Anesthesia in a Patient with Potocki–Lupski Syndrome

Introduction. Potocki–Lupski syndrome (PTLS) is a rare disease caused by the duplication of a small segment of chromosome 17 (17p11.2). The clinical presentation of this syndrome is quite variable and includes hypotonia, failure to thrive, oropharyngeal dysphagia, developmental delay, and behavioral abnormalities. In addition, congenital heart disease, sleep apnea, and mildly dysmorphic features are common and should be considered during anesthetic management. However, because of the rarity and newness of the syndrome, there are few reports on the anesthetic care of patients with PTLS. Case Report. We report a case of a 4-year-old girl diagnosed with this syndrome who underwent general anesthesia for exotropia surgery. The patient exhibited micrognathia; a mild decrease in muscle tone; and a developmental delay in motor, speech, and cognition. She had a history of swallowing incoordination and gastroesophageal reflux. No abnormalities were found on a preoperative echocardiography. A videolaryngoscope was used for tracheal intubation, and the state of neuromuscular blockade was monitored in addition to standard monitoring. Anesthesia was maintained with sevoflurane and remifentanil. The patient recovered without any adverse events. Conclusion. As PTLS patients may have several malformations, preanesthetic evaluation is important. Preoperative echocardiography and cardiologic consultations are required. It is desirable to prepare for the risk of difficult airway and pulmonary aspiration. Postoperatively, close monitoring is needed to prevent airway compromise.

Patient Satisfaction Stratification in Inguinal Hernia Surgery Under Local Anesthesia –Experience of 650 Patients

Aim: To evaluate patient satisfaction undergoing inguinal hernia surgery under local anesthesia. Methods: The study was conducted in Jinnah hospital, Lahore from 2014 to 2019 including 650 clinically diagnosed patients with direct or indirect inguinal hernia with age ranging 20 to 60 years. All of these patients were operated in dedicated day care operation-theater of surgical department, where hernia surgeries under local anesthesia were done on daily basis 6 days a week. We assessed satisfaction in all patients undergoing inguinal hernia surgery with monitoring during anesthesia care known as iowa satisfaction with small anesthesia scale. Results: 80% of patients were between 20 to 45 years of age with male to female ratio 99: Right inguinal hernia patients were 55% and 45% with left inguinal hernia. In the proforma of 11 questionnaire, 96 % patients were found satisfied with the quality of anesthesia care with varying satisfactions ranging above 90 % regarding pain, feeling like throwing up, feeling relaxed as well as feeling hurt. Conclusion: Inguinal hernia surgery under local anesthesia is found profoundly satisfactory with regard to anesthetic care. Local anesthesia hernial surgery has satisfactory patient acceptability similar to those observed in a conventional regional/general anesthesia in tertiary care setup. Keywords: Inguinal hernia, local anaesthesia, satisfaction

Comparison of Gastric Residual Volume and pH between Single and Split-Dose Bowel Preparation in Patients Undergoing Esophago-Gastro-Duodenoscopy and Colonoscopy: A Randomized Controlled Trial

Background: Colonoscopy is an effective surveillance for the diagnosis and screening of colorectal cancer (CRC). Prior to the procedure, people would take laxatives for a good visualization of bowel texture. Although a split-dose bowel preparation has become popular, many anesthesiologists are concerned about pulmonary aspiration. Objective: To study the gastric residual volume and pH in patients taking split-dose bowel preparation as compared to those having laxatives on the day before the procedure. Materials and Methods: One hundred patients were randomized equally into two groups, as A for a single-dose, and B for a split-dose regimen. All patients underwent endoscopy under standard anesthetic care. The total gastric residual volume was suctioned, and pH was measured through the endoscope. The surgical team was unaware of the study protocol. The quality of bowel cleansing was assessed by the endoscopist using the Boston Bowel Preparation Scale (BBPS). Results: The bowel cleansing, the latency period, the endoscopist and patients’ satisfaction of single-and split-dose group were 7.06±1.4 and 8.14±1.1, 13.3±1.1 and 4.2±0.4 hours, 62.0% and 94.0%, and 90.0% and 74.0%, respectively. They all showed statistically significant differences between the two groups (p<0.05). Conclusion: The gastric residual volume and pH were not different between the split and single-dose preparations. Therefore, it might not increase the risk of aspiration pneumonitis. However, the split-dose technique was more effective in colon cleansing, patients’ tolerability, acceptability, and compliance than the preparations administered entirely the day or evening before the surgical procedure. Keywords: Gastro-colonoscopy; Single-dose bowel preparation; Split-dose bowel preparation; Gastric residual volume; Anesthesia

A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts

Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.

Postoperative Drip-Infusion of Remifentanil Reduces Postoperative Pain—A Retrospective Observative Study

Development of remifentanil-induced hyperalgesia (RIH) postoperatively is an unpleasant experience that requires further treatment. This study assessed the effects of gradual withdrawal combined with drip infusion of remifentanil on postoperative pain and the requirement for rescue analgesics. A total of 559 patients receiving total intravenous anesthesia with propofol and remifentanil were enrolled. All patients either underwent gradual withdrawal of remifentanil (GWR) or gradual withdrawal combined with drip infusion (GWDR) with a dose of 1 mcg·kg−1 for 30 min after extubation. The numeric rating scale (NRS) and the requirement of rescue analgesics were assessed. The requirement for rescue analgesics was significantly lower in the GWDR group than in the GWR group (13.2% vs. 35.7%; p < 0.001). At the post-anesthetic care unit (PACU), patients in the GWDR group had a lower NRS pain score (p < 0.001). In addition, in the postoperative 2nd hour, patients in the GWDR group had a significantly lower NRS than the GWR group (beta, −0.31; p = 0.003). No remifentanil-related adverse effects were observed. We found that gradual withdrawal combined with drip infusion of remifentanil required less rescue analgesics and reduced pain scores. The new way of remifentanil administration may be effective to prevent RIH.

Comparative Analysis of Memory and Alertness in the Perioperative Period of Operative Delivery in Pregnant Women With Preeclampsia and Without it With Different Kinds of Anesthesia

Relevance. The article investigates the choice of anesthesia technique during a caesarean section, which would minimally affect such components of cognitive functions as memory and alertness.The aim of the study is to increase the safety of anesthetic care in women of reproductive age by choosing the method of anesthesia.Material and methods. Two groups of maternity patients were examined: with a normal pregnancy and preeclampsia. They were tested according to a specially designed examination, which included: MoCA test, Benton’s test, Wechsler’s test, self-assessment questionnaire, hospital scale of anxiety and depression before and after surgical delivery.Results. According to the test results, it was found that memory and alertness in pregnant women were initially reduced (compared to the norm), especially with concomitant preeclampsia. When comparing the test results before and after abdominal delivery, it was found that the deterioration of memory and alertness parameters occurs less after the use of neuraxial methods (spinal and epidural anesthesia) compared to patients who underwent general combined anesthesia.

Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally

Background One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown. Methods A survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May–June 2019. Results No providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance). Conclusions No providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers.

Effects of Preoperative Low-Dose Gabapentin on Postoperative Pain and Sedation of Patients Undergoing General Anesthesia

Objective: To study the drug interaction between gabapentin and morphine in surgical patients under general anesthesia. Materials and Methods: Two hundred sixty patients undergoing surgery under general anesthesia were randomized into two groups, A with 130 patients receiving gabapentin 2.0 to 3.5 mg/kg orally for premedication add-on, and B with 130 patients getting morphine 0.1 to 0.2 mg/kg intravenously. After surgery, a co-researcher assessed patients using Ramsay sedation scale (RSS) and pain numeric rating scale (NRS) at 2, 4, 8, 12, 16, and 24-hour intervals. Results: Two hundred thirty-two patients were included the present study without procedural adverse events. There were 120 and 112 patients in gabapentin and morphine group, respectively. The administration dosage of gabapentin and morphine between the two groups showed statistically significant differences (p=0.031). During the emergence, the RSS on the sedation, agitation, drowsiness, and pain scores of gabapentin (1.8±0.4) and morphine (1.7±0.5) appeared statistically significant differences (p=0.032); however, the RSS on that in the post-anesthetic care unit (PACU) were 2.0±0.1and 2.0±0.2, respectively, which showed insignificant differences (p-value 0.283). Conclusion: A small, single oral dose of gabapentin as premedication showed a synergistic effect on intraoperative morphine administration. However, this additive effect was not long lasting through the PACU and might not be suitable for an extended surgery. Keywords: Drug interaction; Gabapentin; Morphine; Anesthesia