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  • ISSN: 2333-6641
    Volume 2, Issue 2
    April-June 2014
    Editorial
    Egbohou P*, Sama H, Mouzou T and Tomta
    The goal of Preanesthesia Evaluation (PAE) is to obtain relevant information regarding the patient‘s current and past medical history and formulate anesthetic plan based on risk assessment [1]. Patient satisfaction with anesthesia services is now an important point in the quality of care [2,3]. In Togo, at CHU Sylvanus Olympio de Lomé this PAE is effective, but no study has evaluated patient's satisfaction with this PAE. We therefore conducted this audit to determine the level of satisfaction of patient, identify problems and suggest measure to improve this service.
    Case Report
    Manzo Suzuki1*, Kenji Yokoyama1, Yumiko Oe1, Yasuo Ishida2, Masahiro Ohno2, Hozumi Marumo1 and Yoichi Shimada1
    Abstract: Sivelestat is a potent inhibitor of neutrophil elastase activity. We report a patient who suddenly developed hypoxia during surgery, which improved by the administration of sivelestat. A 72-year-old woman underwent emergency resection of a perforated colon that was capsulated by mesenterium. During the surgical manipulation, the capsule ruptured, causing spillage of dirty discharge into the abdominal space. A few minutes after it ruptured, her oxygen saturation (SpO2) suddenly dropped from 100% to 94%. Ten minutes after it ruptured, administration of sivelestat, 12 mg/hr, was started. Her SpO2 gradually increased and her Arterial Blood Gas (ABG) values improved. After the surgery, the patient was admitted to the Intensive Care Unit (ICU). Her trachea was extubated 30 hours after admission to the ICU. There were no remarkable pulmonary complications after extubation. Sivelestat administration was continued for four days. The time course of oxygen desaturation and her blood parameters suggested that systemic circulation of an endotoxin induced the secretion of elastase from neutrophils, which in turn caused sudden desaturation. If the patient had not been treated with sivelestat, there was a high possibility that she could have developed Acute Lung Injury (ALI) due to the hypoxia. When a patient with risk factors for developing ALI develops oxygen desaturation during surgery, administration of sivelestat may improve the patient's oxygenation and prevent the development of ALI.
    Amarjeetd Patil*, Gogna RL, Olvyna D'souza, Arpan Sashankar, Shikha A Malhotra and Charu Sudan
    Abstract: The anaesthetic management of patient with craniofacial pathology often presents unique challenges because soft tissue and bony abnormities can affect the airway and influence airway management. In emergency cases having difficult airway it's always a dilemma how to go about the case but in our case of Ca cheek with difficult to ventilate and intubate posted for emergency E-lap, we use Lightwand as a intubating aid successfully. They all had a laryngeal view of Cormack–Lehane grade IV and were impossible to intubate using direct laryngoscopy. We consider that lightwand guided intubation technique may be a useful alternative approach to fibreoptic intubation technique in managing the emergency difficult airway.
    Rika Nakayama, Takahiro Mihara*, Yoshiko Mizuno, Yoshihisa Miyamoto, Koui Ka
    Abstract: We present a case of severe hypotension associated with insertion of an Alexis® wound protector/retractor during lower abdominal surgery in a child. A 3-year old female patient underwent ureteroneocystostomy for vesicoureteral reflux under general anesthesia. After skin incision in the lower abdomen, the retractor was placed in position through the incision in the lower abdominal wall, with the inner ring inside the abdomen. Following insertion of the retractor, the patient's blood pressure dropped from 95/40 mmHg to 45/20 mmHg. Physical examination and transthoracic echocardiography did not indicate any signs of anaphylactic reaction, cardiac dysfunction, or pulmonary embolism, and after removal of the wound retractor, the patient's blood pressure quickly recovered to the baseline level. Because these wound retractors may cause severe hypotension, it is important to pay particular attention to blood pressure when they are used in small children undergoing abdominal surgery.
    Research Article
    Hamza Doles Sama1*, Aboudoul Fataou Ouro Bang'na Maman1, Raweguinbasba Armel Flavien Kabore2 and Mofou Belo3
    Abstract:
    Background: Intra-articular injection of lidocaine is a recognized anesthetic technique for closed reduction of Anterior Internal Shoulder Dislocation (AISD), which may be of particular benefit to patients in developing countries.
    Methods: A prospective observational study was conducted of patients admitted to the Sylvanus Olympio University Teaching Hospital, Togo with a diagnosis of AISD between August 1 2010 and March 31 2011. Demographic and relevant clinical data, including patient satisfaction were collected.
    Results: 60 patients with AISD were admitted during this period. There was a male predominance (75%), with median age of 33 years. The injury had occurred in the street in 35 cases. Sub-coracoid dislocation was demonstrated on X-ray in 42 cases. Intra-articular lidocaine 2% was administered and was effective 3 minutes after injection in most cases, with a success rate of 95%. 54 patients required less than 5ml lidocaine 2% in total. No immediate complications were reported, and patient satisfaction was high.
    Conclusion: The use of intra-articular lidocaine is a useful technique for reduction of AISD, which should be considered in developing countries.
    Masashi Ishikawa* and Atsuhiro Sakamoto
    Abstract:
    Introduction: The incidence and risk factors of Postoperative Acute Kidney Injury (PO-AKI) after liver surgery are not well established. The purpose of the present study was to evaluate the incidence and perioperative risk factors of PO-AKI in patients undergoing liver resection.
    Methods: We conducted a retrospective study on consecutive patients undergoing any type of liver resection between November 1, 2008 and May 31, 2012 at Nippon Medical School Hospital. Electronic medical records were abstracted for comorbid conditions and intraoperative predictors with the potential for association with PO-AKI. The development of AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria definition.
    Results: The study included 199 of 204 patients who underwent liver resection during the study period. The other five cases were excluded because they underwent renal replacement therapy before surgery. The AKI rate was 23.6% (47 of 199 patients), four of whom (8.5% of AKI patients) required renal replacement therapy. Multivariate analysis identified BMI (odds ratio: 1.20, 95% CI: 1.07-1.36, P=0.003), CKD (odds ratio: 3.31, 95% CI: 1.32-8.46, P=0.011), platelet count (odds ratio: 0.94, 95% CI: 0.89-0.99, P=0.022) and albumin (odds ratio: 0.32, 95% CI: 0.14-0.70, P=0.004) as independent predictors of PO-AKI, but not intraoperative data such as water balance and urine output.
    Conclusion: This study suggests the importance of assessing patient characteristics preoperatively. Appreciation of risk factors for PO-AKI may help identify high-risk surgical populations.
    Yoshinobu Kameyama1*, Kunihiko Hoshi1, Koji Saito1, Toshihiro Wagatsuma2 and Masanori Yamauchi2
    Abstract:
    Background: Recently, the open-lung concept has been used in the respiratory care of patients with Acute Lung Injury (ALI), however, the expiratory phase in ALI patients has not yet been studied in detail. In this study, we paid attention to the pressure-flow curves that can be generated using the P/V tool on the Hamilton-G5 mechanical ventilator.
    Methods: We conducted a comparative analysis of the Maximum Expiratory Flow Rate (MEFR), pressure at MEFR, etc., in 5 adult control patients who were scheduled to undergo surgery, and 13 ALI patients, including 5 with postoperative respiratory failure, 5 with pneumonia, 2 with interstitial pneumonia, and 1 with acute pancreatitis. The P/V loops were recorded after the induction of anesthesia in the control subjects and after the diagnosis of ALI in the ALI patients.
    Results: At the time of the P/V loop measurement, the compliance (31.8 and 78.2 ml/hPa in the ALI and control groups, respectively), MEFR (-169.4 and -404.0 ml/s, respectively), and pressure at MEFR (10.6 and 4.2 hPa, respectively) were significantly different between the ALI and control groups.
    Conclusion: Thus, analysis of pressure-flow curves may be helpful in grasping the pathogenesis of ALI.
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