Contact force exerted on the maxillary incisors by direct laryngoscopy with mcgrath video laryngoscope in predicted difficult intubation

Patients with difficult airways who are going to undergo surgery under general anesthesia require special consideration from an anesthesiologist. Knowing the most significant risk of morbidity and mortality is often due to difficult cases of airway management. One of the most common complications and often becomes lawsuits in the field of anesthesia is dental trauma that occurs during the intubation process due to contact from laryngoscope blade to the teeth. This descriptive study will show the measured force exerted on the maxillary incisors at the time of performing laryngoscopy using a McGrath video laryngoscope in patients with a potentially difficult intubation (LEMON criteria ≥ 3). The contact force exerted on the maxillary incisors is measured using a special instrument. The contact force exerted on the maxillary incisors in patients with a potentially problematic airway was discovered to vary.

The outcome of surgical resection in complete paraplegia patient due to thoracic schwannoma

Spinal schwannoma is the most common benign intradural spinal tumor. However, studies regarding the neurological outcome of tumor resection in complete paraplegia patients are still lacking. The authors report a case of complete paraplegia due to primary intradural extramedullary low-grade schwannoma of the spinal cord. Surgery was performed 5 weeks after the paraplegia complaint first occurred. The patient did not regain motor nor sensory function in the 1-month follow-up but resolution of pain was achieved. The patient was able to perform daily activity more comfortably. In the event of complete paraplegia, surgery should still be offered promptly as it can still benefit the patient. Possible factors that could have influenced the prognosis in our study are discussed.

Effectivity battle between C-MAC and McGrath® video laryngoscope in a patient with general anesthesia at Sanglah Hospital: A pilot study

Background: Intubation is a common essential procedure to maintain the airway during general anesthesia. Various video laryngoscopes (VL) on the market today assist anesthesiologists in improving intubation success rates and also in complicated airway cases. There are two types of VL found in our institution, which are C-MAC and McGrath®. Each of them has its pros and cons, which withdrawn our curiosity to compare their effectiveness. Methods: A pilot study was conducted in our center; we included all patients undergoing general anesthesia with physical status ASA I-III and consent to the study and divide them into two groups, C-MAC and McGrath®. We compare C-MAC and McGrath® VL effectiveness in terms of time for intubation, ease of intubation, total attempt, failure to intubate, Cormack Lehane degree, POGO Score, and hemodynamic stability. Results: A total of 20 patients were intubated with two different VL, ten patients for each group. Both VLs accommodate ease of intubation, and overall first attempt successful intubation, though C-MAC showed better laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change. Conclusion: C-MAC gives better results in laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change.

The use of CONOX as a guide to the general anesthesia on laparotomy patients compared with standard clinical care – A pilot study

Background: Avoiding excessive doses of anesthesia was fundamental, mainly to reduce the adverse effect of anesthesia. Electroencephalography (EEG)-based monitors can be used to measure the depth level of anesthesia and guide intraoperative hypnosis drug and opioid administration. This study aims to evaluate the benefit of using CONOX monitor when administering anesthesia drugs in laparotomy procedures. Method: Twenty patients aged 18-65 years with physical status ASA I-III who underwent major laparotomy surgery with general anesthesia total intravenous anesthesia (TIVA) were divided into two groups. Group A received general anesthesia guided with the CONOX monitor, while group B using standard clinical care. We later evaluate the total use of propofol and fentanyl, intraoperative hemodynamic profile, postoperative cognitive disorder (POCD), intraoperative awareness, postoperative nausea and vomiting (PONV), and moderate to severe pain in the post-anesthesia care unit (PACU). Results: The mean total propofol used is lower in CONOX group (63.6 ± 11.7 mcg/kg/min vs. 74 ± 17.87 mcg/kg/min). A similar result was obtained with fentanyl. The CONOX group use a lower total of fentanyl (212.5 ± 32.3 mcg vs. 249 ± 54.6 mcg) than the control group. POCD was found to be more prevalent in the control group (5 vs 2 patients). While there is no report of intraoperative awareness. Conclusion: The incidence of PONV and moderate to severe pain in PACU was similar between the two groups. This pilot study is a preliminary study to evaluate the benefit of using EEG-based monitors to adjust anesthesia drugs.

Oral Administration of Red Rice (Oryza nivara) Bran Extract Reduced Weight, Visceral Fat And Liver Steatosis Amount in Obesity Male Wistar Rats (Rattus norvegicus)

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity. Red rice (Oryza nivara) bran is known to contain polyphenol and antioxidants that might be potential in reducing body weight and visceral fat in obese mice and preventing liver steatosis. This study was aimed to prove the effect of oral administration of red rice bran (Oryza nivara) extract on body weight, visceral fat, and liver steatosis amount in obese male Wistar rats. Method: In this research, the subjects were 36 male obese (Lee index > 0.3) white rats (Rattus norvegicus) Wistar strain, 4-5 months old, divided into two groups. The control group received a placebo and the treatment group received 460mg/200gram red rice bran extract for 5-weeks. Bodyweight, visceral fat, and the amount of liver steatosis were observed. Differences between groups in each variable were analyzed. Results: The weight of the control group and the treatment group was 321.17 ± 19.04 grams and 305.72 ± 12.89 grams (p < 0.05). The visceral fat weight was 3.15 ± 0.34 grams in the control group and 2.99 ± 0.34 grams (p > 0.05) in the treatment group. Liver steatosis amount was 41 ± 18 cells per visual field in the control group, and 21 ± 12 (p < 0.05) in the treatment group. Conclusion: Oral administration of red rice bran extract can reduce body weight and liver steatosis amount in obese Wistar rats. The extract of red rice bran did not have a significant effect in reducing visceral fat.

Lumbar drain for CSF leakage: a word of caution

A continuous lumbar drain is a frequently practiced procedure to prevent cerebrospinal fluid (CSF) infection in post-operative neurosurgical cases. However, the level of CSF drained must correspond to the intracranial pressures, where any accidental increase in lumboventricular gradient by slipping of the drainage bag below the level of the iliac crest can lead to over drainage and catastrophe. The learning point is to use automated or manual measures to monitor Intra-Cranial Pressure (ICP) and sound alarm in such an event to prevent sagging of the brain.

The diagnostic problems if right-sided heart failure patient with cardiomyopathy cirrhosis

Heart failure may cause liver damage, known as cardiomyopathy cirrhosis. Conversely, liver disease could also lead to heart failure and cardiovascular abnormalities. Cirrhotic cardiomyopathy is a relatively rare disease. Diagnosis should be found out as early as possible to prevent complications. Unfortunately, epidemiology data of cirrhotic cardiomyopathy is still limited, and the prevalence is still not precisely known. Hence, we reported a case of a young man with the main problem of right-sided heart failure and suspected cardiac cirrhosis with unclear manifestation. This case has a good outcome so that we hope this report could give a great reference on treating cardiomyopathy cirrhosis.

Treatment of panurethral strictures using one side dissection dorsal onlay buccal mucosal graft urethroplasty

The management of panurethral stricture was still challenging and controversial. We presented a case of pan urethral strictures management by using a one-sided dissection of dorsal onlay buccal mucosal graft (BMG) urethroplasty (Kulkarni technique). A 53-years old man admitted with panurethral stricture who had previously undergone several procedures. Bipolar micturition cystourethrography procedure revealed 17 cm stricture length. One-sided dissection dorsal onlay buccal mucosal graft urethroplasty was performed. No drain was placed. The Foley catheter was removed four weeks after surgery, and the results of the micturition were favourable. No fistulae were found at a straight erection and meatus at a normal position. The postoperative flow rate (Qmax) was 24.9 ml/second. As a conclusion Kulkarni technique urethroplasty gained good outcome for panurethral stricture in our case.

Infectious diseases as complications following spinal cord injury

Background: Infectious complications in spinal cord injury (SCI) patients can increase the mortality and morbidity of the patients. The inability to do daily activity is the main cause of the occurrence of infectious complications. Good understanding and high awareness are needed to notice some infectious complications which are difficult to be diagnosed. Method: This paper is a literature review which was done by reviewing and searching journals with “infectious complication”, “spinal cord injury”, “infection” on the search engines. The authors found 52 articles are suitable to be composed as references for this paper. Outcome: Several infectious complications may occur following the incidence of SCI and have a lot of disadvantages. The causes of these infections are multifactorial. Urinary tract infection, infected pressure ulcer, pneumonia, and some other infectious diseases may appear as complications. Extra care in hygiene and sanitation is needed, besides, high awareness is needed to discover these complications. Conclusion: Monitoring post-SCI complications are complex and difficult. A high level of suspicion should be raised with frequent aseptic actions and procedures. Appropriate management including non-surgical or surgical procedures can be chosen to achieve the best outcomes. Early diagnosis and management are critical for the best treatment results.

Ashitaba (Angelica keiskei) leaves extract cream 8% inhibited the increase of melanin amount as effective as hydroquinone cream 4% and inhibited the increase of tyrosinase enzymes not as effective as hydroquinone cream 4% in the ultraviolet B-exposed Guin

Background: Excessive sun exposure results in increased activity of the tyrosinase enzyme and the amount of melanin in the skin which causes hyperpigmentation, a sign of premature aging. The purpose of this study was to prove that Ashitaba (Angelica keiskei) leaves extract cream 8% inhibited the increase of melanin and tyrosinase enzymes as effective as hydroquinone cream 4% in the ultraviolet B-exposed guinea pig (Cavia porcellus) skin. Methods: This study used a randomized post-test only control group design. The subjects were 36 male guinea pigs (Cavia porcellus). Subjects were divided into two groups, the hydroquinone cream 4% group and the Ashitaba leaves extract cream 8% group exposed to UVB light. Skin samples were collected 48 hours after the last exposure to measure the tyrosinase enzyme levels using the ELISA method and the amount of melanin was examined by Masson-Fontana staining. Results: The mean levels of tyrosinase in the hydroquinone cream 4% group was 19.51 ± 5.16 ng/L and the Ashitaba leaves extract cream 8% group was 23.76 ± 3.09 ng/L (p = 0.005). The mean amount of melanin in the hydroquinone cream 4% group was 2.98 ± 2.27% and the Ashitaba leaves extract cream 8% group was 4.77 ± 3.33% (p = 0.069). Conclusion: The administration of Ashitaba (Angelica keiskei) leaves extract cream 8% inhibited the increase of melanin amount as effective as hydroquinone cream 4% and inhibited the increase of tyrosinase enzymes not as effective as hydroquinone cream 4% in the ultraviolet B-exposed guinea pig (Cavia porcellus) skin.