The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

Background: Children with brain tumors experience potential neurologic complications when are treated with radiotherapy, especially if done frequently under anesthesia. Objectives: This study aimed to evaluate the neurologic complications associated with anesthesia in pediatrics treated with radiotherapy under anesthesia. Methods: This cross-sectional study consisted of 133 pediatric patients with a brain tumor who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. Statistical values less than 0.05 were considered significant (P < 0.05). Results: The patients were in range of 1 - 8 years, and the number of 3,208 anesthesia inductions were conducted for daily radiotherapy. Major complications such as stroke, arrhythmia, tachyphylaxis, and aspiration were not observed. There was a significant relationship between the tumor side, anesthesia, and neurologic complications (P < 0.05). No significant differences were found between demographic data (age, sex, and weight) (P > 0.05). Conclusions: Anesthesia complications in this study were slight and insignificant. Some were either due to the tumor effect on other vital organs or prior exposure to radiotherapy and chemotherapy. Thus, for providing safe anesthesia, considering the tumor effect on body organs and neurologic complications caused by it can be a great help to reduce anesthesia complications in pediatrics under radiotherapy.

Comparing the effects of propofol and ketamine on the emergence agitation of male children undergoing circumcision

Background Separation from the family, prolonged hunger, inability to perceive the surgical procedure performed, and feeling pain are among the main reasons for agitation in young children. In operations like circumcision, in which all bodily integrity is disrupted and children cannot make sense of it and feel punished, this agitation increases. The aim of the present study was to compare the effects of propofol and ketamine on the emergence agitation (EA) in children undergoing circumcision. Result When the patients were taken to post-anesthesia care unit (PACU), no statistically significant difference was observed between propofol and ketamine groups in the Aono’s four-point scale at minute 0 (p = 0.073). In the 5th minute, it was higher in the ketamine group compared to the propofol group (p < 0.001). With Aono’s four-point scale, EA diagnosis is made in areas with 3 and 4 points. The average Aono’s four-point scale in the ketamine group at the 5th minute was 3.08 ± 1.02. Since the Modified Steward score was ≥ 6, the time taken was longer in the ketamine group compared to the propofol group (p < 0.001). Conclusion EA does not only occur in inhalational anesthetics, it is also seen with ketamine. In view of the fact that ketamine can cause EA in children, it should not be used alone in anesthesia. Propofol provides a safe anesthesia. Instead of inhalational anesthesia, where the type of surgery is suitable, anesthesia with propofol infusion should be applied. Further research is required to investigate EA.

EP.TU.651Training Opportunity In A Non Covid Private Hospital During The Initals Phase Of Sars-Cov-2 Pandemic-Our Experience

Aim We would like to share our experience in the unique opportunity our surgical trainees had, while operating in a NON COVID private hospital. Methods We did a retrospective data collection from 1st of April till 31st May 2020. The data was collected about the patients who underwent elective surgery in a non COVID private hospital selected by our NHS trust. The selected patients were asked to self-isolate for 2 weeks prior to surgery date. They also underwent 2 swab tests, the first one a week before and another one 48 hours before the surgery date along with a chest X-ray. Only the patients who tested negative on swabs were operated in the private setup. Results There were 17 elective laparoscopic cholecystectomies and 42 breast surgeries performed. The primary operating surgeon were trainees in around 80 percent cases. Ours was the first NHS trust to start this in the North East England. There was no increase in operating time, but the turnover time was nearly doubled because the guidelines for safe anesthesia and surgery during this pandemic were strictly followed. We did not have any complications or readmission related to surgery in this cohort of patients. There was no reported SARS-CoV-2 infection to patients and the involved medical staff. Conclusion The opportunity for continuity of surgical training in a private setup is a possibility and should be explored more in future.

Above knee amputation in a geriatric patient with severe ICMP and DM2: A case report

Geriatric patients with cardiac dysfunction are always a nightmare for anaesthetist in terms of successful intraoperative and postoperative management. We are presenting a case of 68-year-old male patient admitted in surgical emergency with rapidly progressive wet gangrene of right leg. He was a diagnosed case of severe Ischemic cardiomyopathy (ICMP) and Diabetes mellitus type 2 (DM-2) since last 10 years on medications. However, he was non-compliant with medications and had developed severe limitation in the functional status with metabolic equivalents &#60;4 (METs&#60;4) and complaints of chest pain even on minimal exertion. In view of the rapidly progressive wet gangrene and risk of sepsis leading to high possibility of morbidity and mortality, an urgent above knee amputation was planned. However due to the risks associated with general anaesthesia and central neuraxial blockade, an safe anesthesia plan was formulated and implemented utilising only the lower limb blocks to achieve a safe conduct of anaesthesia.

Ultrasonography: The Third Eye of Anaesthesiologist

Anesthesiology is an evolving branch. Most of the procedures done by anesthesiologists, are blind except for endotracheal intubation. Ultrasonography (USG) helps anesthesiologists to see the actual anatomy in real time and thus helps them to give safe anesthesia minimizing the complications in every aspect of the field like difficult airway, vascular access, regional anesthesia, chronic pain management and critical care.

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Background After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical diseases. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have led to the development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Patients who undergo TOEPVA at our institution between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Results Seven patients were operated successfully by this technique, none of which required conversion to conventional open surgery. Two patients required atropine and one patient required ephedrine during insufflation. Conclusion After induction of anesthesia with propofol, remifentanil, and rocuronium and anesthesia managed by desflurane co-administered with continuous infusion of remifentanil provide feasible and safe anesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anesthetist has a great value to improve patient management.

The current state of anesthesia safety in a third world country: a cross-sectional survey among anesthesia providers in Ethiopia

Background Improving patient safety during anesthesia and surgery becomes a major global public health issue due to the increasing in surgical burden. Anesthesia is delivered safely in developed countries, but its safety is hampered by complex problems in third world countries. This survey assesses the unmet anesthesia needs of one of a third world country, Ethiopia. Methods A cross-sectional survey was conducted in Amhara region of Ethiopia from 15/12/2019 to 30/1/2020. All 81 hospitals of the region were stratified by their level as district, general, and referral hospital. The study was conducted in 66 hospitals. The number of hospitals from each strata were calculated by proportional sampling technique resulting; five referral, three general, and fifty eight primary hospitals. Each hospital from each strata was selected by convenience. Each anesthesia provider for the survey was selected randomly from each hospital and questionnaires were distributed. The minimum expected safe anesthesia requirements were taken from World Health Organization-World Federation of Societies of Anesthesiologists International Standard and Ethiopian Hospitals Standard. Anesthesia practice was expected safe if the minimum requirements were practiced always (100%) in each hospital. P < 0.05 with 95% confidence interval were used to compare the safety of anesthesia between higher and lower level hospitals. Results Seventy eight (88.6%) anesthesia providers working in 62 hospitals responded to the survey. On aggregate, 36 (58%) hospitals from the total 62 hospitals have met the minimum expected safe anesthesia requirements. Among the different variables assessed; professional aspects 32 (52.45%), medication and intravenous fluid 33 (53.36%), equipment and facilities 33 (52.56%), patient monitoring 43(68.88%), and anesthesia conduct 38 (62.1%) of surveyed hospitals have met the minimum requirements. Anesthesia safety is relatively higher in higher level hospitals (general and referral) 6 (75%) when compared to district hospitals 30 (55.5%), P < 0.001. Conclusion Anesthesia safety in Ethiopia appears challenged by substandard continuous medical education and continuous professional development practice, and limited availability of some essential equipment and medications. Patient monitoring and anesthesia conduct are relatively good, but World Health Organization surgical safety checklist application and postoperative pain management are very low, affecting the delivery of safe anesthesia conduct.

Nurse anesthetists’ experiences using smart glasses to monitor patients’ vital signs during anesthesia care: A qualitative study

Purpose To describe nurse anesthetists’ experiences using smart glasses to monitor patients’ vital signs during anesthesia care. Methods Data was collected through individual semi-structured interviews with seven nurse anesthetists who had used smart glasses, with a customized application for monitoring vital signs, during clinical anesthesia care. Data was analyzed using thematic content analysis. Results An overarching theme became evident during analysis; Facing and embracing responsibility. Being a nurse anesthetist entails a great responsibility, and the participants demonstrated that they shouldered this responsibility with pride. The theme was divided in two sub-themes. The first of these, A new way of working, comprised the categories Adoption and Utility. This involved incorporating smart glasses into existing routines in order to provide safe anesthesia care. The second sub-theme, Encountering side effects, consisted of the categories Obstacles and Personal affect. This sub-theme concerned the possibility to use smart glasses as intended, as well as the affect on nurse anesthetists as users. Conclusion Smart glasses improved access to vital signs and enabled continuous monitoring regardless of location. Continued development and improvement, both in terms of the application software and the hardware, are necessary for smart glasses to meet nurse anesthetists’ needs in clinical practice.