Effectiveness of Huffing Manoeuvre on Fentanyl Induced Cough

Aim: To determine the effect of huffing manoeuvre to preventing cough caused by intravenous administration of fentanyl during induction of anaesthesia. Study Design: Cross-sectional study Place and duration of study: General Anaesthesia Department, SICU and Pain Management, Civil Hospital Karachi from 1st June 2019 to 30th November 2019. Methodology: One hundred and sixty four patients meeting were enrolled. Every patient was taught to perform huffing manoeuvre by primary investigator visiting patient in ward at night before surgery. The act of huffing manoeuvre was lasts within 5 seconds. Any episode of cough within 60 seconds of fentanyl administration was classified as fentanyl induced cough. All patients were received Propofol (2mg/kg) for induction of anaesthesia. Results: The mean age was 46.42±8.92 years. Incidence of fentanyl induced cough was observed in 4.3% cases and huffing manoeuvre was effective in 95.7% cases. Conclusion: Huffing manoeuvre is an effecting method of reducing fentanyl induced cough in patients undergoing surgery, especially the manoeuvre prevents developing of severe fentanyl induced cough. Keywords: Fentanyl, Cough, Huffing manoeuvre, Analgesic opioids

Comparison of Postoperative Mean Morphine Consumption in patients given Preoperative Gabapentin and Placebo undergoing Major Laparotomies for Lower Abdomen and Pelvis

Aim: Comparison of postoperative mean morphine consumption in patients given preoperative gabapentin and placebo undergoing major laparotomies for lower abdomen and pelvis. Study design: Randomized controlled trial Setting: Anaesthesia department, Hameed Latif hospital, Lahore Duration: Six months i.e. 20-04-2008 to 21-10-2008 Methods: 150 patients having major laparotomies were divided in group I i.e. 75 subjects with multivitamins as control and group II i.e.75 patients with Gabapentin. The two groups were compared for the consumption dose of opioid analgesia, postoperatively. Student’s t test was applied and p<0.05 was taken as significant. Results: The mean dose of tramadol consumed by the patients in group I was 43.6±18.9 mg and in group II was 14.7±5.7 mg. Conclusions: Preoperative use of Gabapentin before laparotomies reduces the morphine usage postoperatively. Keywords: Gabapentin; postoperative analgesia; morphine consumption:

Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements.

Seroprevalence of IgG antibody against SARS-CoV-2 among health care workers of anaesthesia departments from various hospital settings in India

BackgroundHealth care workers (HCWs) are the most susceptible group to get COVID-19 infection and this group always need special attention as they are the key human resource to contain this pandemic.ObjectiveTo track down the seroprevalence among a particular group of HCWs working in the anaesthesia department in hospital settings.Study designTwo rounds of serosurvey were done to track the dynamicity among the 128 and 164 HCWs participants in the first round and second round, respectively. 5 mL of blood was collected and IgG SARS-CoV-2 antibody was tested in Abbott Architect i1000SR.ResultsThe seroprevalence found in the first and second round was 12.5% and 38.4%, respectively. A significant number (n=61, 77.21%) of seropositivity came from the asymptomatic HCWs group as found in both the survey. There was no significant association among different age, gender and RT-PCR tested groups.ConclusionRoutine diagnosis of COVID-19 should be referred among HCWs to identify and act upon unrecognized SARS-CoV-2 infection.

Anaesthesia Department Preparedness and Response for the COVID-19 Outbreak in Portugal: A Perspective from CUF Porto Hospital

A global health emergency has been declared by the World Health Organization (WHO) as the SARS-CoV-2 outbreak spread across the world. Patients infected with SARS-CoV-2 are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to health workers providing care.1 In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here we described the measures for the outbreak adopted by the anesthesia department of a private tertiary care level hospital in Porto. These include engineering controls such as: identification and preparation of an isolation operating rooms, administrative measures such as: modification of workflow and processes, introduction of personal protective equipment, and formulation of clinical guidelines for anaesthetic management. We discuss how the hierarchy of controls should be a framework to plan, the necessary measures during each phase of a pandemic, and review the evidence of the procedures taken. [...]

Characterization of the intensive care unit (ICU) admissions in the Benue State University Teaching Hospital.

Today, intensive care units (ICUs) of most hospitals in developed countries have become separate departments staffed by career intensive care physicians or intensivists from various fields of medicine. In Nigeria, however, ICUs are still part of the anaesthesia department and critical care constitutes a significant part of the workload and responsibilities of anesthetists. This study was carried out to ascertain the types of disease conditions that were brought into the ICU for management at the Benue State University Teaching Hospital (BSUTH), interventions undertaken as well as the outcome of such admissions. A total of 125 patients were evaluated. The age bracket between 21 and 30 years recorded the highest figure of 28 accounting for 22.4% of the study population. This was followed by the age bracket between 31 and 40 years with 24 representing 19.2%. The study population was made up of 81 males and 44 females making up 64.8% and 35.2%, respectively. The most frequent conditions occasioning ICU admissions are post laparotomy (24.8%), head injury (18.4%), and burns (11.2%). A total of 289 interventions in various combinations were carried out on these patients. Of these, monitoring of the patients was undertaken 106 times, representing 36.7%. Oxygen therapy followed closely with 102 (35.3%). The lowest number of days spent by patients in the ICU in this study, was 1, while the longest was 35 with a mean of 5.97 days ± 7.76 days. Majority of the patients, 68, were discharged from the ICU to the wards making up 54.4% of the study population. This was closely followed by those that died, 50, accounting for 40.0% of the study population. This study has established that in our ICU, the most common indications for admission were post-laparotomy, head injury and burns. Also, it has been observed that most of the patients underwent haemodynamic monitoring and oxygen therapy. Finally, while most patients admitted were discharged to the wards, a good number also died in the ICU.

Dr Ian Hamilton McDonald, MBBS, DA, FANZCA: The evolution of paediatric anaesthesia and intensive care at the Royal Children’s Hospital, Melbourne

Dr Ian Hamilton McDonald (1923–2019) was a pioneer of paediatric anaesthesia and intensive care at the Royal Children’s Hospital, Melbourne. He first started working at the hospital in the 1940s, later doing further training from 1953–1955 at the Nuffield Department of Anaesthesia in Oxford under Sir Robert Macintosh. McDonald returned to Melbourne as assistant director supporting Dr Margaret (Gretta) McClelland as the director of anaesthesia, together pioneering the development of a major paediatric anaesthesia department. McDonald, along with Dr John Stocks (1930–1974), was intimately involved in pioneering prolonged nasotracheal intubation in children, following on from earlier work by Dr Bernard Brandstater (an Australian working in Beirut), and Drs Tom Allen and Ian Steven in Adelaide. Ian McDonald was an influential, highly respected and greatly loved paediatric anaesthetist who had a profound influence on the early days of paediatric anaesthesia in Australia.

Introduction of an online discussion forum and electronic communication practice in a tertiary-level Anaesthesia Department

Objective: Electronic communication mediums provide an opportunity for clinicians to enhance communication, collaboration, and sharing of clinical experience, especially via mobile devices. In 2016, the authors implemented a private online discussion forum in a tertiary-level anaesthesia department to improve communication and collaboration amongst members. The objective of this survey was to assess if these aims were met, to determine the degree of communication medium duplication incurred by its introduction, and to assess departmental communication practices more generally.Methods: A qualitative anonymous online survey was conducted 18 months following the introduction of the online discussion forum, over a two-month period. All 120 medical staff were invited via forum message and hard-copy invitation and responses were stratified by training status.Results: Forty-seven responses were collected (39% response rate), comprising 31 anaesthesia specialists and 16 anaesthesia trainees. Sixty-one percent of respondents reported that discussion had improved following the introduction of the online discussion forum, with no significant difference between specialists and trainees. Despite this, 57% overall maintained a preference for email discussion.Conclusions: This study demonstrated that the introduction of an online discussion forum resulted in a perceived improvement in overall departmental communication. However, it is important that workplaces considering implementation of a similar communication medium determine their employees’ cultural perspectives on technology, established communication preferences and aims of implementation to ensure success.