Transient bladder incontinence following ultrasound guided caudal epidural block

Caudal anesthesia is commonly used a regional anesthesia technique for sub-umbilical surgeries in pediatrics and for chronic pain management in adults. Ultrasound guided caudal epidural block improves the success rate with minimizes complications. We report a patient who underwent lateral sphincterotomy under ultrasound guided caudal epidural anesthesia and developed transient urinary incontinence with prolonged perineal sensory loss postoperatively. Key words: Anesthesia, Caudal epidural, Ultrasound. Citation: Preethipriyadharshini R, Vadhanan CP, Bokka N. Transient bladder incontinence following ultrasound guided caudal epidural block. Anaesth. pain intensive care 2021;25(1):102–104; DOI: 10.35975/apic.v25i1.1437 Received: 17 October 2020; Reviewed: 4 November 2020; Accepted: 5 December 2020

The anesthesiologic management of bar removal after the Nuss procedure for repair of pectus excavatum

Introduction. The anesthesiologic management of bar removal after the Nuss procedure for repair of pectus excavatum is not clearly discussed in literature. The aim of the study: analysing the anesthetic technique of bar removal after the Nuss procedure for repair of pectus excavatum. Materials and methods. The prospective randomized study included 24 adolescents undergone the bar removal after the Nuss procedure for repair of pectus excavatum under general anesthesia with tracheal intubation and artificial lung ventilation. The patients were randomized into two groups according to the analgesia technique: in group PVA (n=14) bilateral paravertebral anaesthesia was used and in group G (n=10) fentanyl was used intraoperatively and ketoprophen – postoperatively. Intravenous induction: propofol 2–3 mg/kg, fentanyl 3–4 mcg/kg, atracurium 0.6 mg/kg. The maintenance of anesthesia: propofol 6–10 mg/kg/h, fentanyl 2 mcg/kg as needed. The following parameters were analyzed: blood pressure systolic (BPs), diastolic (BPd), mean (BPm), pulse rate (PR) and pain intensity using visual analogue scale (VAS). Results: The changes in hemodynamic parameters during surgery and anesthesia were statistically significant (p<0.05), but the hemodynamics was clinically stable. BP and PR were more decreased during anesthesia in group PVA than in group G. Anesthesia was adequate in both groups. There was no need in additional fentanyl bolus after the induction dose in PVA group. Patients in G group needed additional 200 mcg fentanyl during surgery. After surgery the pain intensity was significantly higher in group G than in group PVA: at recovery from anesthesia and extubation of trachea in group PVA – 0 (0–1), in group G – 3 (2–4) (U=1.5; р=0.000002); in the evening of the day of surgery in group PVA – 1 (0–1); in group G – 3 (2–3) (U=6.0; р=0.000031); in the next morning after surgery in group PVA – 0 (0-0); in group G – 1.5 (1–2) (U=12.0; р=0.00027) cm according to VAS. There was no patient with pain intensity higher than 3 cm, so all patients had adequate analgesia. Conclusion. Bilateral paravertebral anesthesia provides more adequate analgesia than systemic administration of analgesics perioperatively for bar removal after the Nuss procedure for pectus excavatum correction. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: anesthesia, paravertebral block, pectus excavatum, Nuss procedure, bar removal.

Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion

Anesthetic management of patients with dilated cardiomyopathy (DCM) can be challenging for anesthesiologists because it is associated with high perioperative mortality rate. This case report describes successful management and important anesthetic considerations in a 15-year-old boy, a known case of burn-associated dilated cardiomyopathy, who underwent bilateral ectropion correction surgery. In such patients, it is imperative to have meticulous preoperative planning, wise selection of medications, and tailored anesthetic technique in order to achieve a favourable outcome. Key words: Anesthesia; Burns; Cardiomyopathy, Dilated; Ketamine; Propofol; Dopamine Citation: Sheikh N, Salik M, Faraz A, Aldahish MM. Anesthetic management of burn-associated dilated cardiomyopathy with difficult intubation for bilateral correction of ectropion. Anaesth. pain intensive care 2020;24(5): Received: 22 August 2020, Reviewed: 23 August 2020, Accepted: 28 August 2020

Knowledge about anesthesiology and the anesthesiologists among patients in a tertiary care hospital in Saudi Arabia

Object: To determine the Knowledge about anesthesiologist's role and responsibilities along with the field of anesthesiology among patients. Methodology: This cross-sectional survey was carried at National Guard Health Affairs, from 1st December 2017 to 30th March 2018. After informed consent, patients were asked to answer the questionnaire comprising of 12 open-ended questions regarding their Knowledge about anesthesiologist and anesthesiology. Scoring as per correct and incorrect questions was done using version 19 (SPSS Inc., Chicago, IL). Results: The four months Cross-sectional Survey included 385 patients from teaching hospital. Other variables included age, gender, type of surgery, educational level, occupation, previous surgery. The majority of the patients 375 out of 385 (97.4%) were having very poor Knowledge about anesthesiology and role of anesthesiologists while a few patients 10 our of 385 (2.6%) were found knowledgeable and anesthesiologists (P<0.05). Conclusion: Knowledge of anesthesiologist and anesthesiology is very poor among patients. There is a strong need to spread awareness about anesthesiology and anesthesiologist among common people to increase communication for the betterment of society. Key words: Anesthesia; Anesthesiologists; Knowledge; Questionnaire. Citation: Lal S, Derar R, Malik M. Knowledge about anesthesiology and the anesthesiologists among patients in a tertiary care hospital in Saudi Arabia. Anaesth. pain intensive care 2020;24(5): Received: 20 June 2020, Reviewed: 24, 28 June 2020, Accepted: 1 July 2020

Prevention of cognitive disorders in the postoperative period in preschoolers

Surgeries under general anesthesia may result in reduced cognitive functions in children, which is important for child development Objective. To assess the incidence of cognitive disorders in children aged 3 to 7 years after intraoperative combined balanced anesthesia and to evaluate the efficacy of Cytoflavin in preventing them. Patients and methods. This study included 85 children who had undergone surgery (adenoidectomy and/or tonsillectomy) under general combined balanced anesthesia (sevoflurane, nitrous oxide, rocuronium bromide, fentanyl, and dexamethasone). The patients were randomized into two groups: control group (n = 40) and experimental group, in which children additionally received one infusion of cytoflavin intraoperatively (n = 44). All patients underwent comprehensive testing with the assessment of various cognitive functions before surgery, 24 hours postoperatively, and one month postoperatively. Results. Cognitive disorders were observed in 6%–10% of children after general anesthesia. The main manifestations of cognitive deficits in the postoperative period, such as impaired concentration, were most significant 24 hours postoperatively, but were eliminated one month later. A total of 7.1% of children demonstrated at least 20% decrease of their attention after surgery under general balanced anesthesia (confirmed by at least 3 tests). Six percent of children had a 20% decrease in their memory 24 hours postoperatively (confirmed by 2 tests). Cytoflavin improved cognitive performance 24 hours postoperatively, while patients in the control group had no significant changes. However, administration of cytoflavin had no significant impact on the incidence of cognitive deficit. Further studies are needed to identify children at risk who require prevention of cognitive disorders associated with anesthesia. Key words: anesthesia in children, anesthetics, pediatric surgery, cognitive outcomes, nicotinamide, postoperative cognitive dysfunction, cytoflavin

ECT: Physiology, Indications, and Treatment

Inducing grand mal seizures (electroshock, electroconvulsive therapy) developed as an effective treatment to alleviate the psychosis of dementia praecox. Clinicians quickly recognized that seizures also relieved depressed moods, suicide risk, catatonia, manic excitement, and delirium. It is an unheralded, often stigmatized, medical achievement. Seizures may be induced chemically or with electric or magnetic currents. Grand mal seizures must be repeated for persistent benefits. Not all seizures are equally effective. Effective seizures are marked by bilateral electroencephalographic brain wave changes and neuroendocrine discharges from hypothalamic-pituitary glands. Treatments are remarkably safe, with zero mortality. Immediate effects on memory are common but are almost always transient. They are not a practical deterrent to the treatments, although they are widely cited to reject its use. The stigmatization of induced seizures that places it as a “last resort” therapy is wasteful and unethical. It offers a remarkable opportunity for advancement in neuroscience. This review contains 4 figures, 3 tables, and 90 references. Key words: anesthesia, bipolar disorder, catatonia, delirium, electroconvulsive therapy, electroencephalography, major depression, melancholia, neuroendocrine, seizures

Neonatal Emergencies II: Necrotizing Enterocolitis and Abdominal Wall Defects

Recent advances in perinatal care have dramatically improved the survival of the youngest and smallest infants, including critically ill neonates and those born with congenital malformations. This has increased the neonatal population at risk for intraabdominal diseases due to prematurity that require surgical intervention. Thus, the pediatric anesthesiologist is increasingly confronted with the challenging task of providing anesthetic care for these vulnerable patients. Despite our better understanding of the immature transitional physiology and developmental pharmacology, pathology of the diseases of prematurity and impact of surgery and anesthesia on their fragile homeostasis, the risk for adverse perioperative events is still the highest in neonatal patients. Therefore, thoughtful preparation, anticipation of potential complications, and efficient collaboration within the multidisciplinary team are essential to ensure safety and quality of the delivered anesthetic care. This review focuses on the perioperative management of necrotizing enterocolitis and abdominal wall defects, with emphasis on preoperative stabilization and tailoring of anesthetic intraoperative plan to the unique neonatal physiology and disease process. This review contains 4 tables, and 50 references. Key Words: anesthesia, necrotizing enterocolitis, gastroschisis, omphalocele, neonatal, prematurity, resuscitation, morbidity, mortality.

Airway Procedures

There has been a marked increase in the number and complexity of airway procedures performed both in the operating room and procedural areas. The anesthesiologist is challenged with establishing a patent shared airway and maintaining adequate gas exchange in patients with compromised airways and/or respiratory function. This review presents a general approach to the patient presenting for an airway procedure and highlights the commonly occurring complications. Airway fire, bleeding, and airway disruption or obstruction may occur. Some of the newer interventional bronchoscopic procedures are introduced, with emphasis on anesthetic implications. A more detailed discussion surrounds the anesthetic management of central airway obstruction and airway stenting. This review contains 8 figures, 5 tables, 30 references. Key Words: anesthesia for flexible bronchoscopy, anesthesia for rigid bronchoscopy, airway stenting, bronchoscopy, central airway obstruction, interventional pulmonology, total intravenous anesthesia, ventilation

Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy. This review contains 5 figures, 3 tables and 45 references. Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology

Nonobstetric Surgery during Pregnancy: An Overview for Anesthesia Providers

A pregnant patient’s surgery can be challenging for the anesthesia provider—the needs of the parturient and fetus must be addressed while balancing the physiologic and pharmacologic changes that occur during pregnancy. Improved outcomes have led to an increase in the frequency of surgeries in parturients, with approximately 50,000 procedures performed annually in the US. Due to a lack of randomized controlled studies, determining the optimal anesthetic technique for nonobstetric surgery during pregnancy is predicated on understanding the physiologic changes of pregnancy. The anesthesia provider must become familiar with specific changes and challenges in each parturient to formulate a safe anesthetic plan. Here, we review physiologic and pharmacologic conditions observed in common surgical cases that may occur during pregnancy. Our goal is to inform safe clinical practices determined by the latest scientific methods for nonobstetric surgery during pregnancy. This review contains 5 figures, 3 tables and 45 references. Key Words: anesthesia, nonobstetric surgery, obstetric anesthesia, pregnancy, surgery, physiology, pharmacology, gynecology