ULTRASOUND - A BLESSING FOR REGIONAL ANAESTHESIA

Use of USG in regional nerve blocks is increasing day by day. With the help of USG clinician can view real time image of patient’s anatomy, which offers a new standard in nerve location and needle placement. It allows direct visualization of local anesthetic spread around the nerve. USG guided nerve blocks allow reliable and safe anaesthesia and analgesia. USG is a blessing in a way that, it offers high success rate with low complications, in regional nerve blocks.

Modification in practice of anaesthesia in COVID-19 pandemic: A review article

During current COVID-19 pandemic, anaesthesiologists should modify their practices and take high precautions. Anaesthetist should reduce their exposure to respiratory secretions and risk of perioperative transmission. In this article we explore the practical considerations, concerns for anaesthesiologist and measures recommended for conducting safe anaesthesia. We also emphasise on ensuring safety of healthcare workers, protection of equipment, and prevention of infection. We tried to illustrate the importance of infection control practices in anaesthesia. A proper plan of anaesthesia for management of COVID-19 patients will result in the best possible outcome for both healthcare workers and patients.

Laryngeal suction tube: A novel technique for tracheal ventilation in an obstructed airway in a child with respiratory papillomatosis

Background Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress. Objective: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine. Result and Conclusion Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine via modification of the suction tubing and endotracheal tube (ETT) 15mm male connector. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.

Analysis of risk factors for cement leakage in percutaneous kyphoplasty - does sedoanalgesia increase the risk?

Introduction/Objective. Several studies have evaluated anaesthesia type as a possible risk factor for cement leakage in percutaneous vertebral augmentation procedures. This study has the largest series in the literature revealing data on the incidence of cement leakage in percutaneous kyphoplasty under sedoanalgesia. The aim of the study was evaluating the possible association between sedoanalgesia and cement leakage in percutaneous kyphoplasty procedures. Methods. In this study, 195 vertebral compression fractures treated with percutaneous kyphoplasty under sedoanalgesia in 165 patients were retrospectively reviewed. The association between sedoanalgesia and cement leakage in percutaneous kyphoplasty procedures was evaluated. (3) Results: The mean age (years) of study population was 64.37 years (range, 24-108 years), and the male-female ratio was 71/94. No significant difference in the proportion of males (n = 71, 43.03%) and females (n = 94, 56.96%) was observed between groups. Among the 195 fractured segments, most frequent fractures were observed at the T12 (n = 41, 21.02%) and L1 (n = 65, 33.33%) levels. Conclusion. Sedoanalgesia is not a risk factor for cement leakage in PK and offers a safe anaesthesia option to avoid possible complications.

Endoscopic airway equipment part 1: physical principles

The use of advanced endoscopic airway equipment has become increasingly important to the provision of safe anaesthesia for patients with complex anatomical and pathological conditions. Fundamental to the correct selection and use of the equipment is an understanding of the physical properties underlying its construction and function. This relies primarily on conventional optics, fibreoptics, video sensors and light-emitting diode technology.

Anaesthetic practices in the gynaecology and obstetric department in the principal health facilities of Butembo city, Eastern of the Democratic Republic of the Congo

Background: The practice of anaesthesia should be team work involving Obstetrician and Anesthesiologist to determine the anaesthetic and surgical needs of the patient in order to have a successful plan for the baby and mother. The aim of this survey was to evaluate the practice of anesthesia in obstetric and gynaecology department in the principal health facilities of Butembo city. Methods: A prospective and observational descriptive study was done in four health facilities of Butembo city, from January 1st, 2015 to December 31st, 2019. Results: 64.86% of obstetrical and gynaecological procedures were done under spinal anaesthesia. General anaesthesia with an endotracheal tube was performed in 2.97% of the cases, the laryngeal mask in 0.10% and intra venous anaesthesia without any airway support in 96.93% of the cases. 100% of the cases had benefited from a pre-anaesthetic consultation; 77.75% anaesthesia was administered by anaesthetic officers. 53,27% of the patients were classified as ASA I and 77.25% of cases were electives. Caesareans accounted for 87.83% of emergency cases and 70.73% of elective cases. The pre-medication consisted of atropine and diazepam in 31,02%. Bupivacaine was used for spine anaesthesia in 66.87%. Maintenance during general anaesthesia with ketamine was done in 98.72%. Pethidine was the analgesic used in intraoperative in 48.00%. Tramadol was the most used drugs for pain management in post operative period. Adverse events were recorded in 2.94% of the patients; hypotension was noted in 39,27%. 24 maternal deaths were recorded. Fifteen among them died due to complication related to anaesthesia. There is a dependency between the accidents and complications and qualification of anaesthetists. Conclusion: Anaesthesia is commonly used in the gynaecology and obstetric department. It is important to promote continuous training of Non Physician Anaesthetists as well as Consultants Anaesthesiologists in order to practice safe anaesthesia for the well being of our patients. Spinal anaesthesia was the common used predominantly with few adverse events to the mother and foetus.

Laparoscopic cholecystectomy in a patient with pneumonectomy

Post pneumonectomy patients pose a challenge to the anaesthetist owing to the altered respiratory mechanics and decreased respiratory reserve. Performing laparoscopic surgery in such patients further deteriorates the already compromised lung functions. Authors report a case of laparoscopic cholecystectomy performed in post pneumonectomy patient. A clear understanding of respiratory mechanics and post pneumonectomy physiological changes helped us to administer a safe anaesthesia and safe perioperative outcome.

Current Status of Obstetric Anaesthesia Services (OASIS); A Cross-sectional Survey of Public Hospitals in Khartoum State, Sudan

Background: Medical services in general, and anaesthetic services in particular, in Sudan have been vulnerable to changes secondary to the socio-economic factors over the last few decades. Objective: This cross-state survey aims to identify the current set up of obstetric anaesthesia services in 19 hospitals - representing all public hospitals in Khartoum State with maternity units- and audit them against internationally set standards. Methodology: This is a cross-sectional descriptive non-interventional study. Questionnaires- based on the World Federation of Societies of Anaesthesiologists (WFSA) Safe Anaesthesia Standards- were distributed to Anaesthetic departments’ heads at the time of the study (first to fourteenth of May 2016) of 19 public hospitals. This is the total number of public hospitals delivering obstetric services in Khartoum State. All filled out questionnaires were returned (response rate 100%). Collected information/data provided were subsequently entered into an Excel sheet and analysed. Results were tabulated. Results: There was a considerable variation in the capacity of the surveyed hospitals in terms of human resources, caseload and set up. Improper utilisation of already deficient anaesthesiologist in covering high load obstetrics services was also noticed. All the hospitals fell short of recommendations for minimum standards set by the World Federation of Societies of Anaesthesiologists (WFSA). Conclusion: There is a vast gap between international set standards and the current set up of obstetric anaesthesia in Khartoum State public hospitals. Necessary concerted efforts from governmental, non-governmental and professional bodies are warranted to improve obstetric anaesthetic services in Khartoum State.