Dr. Jean-Pierre Estèbe

It is with great sadness that we heard of the death of Dr Jean-Pierre Estèbe, French anesthesiologist, on the 16th of March 2021. Jean-Pierre Estèbe was born in 1955. He started his medical studies in Rennes, France in 1975 and continued with training in anesthesia-intensive care, primarily wanting to become an intensivist. He was passionate about his job, spending his energy on two fronts: pain and loco-regional anesthesia, problems within and the relevant fundamental research; more specifically the prolongation of analgesia with local anesthetics, which were finalized by a university thesis in 2001.

PAIN CARE ESSENTIALS

The best kept secret in pain management is in your own hands. Pain Care Essentials offers the readers a fingertip access to numerous topics in still emerging field of pain medicine, including physical rehabilitation in pain management, peripheral nerve blocks, neuropathic pain, pediatric and elderly pain. This book provides an overview of pain mechanisms as currently understood, and details a variety of approaches to pain management used across a wide range of complementary disciplines. Divided into four convenient sections; the book addresses Fundamentals and Evaluation, Treatment Modalities (including opioids, interventions and alternative medicine), common Chronic Pain and Urgent Pain Problems. Integrative care concepts are presented, emphasizing multi-disciplinary approaches to address the pain. Expert contributors describe therapeutic approaches of various pain conditions and implementing self-care management options.

CARE OF THE ACUTELY ILL ADULT-An essential guide for nurses. Second Edition

Second edition of Creed and Spiers book continues to address the difficult subject of caring for the rapidly deteriorating patient. Updated National early Warning Score-2 is used in this edition and enables the nurse to respond effectively to the quickly changing needs of such patients. Each chapter is divided into separate sections of Contents, Learning Outcomes, Multiple Choice Questions for self–assessment and an End of Chapter test with separate sections for knowledge and skills assessment. Each chapter ends with a complete list of references used that add to the scientific quality in addition to giving an evidence base to the information presented.

Cancer, cancer pain and the ‘Cancer Pain Initiative’

The number of cancer patients has been steadily increasing and with it the number of cancer related pain patients is also increasing. Cancer pain (CP) is the most unique and versatile pain, regarding type, intensity, site, variations and the needed management modalities. No one pain specialist or the pain center can be capable of adequately manage every cancer patient. In this background, an idea to confront this menace at a national level with a combined effort is presented. If implemented it is hoped that the CP patients will get rid of at least the worry about their excruciating pain. The idea of the ‘Cancer Pain Initiative’ has been in circulation for quite some time, but needs to be discussed at various levels. Key words: Cancer; Cancer pain; Pain management Citation: Khan TH. Cancer, cancer pain and the ‘Cancer Pain Initiative’. Anaesth. pain intensive care 2021;25(2):126–12. DOI: 10.35975/apic.v25i2.1482

Quantitative biofilm for bacterial pathogens of ventilator-associated pneumonia

Background & Objective: Ventilator–associated pneumonia (VAP) is one of the most common nosocomial infections in clinical care settings. Several bacteria with biofilm–producing ability offer serious challenge in their eradication. Prompt and accurate diagnosis is needed to provide the best care for the patients. This study aimed to analyze whether biofilm examination using quantitative method can be used as a diagnostic tool for bacterial pathogens associated with VAP. Methodology: This observational analytical study was conducted in Intensive Care Units of three teaching hospitals in Surakarta, Central Java, Indonesia, from November 2019 to April 2020. The subjects were between 19 and 65 y old, with a newly introduced endotracheal tube (ETT) connected to mechanical ventilators, and without pneumonia. Biofilm quantitative measurement used a microtiter plate method from bacterial culture found on ETT at the 48th hour after being mechanically ventilated. The Clinical Pulmonary Infection Score (CPIS) assessment was done at the 48th hour and CPIS of less than 6 was defined as VAP. The analysis used Spearman’s rank and Kendall tau–b correlation. The samples were taken using a consecutive sampling technique. Results: A significant correlation between biofilm and VAP was found (ρ = 0.039, p < 0.05). Biofilm was also sufficiently correlated with an increase in CPIS (τb = 0.341, p < 0.05) Conclusions: Quantitative biofilm can be used as a diagnostic tool for establishing the diagnosis of VAP so that appropriate therapy can be administered immediately. Key words: Bacterial pathogen; Biofilm; Ventilator–associated pneumonia Abbreviations: CPIS: Clinical Pulmonary Infection Score; VAP: Ventilator–associated pneumonia; ETT: Endotracheal tube; PCR: Polymerase chain reaction; OD: Optical density Citation: Dewi FH, Suradi, Purwanto B, Wasita B. Quantitative biofilm for bacterial pathogens of ventilator-associated pneumonia. Anaesth. pain intensive care 2021;25(2):132-137. DOI: 10.35975/apic.v25i2.1468 Received: 24 September 2020, Reviewed: 27, 30 October 2020, Accepted: 3 March 2021

Anesthetic management of a patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol. Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints. Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474 Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021

Pathogenesis and management of pain in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease is characterized by deadly progressive motor neuron disease and other neuronal cells death, which is featured by progressive paralysis and leads to advanced disability and mortality due to respiratory failure.1,2 By the year of 2040, ALS is estimated to nearly double due to global population aging.3 Pain is one of the overlooked symptom, but widely complained by patients with ALS. It can arise at any stage of the disease; and the intensity of pain may increase with the course of the disease. The pain characteristic depends upon its pathogenesis in inducing pain such as nociceptive, neuropathic, or painful cramps. Pain intensity can be severe at an advanced stage of ALS thereby increasing the use of pain relievers and sedatives. It has been related to a declined functional status leading to a decreased quality of life and escalating the rate of depression. Management in ALS patients with complaints of pain differs according to the multifactorial character of pain.4,5 The different aspects of pain in ALS has not been much discussed. Therefore, this article will provide an overview about it. Key word: Pain; Amyotrophic lateral sclerosis; ALS; Pathogenesis; Pain management Citation: Hidayati HB, Pranata CA. Pathogenesis and management of pain in amyotrophic lateral sclerosis. Anaesth. pain intensive care 2021;25(2):236-243. DOI: 10.35975/apic.v25i2.1478 Received: 26 November 2020, Reviewed: 27 December 2021, Accepted: 21 February 2021

Evolution of ASA Physical status scoring system

Anesthesia Preoperative evaluation holds a prime importance in improving overall patient outcomes and decreases hospital expenditure. The American Society of Anesthesiologists Physical Status scoring system ASA-PS was introduced 70 years back in clinical practice and it still holds the lime light for stratifying patient population and considering the risk index and mortality outcomes to warn the surgeon. How has it evolved since the passing years? We will see how over centuries it has evolved. ASA PS has been a significant predictor in depicting morbidity and mortality and evaluating peri-operative risks in patients going for surgery for clinicians, researchers, hospital administrators and government. Further addition of examples of modifying ASA PS status is necessary to make it more comprehensive and easier to use even for non-anesthetists to improve overall peri-operative morbidity and mortality. Key words: ASA PS (American Society of Anesthesiology Physical Status); Peri-operative outcomes Citation: Malik M, Urooj S, Imtiaz A, Arif AM. Evolution of ASA Physical status scoring system. Anaesth. pain intensive care 2021;25(2):225-232. DOI: 10.35975/apic.v25i2.1476 Received: , Reviewed: , Accepted:

COVID-19 and the fundamental role of bioethics

Key words: COVID-19, bioethics, palliative care Citation: Esteban LAT, Jurez MG. COVID-19 and the fundamental role of bioethics. Anaesth pain intensive care 2021;25(2):244-245. DOI: 10.35975/apic.v25i2.1479 Received: 26 January 2021, Reviewed: 30 January 2021, Accepted: 13 February 2021

High flow nasal cannula to prevent intubation in obese patient with COVID-19 induced ARDS: a case report

Obese patients have been identified to have a poor prognosis and a higher risk of death from coronavirus disease-2019 (COVID-19). We present reports of two obese patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) who showed improvement with high flow nasal cannula (HFNC). HFNC is a noninvasive oxygen delivery device which is capable of delivering a high concentration of oxygen that can reduce the requirement for tracheal intubation. HFNC is convenient to use, can reduce dyspnea without effecting the length of stay in ICU in these cases; and has a high merit to be used in selected patients requiring oxygen before attempting intubation and mechanical ventilation. Key words: ARDS; COVID-19; High flow nasal cannula; HFNC; Obese Citation: Mariati NMAS, Sugiarto A, Endriani E, Lestari R, Anindita K. High flow nasal cannula to prevent intubation in obese patient with COVID-19 induced ARDS: a case report. Anaesth pain intensive care 2021;25(2):212-216. DOI: 10.35975/apic.v25i2.1473 Received: 18 November 2020, Reviewed: 24 November 2020, Accepted: 7 December 2020