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  • ISSN: 2333-6641
    Volume 2, Issue 1
    January-March 2014
    Case Report
    Sebastiano Mercadante1*, Cristina Agozzino1, Rosalia D’ Angelo1, Mario Mazzara1, Dario D’ Anna1, Benedetto Santostefano1, Rosanna Bellingardo1, S Mangione2 and Alessandra Casuccio BS3
    Abstract: The aim of this study was to assess the characteristics of patients admitted to a recovery room [RR] in an oncological department. The secondary outcomes were to evaluate how RR was able to prevent immediate postoperative complications and which are the principal factors influencing RR stay.
    A consecutive sample of cancer patients who were admitted in RR was surveyed. Patients who received some form of anesthesia by specialized staff were included. Patients were discharged to their ward when they achieved a safety score and adequate symptom control. The patient’s level of consciousness, respiration, hemodynamics, mobility of the extremities, oxygen saturation [SO2] were recorded, on a scale from 0 to 2 [modified Aldrete score], as well as pain intensity, vomiting, shivering, and drugs administered in RR. Patients, who were expected to need respiratory support for the subsequent 24-48 hours after evaluation in RR, were discharged to continue non-invasive ventilatory support [NIV] in a sub-acute unit, according to local policy.
    1185 patients were surveyed. The mean age was 59.4 yrs [SD 14]. At RR admission, the mean SO2 was 98.1 [SD 2.2], with 10[0.8%] patients having a SO2 of less than 90%. The level of consciousness was normal in 847 patients, patients were sedated [score 1] in 246 cases, and 8 patients had more profound level of unconsciousness [score 2]. (NOTE: this does not make sense – do you mean unconsciousness?). On admission to RR, 1079 patients were spontaneously breathing, one patient was intubated and breathing spontaneously, three patients had a laryngeal mask airway, 87 were intubated and manually ventilated a but extubated shortly after arriving to RR. Seven patients were intubated on arrival to the RR and received CPAP.One patient underwent controlled ventilation. Two patients had to be re-intubated in RR, and one patient needed alaryngeal mask airway to be inserted. The mean duration of RR stay was 61.3 minutes [SD 54].Using an univariate analysis, the duration of RR stay was correlated to age, duration of surgery, ASA, gender [male], obesity, cardiovascular disease, renal disease, and abdominal surgery. Significant correlation was found only with gender, ASA, obesity, cardiovascular disease, and duration of surgery. In order to maintain respiratory support mainly through non-invasive ventilation [NIV], 51 patients [4.3%] were discharged from RR to a sub-intensive Care unit for a median duration of 1 day.
    RR is of paramount importance for the management of cancer patients undergoing different types of surgery. Patients can be monitored and stabilized after an appropriate treatment until the best balance is achieved.Thus, admission to RR improves patient safety and efficacy of treatment.
    Daniela Smith* and Douglas G. Martz
    Abstract: Brugada syndrome (BS) is a rare cardiac channelopathy that was first described in 1992. It accounts for four percent of all sudden deaths and up to twenty percent of sudden deaths in patients without structural cardiac defects. Since known and unknown BS patients can present for surgery at any time, it is important for the anesthesiologist to be familiar with this syndrome and how to safely manage these patients peri-operatively. A case study is described in which a 53 year old woman with BS required emergent embolization of her left facial artery and bilateral internal maxillary arteries due to severe epistaxis on two consecutive days. The etiology, mechanism and proper peri-operative management of BS are then reviewed, and a summary of appropriate medications is provided.
    Ahmad Elsharydah*
    Abstract: Restrictive familial cardiomyopathy (RCM) is a rare cardiac disease which imposes serious risks on the parturient, especially during labor and delivery. I describe a case of a patient with severe RCM who successfully underwent emergency cesarean section utilizing epidural anesthesia. Other similar cases in the literature were reviewed and discussed. To the best of my knowledge this is the first case report describe the anesthetic management of the restrictive type of this disease.
    Herring Keith G1, Panthayi Sreelatha2, Sheinbaum Roy2, Hagberg Carin A1, Karni Ron J3 and Cattano Davide1*
    Abstract: Venous-venous extracorporeal membrane oxygenation [ECMO] can be life saving in clinical situations where awake, fiberoptic intubation or tracheostomy were indicated but were not feasible because of critical airway obstruction in the lower airways. We present a case of unusual airway obstruction by a neck mass extending in the mediastinum in a young adult. A flexible fiberoptic bronchoscope was used to confirm the extent of external compression and airway obstruction. The nature of invasion was concerning for bleeding and obstruction of the airway if we attempted to manipulate the airway by fiberoptic intubation. The extension of the mass into the chest prevented other methods for securing the airway such as retrograde intubation or awake tracheostomy. There was also a concern that the use of standard induction and neuromuscular blocking drugs would cause irreversible tracheal compression or cardiovascular compromise. ECMO was utilized to provide safe oxygenation while establishing a definitive airway.
    John P Scott*, George M Hoffman, James S Tweddell, David C Cronin II, L. Eliot May and Harvey J Woehlck
    Palliated single ventricle anatomy imposes unique physiologic limitations that increase the risk for cardiac and end organ failure. Patients with failing univentricular circulation often have very high systemic venous pressures as a result of the superimposition of the trans-pulmonary pressure gradient on elevated ventricular end-diastolic pressure, with increased risk of cardiac cirrhosis and end stage liver disease. Here we present the case of a 14-year-old male, with failed bidirectional Glenn circulation and cardiac cirrhosis, who required a combined heart-liver transplant (CHLT). Informed consent from the patient’s legal guardian was obtained for this case report.
    Review Article
    Gary E. Hill*
    Abstract: This article discusses risk and uncertainty of general anesthesia, taking into account consideration of unknown and random variables and probabilities as well as the acknowledgment of known and possibly controlled variables as it applies to anesthesia. It shows the difficulty in quantifying risk of individual case and the somewhat arbitrary and even incorrect and naïve assignment of risk in individual patient care management. Effective and honest communication remains at the core of physician - patient relationship in discussing, evaluating, and managing the individual case for optimum outcome as well as patients’ and family satisfaction and the acceptance of the inherent risks involved in the administration of general anesthesia in humans.
    Risk is an integral part of life that is brought by natural forces as well as human activity. Though it is reasonable to assume that many people pondered on the nature of the risk, one can, somewhat arbitrarily, trace the beginnings to 16th century Italian mathematician and physician Gorelamo Cardano, who was more interested in risk related to money wagering and potential monetary gain than to outcomes of medical practice [1]. The assessment of the inherent risk of general anesthesia administration became possible only after introduction of anesthesia record over 100 years ago, which allowed more substantiated and reproducible comparisons [2]. Once risk is quantified it can and should be used to guide the decision process through the meaningful narrative. It is common to express risk as a probability or probability distribution. That method, even in simple models, forces us to make certain assumptions and often tends to obscure the difference between the uncertainty about the sensitivity and specificity of the collected data and the uncertainty about the accuracy and significance of the results.
    In this review we attempt to broadly define the risk in anesthesia and discuss the relation between risk and uncertainty. We also want to bring to light some imperfection of human mind that are relevant in addressing risk. The decision process, studied by cognitive psychologists, has innate flaws that, even with obvious data limit our ability to recognize, to address, and to properly react to issues related to risk.
    Research Article
    Chaibou MS1*, Sani R2, Bako H3, Kotanou M1, Daddy H1, James Didier L2, Abarchi H2 and Chobli M4
    Abstract: Objectives: The aim of this study was to evaluate the management of surgical acute abdominal emergencies at the National Hospital of Niamey.
    Methods: Prospective study was conducted in emergency unit of the Niamey National Hospital, from March to September, 2010. Data collected included: age, sex, mean of transportation used, clinical signs, indication of surgery, delay of admission, pre operative check, American Society of Anesthesiologists (ASA) physical status classification, preoperative prescriptions, delay of the intervention, technique of anesthesia, incidents, accidents and the outcome of the patient.
    Results: The sample included 255 patients. The functional signs were: abdominal pain and vomit. The delay of admission was 72 hours. The radiography of the abdomen has been realized in 58%. Seven patients have an abdominal computed tomography (CT). The indications of surgery were: peritoneal syndrome (38.4%), occlusive syndrome (24.5%) and appendicitis (15.9%). The abdominal contusions represented 10.9%, penetrating wounds 1.9%. The gynecological emergencies represented 2.7%. 54.5% of the patients were classified ASA E 1; 35.3% ASA E 2. The delay of the surgery was 8 hours. 220 patients have been operated. General anesthesia was performed in 94%. Anesthetic drugs used were: ketamine in 94% of cases, fentanyl was the only narcotic available. We have 36 cases of incidents or accidents during the anesthesia (16.3%). The average expenses occurred for the families were US$ 240. Duration of hospitalization average was 12 days and 7.4% of patients were deaths.
    Conclusion: The management of acute abdominal emergencies at the Niamey represents public health problem, the solution to this problem passed by the empowerment of the people, reforms in the management of emergencies in the peripheral medical centers and medically transportation of the patients.
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