Anesthetic Challenges Research Articles

Twin anaesthetic challenges in a patient recovered from Guillain-Barre syndrome.

Twin anaesthetic challenges in a patient recovered from Guillain-Barre syndrome.

Evaluating predisposing factors and anaesthetic challenges in the emerging problem of mucormycosis in post COVID-19 patients

Background and Objectives: The epidemic of Mucormycosis came hovering like a tsunami in Covid- 19 recovered patients during second wave of the pandemic.. Mucormycosis is a rapidly progressive, angio-invasive, opportunistic fungal infection commonly caused by Rhizopus and mucor species. Mucormycosis can affect any organ system and pose several problems like uncontrolled diabetes, unstable hemodynamics, immunosuppression and difficult airway. Our study aimed to evaluate the predisposing factors and anaesthetic challenges encountered in Rhino-orbito-cerebral mucormycosis(ROCM) taken for surgical intervention under anaesthesia. Method: A retrospective, cohort study where we evaluated 100 covid-19 recovered patients who underwent surgical resection for ROCM under general anaesthesia. Hospital records of each patient were reviewed for demographic details, comorbid conditions, treatment modalities, covid associated organ damage, hemodynamics, surgical procedures, anaesthetic technique, and mortality. Results: Demographic data showed a male preponderance with 67 males and 33 females in the age group of 25-74yrs. 68 patients were ASA grade 3, 31 patients were ASA grade 4 and 1 patient was ASA grade5. Comorbid conditions showed 78 patients had DM, 8 patients had hypertension, while 14 had both.

Complete Temporomandibular Joint Ankylosis with Nil Mouth Opening: An Anesthetic Challenge

Complete Temporomandibular Joint Ankylosis with Nil Mouth Opening: An Anesthetic Challenge

Surgical and Anaesthetic Challenges Faced During Successful Management of a Complex Tracheal Injury Using Montgomery T Tube in a Zonal Hospital.

Surgical and Anaesthetic Challenges Faced During Successful Management of a Complex Tracheal Injury Using Montgomery T Tube in a Zonal Hospital.

Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care

Features| May 2022 Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care Amr E. Abouleish, MD, MBA, FASA Amr E. Abouleish, MD, MBA, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor May 2022, Vol. 86, 27–29. https://doi.org/10.1097/01.ASM.0000830836.76055.38 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Amr E. Abouleish; Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care. ASA Monitor 2022; 86:27–29 doi: https://doi.org/10.1097/01.ASM.0000830836.76055.38 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: anesthesia care, personnel staffing and scheduling In our previous ASA Monitor article, we showed that moving from anesthesiologist-only care to the anesthesia care team may not result in a significant reduction in staffing costs and actually increase the cost (ASA Newsletter 2010;74:30-51). In the intervening decade, the cost analysis of one's staffing model and hypothetical changes in the model continue to be a challenge for anesthesiologists and anesthesiology leaders. Unfortunately, basic errors or omissions in the analysis can lead to erroneous conclusions that can ruin a well-functioning facility for many years. Therefore, in this article, we discuss the issues that need to be considered when doing a cost analysis as well as updating our previous evaluation of moving from anesthesiologist-only to anesthesia care team staffing. A discussion of how to determine the best staffing model is beyond this article (ASA Monitor 2022;86:14-5; ASA Newsletter 2013;77:10-3). The World Health Organization and World... You do not currently have access to this content.

Anaesthetic challenges in staged correction of Andy Gump deformity in a young girl with severe obstructive sleep apnoea.

Anaesthetic challenges in staged correction of Andy Gump deformity in a young girl with severe obstructive sleep apnoea.

Placenta accreta. A review of current anesthetic considerations.

Placenta accreta spectrum (PAS) is a potentially life-threatening disorder with unique anesthetic challenges, and its incidence has increased over the past decades. We review current guidelines and best practice evidence for antenatal diagnosis and preoperative evaluation, management pathways, multidisciplinary staff coordination, and surgery location. We address specific considerations for choice of anesthesia modality, the role of interventional radiology, and various techniques for minimizing hemorrhage for both planned and unplanned cases, as well as postoperative care for the PAS patient.

P.81 Anaesthetic challenges of decompensated cirrhosis & COVID-19 in emergency caesarean section

P.81 Anaesthetic challenges of decompensated cirrhosis & COVID-19 in emergency caesarean section

Foreign Body in the Glottis

This case report highlights some of the anesthetic challenges of an airway foreign body removal. We present a case report of foreign body removal in a 50-year-old male with an oxtail bone lodged between the vocal cords. We used face mask general anesthesia with sevoflurane.

Congenital epulis: A surgical and anaesthetic challenge

Congenital Epulis or Neumann’s tumour is a rare benign outgrowth commonly from the maxilla in a new-born. It presents dramatically at birth of a child with breathing or feeding problems. The treatment in such symptomatic infants is prompt excision which presents a challenge to Surgeons but more so to the anaesthesiologist. A case report is presented here with a focus on the methods of anesthesia and surgery. A brief literature review is also presented.

Perioperative management of patients with post Covid rhino-orbito-cerebral mucormycosis: Prospective observational study

Mucormycosis is a life-threatening, locally invasive, rapidly progressive, opportunistic fungal infection, associated with several anaesthetic challenges. We aimed to study its relation with patient’s comorbidities, covid treatment strategies, also to observe the intubation difficulties, changes in hemodynamic parameters, post anaesthesia recovery status and perioperative complications. In this time bound study, total 160 patients were included. During pre-anaesthetic evaluation, presence of associated co-morbidities, course of Covid-19 disease, requirement of O2 therapy were noted. On the day of surgery, premedications and sedation were given. Induction was done with propofol/etomidate along with sevoflurane/desflurane. Intubation was done with succinyl choline/ atracurium and difficulties in intubation were graded according to Modified Intubation Difficulty Scale. Anaesthesia was maintained with the mixture of Oxygen, Air and inhalation agent along with intermittent Atracurium. Hemodynamic parameters, intra operative and post operative outcome were noted. Unstable patients were shifted to intensive care unit. Among patients of rhino-orbito-cerebral mucormycosis, most common co morbidity found was diabetes mellitus (42%). Here, 61% were on room air, rest needed oxygen therapy. Total 52% patients required >/= 2 intubation attempts, in which 9% were video laryngoscope assisted and 11% required additional maneuvers. 22% patients were started on intravenous nitroglycerin to manage intraoperative hypertension. 9.3% patients required ICU admission, of which 2.5% could not survive. Possibilities of developing rhino-orbito-cerebral mucormycosis in patients having diabetes mellitus are high. The anaesthetic management requires eternal vigilance to encounter difficult intubation, delayed recovery, and higher rate of morbidity and mortality.

Anaesthesia management of transvenous implantation of a single‐chamber, rate‐adaptive pacemaker in a donkey with high‐grade second and third degree atrioventricular block

AbstractA 17‐year‐old, domestic, entire, male, miniature donkey with a history of syncope because of sinus bradycardia, high‐grade second degree and occasional third degree atrioventricular block was referred for pacemaker implantation under general anaesthesia. After local anaesthesia with topical EMLA cream and subcutaneous mepivacaine infiltration and following tranquilisation with intravenous acepromazine, a temporary pacing catheter was inserted via introducer catheter through the left jugular vein into the right ventricle's apex. After initiation of internal pacing, medetomidine and butorphanol were administered intravenously, followed by ketamine and diazepam. Maintenance of anaesthesia was with isoflurane combined with medetomidine and lidocaine constant‐rate infusions. Intramuscular morphine and intravenous medetomidine were administered for recovery. The procedure was uneventful with no anaesthesia‐related complications, and manually assisted recovery was smooth. The present report describes the anaesthetic challenges and management of pacemaker implantation under general anaesthesia in a miniature donkey.

Anaesthetic challenges and implications in patient with neurofibromatoses posted for Whipple's surgery: A case report

Background: Neurofibromatosis Type 1or Von Recklinghausen disease is a group of autosomal dominant disease that have widespread effect on ectodermal and mesodermal tissue. Neurofibromas are the characteristic lesions of the condition that occur not only in the neuraxis but can also be found in the oropharynx and larynx; making laryngoscopy and tracheal intubation difficult. Neurofibromas may also affect the gastrointestinal tract and carcinoid tumours may be found in the duodenum. Aim: We report a case of 50-year-old male patient with NF1 posted for Whipple’s surgery. This study discusses the aetiology, clinical presentation and anaesthetic challenges of neurofibromatosis with its significance to the anaesthetist. We did a brief review so as to optimise anaesthetic management and reduce the complications associated with systemic manifestations of this syndrome. Case Report: A 50-year-old male patient with neurofibromatosis 1 was diagnosed with periampullary carcinoma. He presented with yellowish discolouration of eyes and urine for one month, associated with abdominal pain but with no h/o fever, GI bleed, abdominal distention. He had multiple small neurofibromas all over the face, body, back, hands and the nape of neck. A difficult yet successful epidural was inserted in T9-T10 space keeping in mind various spinal abnormalities that occurs in these patients. Presuming it to be difficult airway, patient was intubated with C-MAC. The histopathological report of the Periampullary specimen showed mucosa with small areas of neuroendocrine tumour (CK and Synaptophysin positive). Result and Conclusion: The surgery was conducted successfully and the patient was extubated. This case report demonstrates the importance of knowing the peculiarities of neurofibromatosis presenting for surgery so that a systematic approach to the pre-operative assessment of these patients can result in rational perioperative management.

Anesthetic Concerns in Resection of Liver: Case Series.

Liver resection is a major abdominal surgical procedure with its associated complications. A multidisciplinary team approach with appropriate preoperative planning is of utmost importance. The four cases managed successfully under general anaesthesia in a tertiary government hospital put forth a protocol based management for better outcome. The case series help to find out the perioperative anaesthetic challenges in management of liver resection. A 27-years old female and 40-years old male patients were admitted to a tertiary government hospital with diagnosis of hepatocellular malignancy and a 56-years old male and 52-years old female patients with gall bladder malignancy with liver metastases were admitted in the hospital for definitive cure. All patients were posted for tumour resection under general anaesthesia. This case series highlights the optimum preoperative preparation, optimization and discussion of perioperative concerns and anaesthesia management and importance of total intravenous anaesthesia. Role of protocol-based anaesthetic management and knowledge about surgical techniques for minimization of blood loss may decrease morbidity and mortality in liver resection surgery.

Fascial Plane Blocks Combination for Breast Surgery in Obese Patients With Difficult Airway Management: Insidious or a Valid Alternative

Obesity poses several challenges for anesthetists. The several comorbidities associated with obesity can result in very complex management, which requires a multimodal and reasoned approach. The possible difficult airways are, certainly, the obstacle that most can put the anesthetist to the test. From this point of view, regional anesthesia (RA) can be a valid alternative to general anesthesia (GA) in selected patients. The possibility of performing an anesthetic block allows the fulfilment of the surgical act. We present the case of a 56-year-old woman, with a BMI of 43. In her medical history, she has obstructive sleep apnea syndrome (OSAS) on home-oxygen therapy without continuous positive airway pressure (CPAP) therapy. The patient reported probable airway difficulties in previous breast surgery, and the preoperative evaluation highlighted and confirmed the high risk. For this reason, in agreement with the surgeons and the patient, we decided to perform RA. Forty minutes before the start of the surgery, a deep anesthetic ultrasound-guided serratus anterior plane (US-SAP; branches of the intercostal nerves in the middle axillary line [BRILMA]) was performed, followed by a right ultrasound-guided erector spinae plane (US-ESP) block. Mild sedation with propofol 1 mg/kg/h was administered and SpO2 always remained above 97% with nasal oxygen at 3 l/min. The surgery was completed in 35 minutes, the patient complained of no pain, and received opioid rescue therapy during the post-operative period. This case presents clinical evidence that RA can help in avoiding some dreadful complications that can occur during GA in obese patients. In any case, the anesthetic management choice must be carefully reasoned, considering the patient's clinical conditions, surgical needs, and, not least, the skills of the anesthetist.

Cohen’s Comprehensive Thoracic Anesthesia

Cohen’s Comprehensive Thoracic Anesthesia

Anesthetic challenges in bilateral pheochromocytoma with history of percutaneous transluminal coronary angioplasty (PTCA)

Pheochromocytoma are catecholamine-producing neuroendocrine tumors that can be adrenal or extra-adrenal (paraganglioma) in origin. The mainstay of definitive therapy is surgical resection, and successful management depends on careful preoperative optimization, meticulous intraoperative and postoperative hemodynamic management.

Pregnancy complicated with Wunderlich's syndrome: Anaesthetic challenges.

Pregnancy complicated with Wunderlich's syndrome: Anaesthetic challenges.

Anesthesia management of patients posted for resection of rhino-orbital mucormycosis developed as a postCovid sequale: Sharing our experiences

Background: Although Mucormycosis is a rare life-threatening fungal infection mainly seen in immunocompromised patients, there has been increasing number of mucormycosis cases presenting as a post COVID sequale mainly from India. Uncontrolled diabetes and overzealous use of steroid seems to be two main aggravating factors. Aggressive medical and surgical management of mucormycosis decreases mortality rate from 88% to 21%.
 Aim: This study is aimed to evaluate anaesthetic challenges in the post COVID patients coming for surgical clearance of mucormycosis.
 Demographic characteristics, associated comorbidities, procedural data, surgical details, hospital stay and mortality rates were reviewed in 32 patients. The mean age of our patients was 52.66 yrs. and 96.9% had associated comorbidities. Two (6.3%) patients had mallampati classification (MPC) IV and 12 had III (40.6%). Average anaesthesia duration was 282.5 min with mean blood loss 792 ml. Twenty-one (65.6%) patients were shifted to ICU (intensive care unit) out of which 15 (46.87%) were electively ventilated. Mortality was seen in 2 patients with mortality rate of 6.25%.
 Conclusion: Surgical resection of mucormycosis in post covid patients presents unique challenges – associated comorbidities, difficult airway, prolonged surgical duration, intraoperative hemodynamic instability massive blood loss, Amphotericin B related side effects mainly nephrotoxicity and hypokalemia, need for postoperative ventilation and prolonged hospital stay. Preoperative optimization, careful intraoperative monitoring and postoperative management are necessary for better outcome.

Obesity: An Independent Risk Factor for Complications in Anterior Lumbar Interbody Fusion? A Systematic Review.

Study DesignSystematic Review and Meta-analysisObjectivesRaised patient BMI is recognised as a relative contraindication to posterior lumbar interbody fusion (PLIF) due to the anaesthetic challenges, difficult positioning and increased intraoperative and postoperative complications, with the relative risk rising in patients with a BMI >25 kg/m2. The impact of obesity defined as a BMI > 30 kg/m2 on Anterior Lumbar Interbody Fusion (ALIF) outcomes is not yet established. The aim of this review was to evaluate if the presence of a raised BMI in patients undergoing ALIF procedures was an independent risk factor for intra- and postoperative complications.MethodsA systematic review of search databases PubMed; Google Scholar and OVID Medline was made to identify studies related to complications in patients with increased body mass index during anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Complication rates in raised BMI patient cohort was compared to normal BMI complication rates with meta-analysis where available.Results315 articles returned with search criteria applied. Six articles were included for review, with 2190 patients included for analysis. Vascular complications in obese vs. non-obese patients undergoing the anterior approach demonstrate no significant difference in complication rates (P = .62; CI = −.03–.02). Obesity is found to result in an increased rate of overall complications (P = .002; CI = .04–.16).ConclusionsObesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs. Increased focus on patient positioning and reporting of outcomes in this patient cohort is warranted to further evaluate perioperative complications.