinded fashion, and supraclavicular block was performed using ultrasound guidance in an in-plane technique. Diaphragmatic excursion and velocity were studied using a curvilinear 3.5 MHz transducer before and 20 min after giving the block. Results: The incidence of reduction in diaphragmatic excursion and velocity in the group receiving 30 mL was 45% and 45%, respectively, which was higher, whereas it was 47.5% and 32.5% in the 25 mL group and 40% and 25% in the 20 mL group, respectively, which were still lower. Pre- and post-block data were studied using T-test, Kruskal–Wallis test, and Mann–Whitney U test. The probability of reduction in diaphragmatic excursion and velocity in each group was <0.05, which was statistically significant. Conclusion: Our results suggest that there is a greater risk of inadvertent phrenic nerve blockade even in supraclavicular brachial plexus block. The resulting hemidiaphragmatic paralysis is volume dependent, and the overall incidence is higher at greater volumes. Hence, caution is required against compromised perioperative lung function in patients with preexisting cardiorespiratory dysfunction.
  1,355 152 -
Oliceridine- Opioid of the 21st Century
Basavana Goudra
January-March 2022, 16(1):69-75
Oliceridine (Olinvyk® Trevena, PA, USA) was approved by the United States Food and Drug Administration for clinical use on Aug 8, 2020. Even though, the indication of its approval is very restrictive (to manage moderate-to-severe acute pain in adults when the pain is severe enough), for such an innovative opioid, off-label indications are bound to abound. What could be described as the “opioid of the century,” it aims to overcome some of the stubbornest barriers to opioid prescribing, namely addiction liability, respiratory depression, and gastrointestinal (GI) side effects, just to name a few. The novel opioid accomplishes this by a unique mechanism of action. By selectively acting on the G-protein sub-pathway in preference to the beta-arrestin, it aims to mitigate these unwanted μ-opioid receptors-associated opioid side effects, while preserving its analgesic activity. What remains to be seen, however, is if these observations seen in phases 2 and 3 trials will be borne in actual large-scale clinical use, both inside and outside the USA. Unfortunately, the field of anesthesia is rife with innovations that have shown enormous promise at the research stage, only to end up as damp squibs when released to the clinicians for general use. Rapcuronium and althesin are some such examples. We aim to present some of the contentious and emerging issues associated with this drug and some of the potential pitfalls of this new opioid.
  1,310 193 -
Total intravenous anesthesia in a child with Schwartz Jampel syndrome
Onur Palabiyik
January-March 2022, 16(1):137-138
  1,378 83 -
Airway management in patients with obesity
Bhavana Thota, Kathryn M Jan, Matthew W Oh, Tiffany S Moon
January-March 2022, 16(1):76-81
Airway management in patients with obesity remains a complex and evolving topic that is becoming more pertinent given the increasing prevalence of obesity and bariatric surgery worldwide. Obesity is associated with increased morbidity and mortality secondary to anesthetic complications, especially related to airway management. Preoperative assessment is especially vital for the bariatric patient so that potential predictors for a difficult airway can be identified. There are several airway management strategies and techniques for the bariatric population that may help reduce postoperative pulmonary complications. This review aims to discuss assessment of the airway, ideal patient positioning, intubation techniques and devices, apneic oxygenation, optimal ventilation strategies, and extubation and post-anesthesia care.
  1,248 213 -
An interesting case of central venous catheter misplacement
Priyanka Pavithran, Biju Sekhar, Moidu Shameer, Namitha Manchakkal
January-March 2022, 16(1):135-136
  1,362 80 -
Migration of chemoport catheter to the right ventricle: A catastrophic rare complication
Neha Goyal, Manoj Kamal, Bharat Paliwal, Rakesh Kumar
January-March 2022, 16(1):124-125
  1,368 73 -
Management of leptospirosis in postpartum period in ICU
Shubhra , Amlendu Yadav, Ajay K Goila, Ranvinder Kaur
January-March 2022, 16(1):130-131
  1,360 60 -
A novel method of metered-dose inhaler delivery in intubated COVID-19 patients
Mohd. Mustahsin , Garima Singh, Sanjay Choubey
January-March 2022, 16(1):127-128
  1,348 67 -
Postoperative sore throat prevention: Is there an evidence or is it much ado about nothing?
Abhijit Nair, Suresh Seelam
January-March 2022, 16(1):125-127
  1,348 62 -
Pseudoventricular tachycardia due to a silicone tourniquet
Hidekazu Ito, Shoji Mizuno, Kenji Iio
January-March 2022, 16(1):128-130
  1,348 59 -
Assessment of Emergency Department Satisfaction Level in Saudi Arabia General Hospital
Ahmed M Al-Wathinani, Saad Aldawsari, Mohammed Alhallaf, Yousef Alotaibi, Dhaifallah Alrazeeni, Mohammed M Ageli, Charles A Villanueva, Nawaf Albaqami
January-March 2022, 16(1):4-9
Background and objectives: An overcrowded emergency department (ED) cannot meet the patients' growing demand. This situation harms employees' performance and, alternatively, causes anxiety and dissatisfaction among patients since the quality of healthcare outcomes fall below their expectations. This study aimed at improving and validating a scale for assessing patient satisfaction in the ED. Methods: In this study, 134 participants from Wadi Al-Dawasir General Hospital were enrolled using a convenient sampling technique. A cross-sectional survey was conducted using 5-point Likert scales. Results: All tested hypotheses showed statistical significance (P < 0.05). Our results show that male employees were more satisfied compared with their female counterparts. Furthermore, Saudi employees were more satisfied with the health services than non-Saudi ones. Conclusion: The findings of this study brought to the fore that patients and their families were satisfied with the healthcare services and their quality. This means better service delivery played a crucial role in enhancing satisfaction levels. Nevertheless, this study also highlights that overcrowding is a significant problem for healthcare organizations. Wadi al-Dawasir General Hospital's ED should continually improve its quality to meet the growing needs of its clients.
  1,171 168 -
How short or long should be a questionnaire for any research? Researchers dilemma in deciding the appropriate questionnaire length
Hunny Sharma
January-March 2022, 16(1):65-68
A questionnaire plays a pivotal role in various surveys. Within the realm of biomedical research, questionnaires serve a role in epidemiological surveys and mental health surveys and to obtain information about knowledge, attitude, and practice (KAP) on various topics of interest. Questionnaire in border perspective can be of different types like self-administered or professionally administered and according to the mode of delivery paper-based or electronic media–based. Various studies have been conducted to assess the appropriateness of a questionnaire in a particular field and methods to translate and validate them. But very little is known regarding the appropriate length and number of questions in a questionnaire and what role it has in data quality, reliability, and response rates. Hence, this narrative review is to explore the critical issue of appropriate length and number of questions in a questionnaire while questionnaire designing.
  860 157 -
Awareness of general nurses in management of postoperative pain through patient controlled analgesia - Comparison among the Czech Republic and the Kingdom of Saudi Arabia
Denisa Mackova (Porter), Mohammed Al Harbi, Nasser A Tawfeeq, Andrea Pokorna
January-March 2022, 16(1):10-16
Background: Postoperative pain management is one of the largest worldwide challenges faced by healthcare professionals and is one of the most common problems that accompany patients in the postoperative period. Objectives: We evaluated the awareness of general nurses on the management of postoperative pain through PCA (patient-controlled analgesia) on a multicultural level among general nurses from the Czech Republic (CZ) and the Kingdom of Saudi Arabia (KSA). Materials and Methods: A cross-sectional study was performed by the distribution of the questionnaires. We distributed 403 questionnaires in CZ and 550 questionnaires in KSA. Statistical analysis was performed by program STATA15 at the significance level =0.05. Results: The study included total of 833 respondents (N = 360 CZ; N = 473 KSA). In both countries, the majority of the respondents were female (CZ 89, 7%; KSA 92, 4%). The average age was similar in both countries (38.6 years in CZ and 35.6 years in KSA). We found out that the use of the treatment through PCA differs between both countries according to the type of department (P < 0.05). We verified that the frequency of use of the PCA method differs in the post-anesthesia care unit between CZ and KSA (P = 0.000). Conclusions: According to the available results, we can state that the general nurses in KSA care for patients with the PCA much more often and have more experience with the PCA than general nurses from CZ.
  862 114 -
Amlodipine overdose complicated by non-cardiogenic pulmonary edema and diffuse alveolar hemorrhage: A case report
Will R Bringgold, Micah T Long
January-March 2022, 16(1):104-107
A young adult female presented with hypotension and depressed mental status after intentional overdose of Amlodipine. After intubation and institution of lung-protective mechanical ventilation, initial management focused on maintenance of a mean arterial blood pressure over 65 mmHg and included fluid resuscitation (eight liters of crystalloid), Insulin and dextrose, intravenous calcium and, finally, vasopressor support. Her course was complicated by hypoxia due to non-cardiogenic pulmonary edema requiring diuresis. She was extubated soon thereafter but developed severe hypoxia within 72 hours requiring re-intubation. A subsequent bronchoscopy demonstrated diffuse alveolar hemorrhage (DAH). This is the first report of DAH complicating amlodipine overdose.
  746 179 -
Prophylactic use of donut-shaped cushion to reduce sacral pressure injuries during open heart surgery
Min Hee Heo, Ji Yeon Kim, Beom Il Park, Sang Il Lee, Kyung-Tae Kim, Jang Su Park, Won Joo Choe, Jun Hyun Kim
January-March 2022, 16(1):17-23
Background: Pressure injuries are likely to develop in the operating room due to the high temperature and humidity underneath the patients. This study was designed to reduce sacral pressure injuries using donut-shaped cushions on patients undergoing open heart surgery in a supine position for more than three hours. Materials and Methods: Patients undergoing open heart surgery for more than three hours were randomly allocated. Depending on the allocation, either the donut-shaped cushion (donut group) or hydrophilic foam dressing (control group) was applied before draping. Patients were evaluated for the development of pressure injuries, National Pressure Ulcer Advisory Panel (NPUAP) stage, and injury size immediately after surgery, 48 hours, and seven days after surgery. Results: Forty-five patients were enrolled in this study. Twenty-two were assigned to the donut group and 23 were assigned to the control group. Three patients developed pressure injuries of NPUAP stage I or higher. All injuries occurred in the control group, but there was no statistically significant difference (P = 0.083). Conclusions: Patients who underwent cardiac surgery for more than three hours and used a donut-shaped cushion did not develop pressure injuries, although no statistical difference was noted. Specific preventative measures in the operating room may play a crucial role in preventing pressure injuries, and further research should be pursued.
  789 124 -
Cardiovascular monitoring in patients with hypertrophic obstructive cardiomyopathy in a prone position: A report of 2 cases
Yukihide Koyama, Yu Asami, Haruko Nishikawa, Hiroyuki Ikezaki, Koichi Tsuzaki
January-March 2022, 16(1):108-110
Supine positioning in patients with hypertrophic obstructive cardiomyopathy (HOCM) can affect their preload, afterload, and heart rate, potentially leading to cardiovascular collapse. Here, we report the successful anesthetic management of two patients with HOCM who underwent spinal surgery in a prone position. The approximate values of the systemic vascular resistance index (SVRI) were continuously calculated without measuring the central venous pressure. Intraoperative monitoring of the SVRI estimates may be helpful in patients with HOCM so as to avoid cardiovascular collapse when monitoring with both transesophageal echocardiography and a central venous catheter is clinically inappropriate.
  754 116 -
The efficacy of sphenopalatine ganglion block for the treatment of postdural puncture headache among obstetric population
Mohammed S Albaqami, Faris I Alwarhi, Adel A Alqarni
January-March 2022, 16(1):45-51
Background: Postdural puncture headache (PDPH) is a common complication among parturients who had undergone obstetric neuraxial block. Epidural blood patch is the current gold standard treatment for PDPH, although it is an invasive procedure. We conducted this systematic review to assess the efficacy of sphenopalatine ganglion block (SPGB) as a noninvasive treatment of PDPH. Methods: Relevant reports were searched from Google Scholar, PubMed, Science Direct, and Scopus from the inception of the databases to November 30, 2020. A total of 10 reports found to be related to SPGB for the treatment of PDPH in the obstetric population were enrolled. Significant relief of headache with no further intervention and initial relief of headache that requires further interventions were considered as the primary outcomes. The secondary outcome was the complications after SPGB. Results: A total of 68 patients were identified. We found that 41 of 68 patients (60.3%) had effective management with significant relief of headache with no further interventions needed. Moreover, a total of 27 of 68 patients (39.7%) had initially effective management that needed further interventions. The use of 2% lidocaine was found to be the most effective among all used local anesthetics with 85.7% effective management. Furthermore, parturients who developed PDPH after spinal anesthesia responded to SPGB better than other obstetric neuraxial techniques. Conclusions: This systematic review showed that SPGB is a promising treatment modality for the management of PDPH with no reported complications. Before recommending this technique for treating PDPH, we are calling for randomized clinical trials to prove its efficacy.
  694 141 -
Hemophilia C management in obstetric anesthesia
Cristina Guadalix-Sanchez, Andrea Albajar-Bobes, Macarena Barbero-Mielgo, Inocencia Fornet-Ruiz
January-March 2022, 16(1):111-113
Coagulation alterations might represent a problem in obstetric anesthesia considering that they may contraindicate neuraxial techniques and worsen a case of uterine atony with more severe bleeding if they are not correctly recognized and treated. We report the case of a parturient diagnosed with severe factor XI deficiency during the delivery progress. In this case, non-steroidal anti-inflammatory drugs and neuraxial techniques were avoided and intravenous patient-controlled analgesia with boluses of remifentanil was used for pain management. Treatment with tranexamic acid and fresh frozen plasma was initiated and the absence of urgent factor XI availability was notified. Due to no progression of labor, cesarean section was required and a general anesthesia was performed. During the procedure, uterine atony occurred. Uterine massage and several uterotonic drugs were needed to control it. The patient remained stable and the delivery was accomplished without further incidents. The objective of this report is to present the pain, coagulation and bleeding management of a patient with hemophilia C in our obstetric department and to alert for the need of multidisciplinary work to successfully approach this type of patient.
  644 166 -
Adductor canal catheter block after total knee arthroplasty in patients with severe osteoarthritis and limited mobility. A single center study in Riyadh, Saudi Arabia
Abdullah Alturki, Khalid Alsheikh, Sarah A Aldeghaither, Firas M Alsebayel, Saleh Alazzam, Ali A Alhandi
January-March 2022, 16(1):29-33
Purpose: Total knee arthroplasty (TKA) is one of the most performed procedures. Postoperative pain control is an important factor for the improvement of patient's quality of life. The aim of this study is to report pain control results and functional outcome scores associated with adductor canal blockade (ACB) usage post-TKA. Methods: A prospective case series study of patients who underwent TKA for degenerative osteoarthritis with ACB postoperatively from 2018 to 2019 in a single center in Saudi Arabia, Riyadh. Assessment of functional outcome scores and pain level were measured preoperatively and postoperatively respectively using Knee injury and Osteoarthritis Outcome Score (KOOS) and the Visual Analog Scale (VAS). Results: Average KOOS score preoperatively for all 5 domains showed a marked improvement at 3 months compared to preoperative values. Pain score postoperatively was measured at 12, 24, and 48 h with an average of 0.7, 1.2, and 0.6 out of 10 on the VAS scale, respectively. The incidence of associated common side effects with the use of analgesic use was included as an add-on in the postoperative questionnaire. Conclusion: In conclusion, by comparing preoperative and postoperative pain levels and functional outcome scores, our study showed a significant pain control and improved functional outcome scores following TKA using ACB.
  570 130 -
Sedation with dexmedetomidine and propofol in children with Fontan circulation undergoing cardiac catheterization: A descriptive study
Ayaka Omori, Fumio Watanabe, Taiki Kojima
January-March 2022, 16(1):34-37
Background: A combination of dexmedetomidine and propofol is considered advantageous for maintaining spontaneous breathing with a satisfactory depth of anesthesia. However, the incidence of upper airway obstruction under sedation with dexmedetomidine and propofol in patients with Fontan circulation remains unanswered. This study aimed to evaluate upper airway patency and oxygen desaturation during sedation with dexmedetomidine and propofol for cardiac catheterization in pediatric patients with Fontan circulation. Methods: In this descriptive study, we reviewed medical records of patients with Fontan circulation who underwent cardiac catheterization between December 2018 and August 2020 at a single-center 200-bed academic children's hospital in Japan. Results: A total of 35 patients with Fontan circulation sedated with a departmental protocol of dexmedetomidine and propofol infusion for cardiac catheterization were reviewed. Overall, the incidence of airway interventions and oxygen desaturation were 31.4% and 28.6%, respectively. In children with a history of snoring and additional use of intravenous midazolam, the rates of airway interventions were 50% and 100%, respectively. In patients ≤2 years old with recent upper respiratory infection (URI) symptoms, oxygen desaturation rate was 75%. Conclusions: In children with Fontan circulation, the incidence rate of upper airway obstruction was high under sedation with dexmedetomidine and propofol during cardiac catheterization, which is commonly considered safe in children without Fontan circulation. A history of snoring, an additional bolus of IV midazolam, and the presence of recent URI symptoms in patients ≤2 years old are potential risks for upper airway obstruction.
  542 142 -
Crystalloid fluids and delayed graft function in kidney transplant: A cohort study
Amr ALKouny, Mohammed K ALHarbi, Abdulrahman R ALTheaby, Ghaleb Aboalsamh, Amel Fayed
January-March 2022, 16(1):38-44
Background: Normal saline is commonly used in the perioperative kidney transplant period; its high chloride content can cause hyperchloremic metabolic acidosis giving a possible advantage to balanced electrolyte solutions due to their lower chloride content. The evidence regarding the best practices in fluid management during kidney transplantation and its effect on the incidence of delayed graft function (DGF) is still limited. Materials and Methods: One hundred thirty-eight patients were included and followed up for seven days after surgery. Administered crystalloid type and volume were compared among patients with and without DGF, along with additional patient and surgical variables. To investigate whether intraoperative fluid type/amount influence DGF, patients were categorized into three groups: those who received mainly (>50%) lactated Ringer's solution, normal saline, or plasmaLyte. A logistic regression analysis was used to define variables independently correlated with DGF, and odds ratios (OR) with a 95% confidence interval (CI) were reported. Results: The incidence of DGF was 8.7%. Cold ischemia time independently increased the odds of DGF (OR = 1.006 (95% CI: 1.002–1.011) while fluid type (saline versus PlasmaLyte OR = 5.28, 95% CI: 0.76–36.88) or amount (OR = 1.00, 95% CI: 1.00–1.01) did not significantly modify the odds of DGF. Central venous pressure, systolic blood pressure, and mean arterial pressure were higher in the non-DGF group, but this was not statistically significant (P > 0.05). Significant intraoperative acidosis developed in patients who received normal saline compared to those in PlasmaLyte and lactated Ringer's groups; however, acid–base balance and electrolytes did not vary significantly between the DGF and non-DGF groups. Conclusion: DGF was primarily influenced by surgical factors such as cold ischemia time, whereas intraoperative fluid type or amount did not affect DGF incidence.
  564 112 -
Incidence of postoperative delirium in patients with preoperative and postoperative Obstructive Sleep Apnea Syndrome. A Systematic Review of the literature
S Dooijeweerd, Bart Torensma, D Faraj, AA Eldawlatly
January-March 2022, 16(1):94-103
Introduction: Clinical research has suggested that there might be a correlation between postoperative delirium (POD) and obstructive sleep apnea (OSA) syndrome. We aimed to assess the association between POD and OSA syndrome. Methods: The electronic database PubMed was searched using combinations of terms for “Delirium,'' “Obstructive Sleep Apnea,'' and “postoperative delirium.'' Excluded were studies without comparison as well as cross-sectional studies, case series, and case reports. The search was conducted with restriction toward English or not to the date of publication. Results: We included four studies in this review. In two of those studies, an association was found between POD and OSA syndrome. Pooled analysis showed a significant correlation between the two. Conclusion: High-quality studies regarding the subject are rare and heterogeneous. However, despite the lack of high-quality studies regarding the subject, the ones that are performed well conclude that there is a correlation between POD and OSA syndrome. Future studies addressing the matter should be well set up controlled clinical trials to draw conclusions and be able to investigate modifiable factors that can be used in a standardized protocol.
  506 130 -
Factors determining the need for general anesthesia to deliver dental treatment for adults with intellectual and developmental disabilities
Abdullah Aloufi, Fawz Alatawi, Faisal F Hakeem, Hassan Abed
January-March 2022, 16(1):24-28
Aim: To investigate factors determining the need for general anesthesia (GA) to deliver dental treatment for adult people with intellectual and developmental disabilities (IDD). Methods: This study involved a retrospective review of medical records of adult patients with IDD who received dental treatment under GA at Tabuk Specialist Dental Center, Saudi Arabia, between 2018 and 2020. Demographic characteristics and dental-related details, level of cooperation, and methods of delivering dental treatment were collected. Results: A total of 86 adult patients with IDD were included. The mean age of the study participants was 34.8 years (standard deviation [SD] 6.5), and the majority were males (n = 47, 54.7%). Eighteen patients had aphasia (20.9%), 16 had epilepsy (18.6%), and 10 had cerebral palsy (11.6%). Most dental treatments delivered were complex dental treatments (n = 39, 45.3%) followed by dental extraction (n = 25, 29.1%), and non-surgical periodontal therapy (n = 22, 25.5%). Females had higher odds of undergoing GA compared to males (Odds ratio (OR) =6.79, 95% Confidence intervals (CI): 1.62–28.41). Furthermore, patients who had aphasia had higher odds of undergoing GA compared to patients who had no medical conditions (OR = 14.03, 95% CI: 1.05–186.7). Conclusion: Being female or having aphasia are independent factors related to the need for GA to deliver dental treatment for Saudi adults with IDD.
  504 131 -
Prevalence, distribution and correlates of pain in patients with mucormycosis-A cross-sectional study
Milon V Mitragotri, Roopa Sachidananda, Mahesh D Kurugodiyavar, Raveendra P Gadag, Vignesh M Thirunavukarasu, C.M V Suhas
January-March 2022, 16(1):52-57
Context: COVID-19 has led to a spate of rhino-orbital-cerebral mucormycosis cases in India, the epidemiology of which was least understood before. Only a few case series and case reports discuss the symptomatology of mucormycosis. Aims: The primary objective of our study was to estimate the prevalence of pain in patients with mucormycosis. The secondary objectives include the type, regional distribution, characteristics and determinants of pain in patients with mucormycosis. Settings and Design: A cross-sectional study was conducted on consecutive adult patients with mucormycosis in our hospital. Materials and Methods: Following recruitment, a preplanned written questionnaire that was tested for validity with peers, with closed-ended queries was filled on a sole visit by an anesthesia postgraduate based on the response by the patient. Statistical analysis used: Categorical variables were summarized as proportion and percentage. To compare quantitative variables, Chi-square test was used. Results: A total of 69 out of the 80 patients recruited complained of pain (P value = 0.468). A total of 76.8% of patients had pain in the supraorbital region with 84% of the patients complaining of throbbing pain and 98.6% needing analgesics. Gender, pre-existing diabetes mellitus, organs affected due to mucormycosis, prior steroid usage, prior COVID illness, surgical intervention, and previous experience of pain in the same region had no influence on the presence or severity of pain. Conclusions: Pain is one of the presenting symptoms in patients with mucormycosis which is usually in the supraorbital and maxillary region, nociceptive type and throbbing in nature, and moderate to severe in intensity usually managed with simple analgesics.
  456 115 -
Laryngeal mass induced severe ventilatory impairment during induction of anesthesia
Jeongeun Kim, Deok-Hee Lee
January-March 2022, 16(1):117-119
A 77-year-old man with laryngeal cancer was scheduled for total laryngectomy and lymph node dissection surgery under general anesthesia. The patient did not present with airway obstruction signs, including dyspnea or wheezing sounds during spontaneous respiration, and the laryngeal opening could be easily identified on the fiberoptic bronchoscope examination preoperatively. Due to his poor cognition and cooperation, we decided not to try awake fiberoptic intubation. During the induction of general anesthesia, total airway obstruction occurred a few minutes after muscle relaxation. The patient could not be ventilated by mask ventilation; nevertheless, tracheal intubation using a conventional laryngoscope was performed without difficulty. It turned out that even a laryngeal mass that does not cause obstructive symptoms, not large in size or totally blocking the airway, can cause difficulty in mask ventilation.
  472 98 -
Is intranasal dexmedetomidine superior to oral chloral hydrate for procedural sedation in children: A systematic review
Mohamed B Delvi
January-March 2022, 16(1):82-85
Background: This systematic review was undertaken to compare the benefits of intranasal dexmedetomidine (IND) versus oral chloral hydrate (OCH) in the pediatric age group undergoing procedural sedation analgesia (PSA). Randomized clinical trials (RCT) of the various studies done over the years were taken up and analyzed. Since IND has the additional advantages of a faster onset of action, greater success with a single bolus dose, and enhanced recovery, this systematic review was conducted to prove the superiority of IND over OCH in pediatric PSA. Objective: To compare the efficacy of IND versus OCH for PSA in pediatric patients. Search Strategy: We searched the electronic databases from August 2012 to September 2019 without language restrictions. Design and Selection Criteria: A review of 10 RCTs on the use of IND and OCH for PSA in the pediatric age group for a variety of diagnostic procedures was done and the superiority of IND as per the sedation time and adverse effects were analyzed. Results: Out of the RCTs considered, six trials were a direct comparison between OCH and IND which showed that IND had a faster onset of action, improved recovery characteristics with better return to baseline physical activity on the same day of the procedure. When compared to OCH, IND showed no evidence of second-dose requirement and no record of postoperative nausea and vomiting (PONV). Conclusion: This systematic review revealed that IND is superior to OCH for PSA in the pediatric age group and proved to be safe and effective with better recovery characteristics.
  464 102 1
Spontaneous intracranial hypotension following spinal anesthesia initially misdiagnosed as postdural puncture headache
Hyun-Seong Lee, Daeseok Oh
January-March 2022, 16(1):114-116
Spontaneous intracranial hypotension (SIH) is not rare, but its diagnosis remains challenging. SIH tends to be misdiagnosed as postdural puncture headache when orthostatic headache develops subsequent to spinal anesthesia because both have similar symptoms. We report the case of a 35-year-old man with orthostatic headache following spinal anesthesia, who did not respond to conventional therapy for postdural puncture headache. SIH was confirmed after epidural fluid collection was identified at the thoracic spine level on magnetic resonance myelography. Physicians must consider SIH despite a history of neuraxial block. Diagnostic work-up is necessary to identify potential cerebrospinal fluid leakage in refractory cases.
  446 106 -
Management of refractory hypoxemia during elective extracorporeal support for complex tracheal resection
Ranjani Venkataramani, Alexander E Lewis, Ivette Perez-Munoz, Neal S Gerstein
January-March 2022, 16(1):120-123
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used in managing challenging airway and thoracic cases with complex airway manipulations. We present a case of a complex tracheal resection needing prolonged apnea times for which VV-ECMO was electively planned. Intraoperatively, the team was faced with continued oxygen desaturations during periods of apnea. With an algorithmic approach to troubleshooting hypoxemia, several factors were taken into consideration. Apneic oxygenation was applied to the open tracheal segment. Despite an open airway, the applied apneic oxygenation facilitated oxygenation to the portion of the cardiac output that was being shunted through the lungs as opposed to the VV-ECMO circuit, enabling uninterrupted completion of the surgical resection and reanastomosis.
  306 82 -
Medication errors in delivery room: Avoidable?
Olga Martín-García, Inocencia Fornet-Ruiz, Natalia Muñoz-Ávalos, Cristina Guadalix-Sánchez
January-March 2022, 16(1):138-139
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