1 Airway Pressure and Respiratory Mechanics Variability with Different Body Positions in Mechanically Ventilated Critical Care Patients: A Prospective Comparative Clinical Study , Alaa Ali M. Elzohry*, Eman Fadl Abd El Khalik, Al Shimaa Ismael Roushdy, Marwa Mohammad Abdelbaky
Mastitis is an inflammation of breast parenchyma, predominantly occurring in the breastfeeding period, with or without accompanying infection and appears as lactational or puerperal and non-lactational as is associated with duct ectasia. Breast abscess is a focal accumulation of purulent substances within the breast parenchyma emerging as a complication of mastitis and is common in lactating women. Comprehensive incidence of mastitis is around 33% whereas breast abscess arises in approximately 3% to 11% of subjects with mastitis. An estimated two fifths (40%) of breast abscess or certain breast infections are poly-microbial and specific aerobes such as Staphylococcus, Streptococcus, Enterobacteriaceae, Corynebacterium, Escherichia coli and Pseudomonas along with anaerobes as with Pepto-streptococcus, Propionibacterium, Bacteroides, Lactobacillus, Eubacterium, Clostridium, Fusobacterium and Veillonella can engender the disease. Subjects with mastitis enunciate flu-like symptoms with malaise, myalgia, fever, mammary pain, decline in milk egress, local warmth, tenderness, firmness and swelling of breast region and localized erythema. Breast abscess usually delineates mammary pain and/or a breast lump. Lactational breast abscess morphologically recapitulates an acute inflammation whereas non-lactational breast abscess is commonly sub-areolar and appears as a fistula of lacteriferous ducts, eventually emerging as chronically draining sinuses and breast abscess adjacent to the areola. Squamous metaplasia of lacteriferous duct epithelium, duct obstruction, and sub-areolar ductal dilatation or duct ectasia can ensue.
2 Airway Pressure and Respiratory Mechanics Variability with Different Body Positions in Mechanically Ventilated Critical Care Patients: A Prospective Comparative Clinical Study , Alaa Ali M. Elzohry*, Eman Fadl Abd El Khalik, Al Shimaa Ismael Roushdy, Marwa Mohammad Abdelbaky
Mastitis is an inflammation of breast parenchyma, predominantly occurring in the breastfeeding period, with or without accompanying infection and appears as lactational or puerperal and non-lactational as is associated with duct ectasia. Breast abscess is a focal accumulation of purulent substances within the breast parenchyma emerging as a complication of mastitis and is common in lactating women. Comprehensive incidence of mastitis is around 33% whereas breast abscess arises in approximately 3% to 11% of subjects with mastitis. An estimated two fifths (40%) of breast abscess or certain breast infections are poly-microbial and specific aerobes such as Staphylococcus, Streptococcus, Enterobacteriaceae, Corynebacterium, Escherichia coli and Pseudomonas along with anaerobes as with Pepto-streptococcus, Propionibacterium, Bacteroides, Lactobacillus, Eubacterium, Clostridium, Fusobacterium and Veillonella can engender the disease. Subjects with mastitis enunciate flu-like symptoms with malaise, myalgia, fever, mammary pain, decline in milk egress, local warmth, tenderness, firmness and swelling of breast region and localized erythema. Breast abscess usually delineates mammary pain and/or a breast lump. Lactational breast abscess morphologically recapitulates an acute inflammation whereas non-lactational breast abscess is commonly sub-areolar and appears as a fistula of lacteriferous ducts, eventually emerging as chronically draining sinuses and breast abscess adjacent to the areola. Squamous metaplasia of lacteriferous duct epithelium, duct obstruction, and sub-areolar ductal dilatation or duct ectasia can ensue.
3 Anesthetic Management of a Large Retroperitoneal Paraganglioma: A Rare Case Report , R Arun Kumar*, S Vishnu Priyangan, B Kavin Kumar
Paragangliomas are rare tumors derived from the neural crest cells. Most of the paragangliomas occur as sporadic tumors. The commonest incidence occurs in the second and third decade of life with a slight male preponderance. Clinically patients with a retroperitoneal paraganglioma often present with back pain or a palpable mass. There is a 5% incidence of turning into malignancy and these tumors are associated with a high risk of morbidity and mortality from cardiovascular complications. Management for paragangliomas typically involves complete surgical excision. A multi-disciplinary approach is suggested for a better outcome of the procedure.
4 Supraclavicular Block: Challenging but Safer Option in Obese Patient During Covid-19 Pandemic , Kamakshi Garg*, Nitika Singla, Pratibha Chauhan, Richa Jindal
Introduction: Brachial plexus block is a boon for an anesthesiologist in difficult airway especially in the COVID-19 pandemic. The provision of regional anesthesia in this pandemic reduces the need for general anesthesia and the associated risk from aerosol-generating procedures. Case Report: A 35-year-old male weighing 130 kg with BMI 39.8 post-bariatric surgery 3 years back presented to casualty with the alleged roadside accident with fracture right midshaft humerus, right radius ulna, multiple facial injuries and suspected C3-C4 fracture. An USG guided supraclavicular block was given using 20 ml 2% lignocaine with adrenaline and 20 ml 0.75% ropivacaine. The patient shifted to COVID-19 post-anesthesia care unit for further management. Discussion: During the COVID-19 pandemic, regional anesthesia though challenging but considered the first choice and safer mode of anesthesia in COVID19 suspected patients with a difficult airway. The advent of USG has made supraclavicular nerve block safe for obese patients and reduce the risk of local anesthetic systemic toxicity. Conclusion: Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. Also, recent advances in techniques of regional anesthesia have dropped the failure rates of the procedure.
5 Anaesthetic Challenges with DBS Device In Situ: Case Series with Review of Literature , Parin Lalwani, Chhavi Sawhney*, Lokesh Kashyap
Deep Brain Stimulation (DBS) can be an effective treatment option for patients with essential tremors, Parkinson’s disease, dystonia, epilepsy, chronic pain, major depression, and its role is being evaluated in a variety of other neurological diseases. Anesthesia concerns take into account the primary pathology for which the device was inserted, assessment of device functioning and its interference with diathermy, electrical electromagnetic, ultrasound, and laser devices used perioperatively for different purposes. We discuss anesthetic management with a brief review of two cases with DBS device In Situ.
6 Correlation Between Monitoring Practices During Anesthesia and Patient Recovery , Tariq No’aman Al-Shurbaji*, Mohammed Al-Falaki
Anesthesia is used by healthcare professionals to induce loss of sensation in the body of the patient so that the surgical process of treatment is carried out effectively. Anesthesia doses that are given to patients have been classified into three types which are general anesthesia, sedation anesthesia, and regional or local anesthesia. These medications are given to patients as per the severity of the injury and treatment process. The provision of anesthesia includes monitoring processes such as Electrocardiography (ECG), Noninvasive Blood Pressure (NIBP), pulse oximetry, and others so that patient safety is ensured at all the levels of treatment. It also includes Depth of General Anesthesia (DGA) is an advanced monitoring process of anesthesia through which accurate drug administration in the individual patient is executed. The study introduces current prospects of anesthesia monitoring and mentions details about important methods and technologies in use and their both advantages and disadvantages. It also provides details about DGA and other latest upcoming methods for anesthesia monitoring.
7 Comparative Study for Anaesthetic Quality with the Addition of Clonidine, Fentanyl or Dexmedetomidine to 0.5â„… Ropivacaine in Supraclavicular Brachial Plexus Block at a Tertiary Hospital , Naveen P*, Vikas Kumar Gupta, Aditya Agarwal
Background: Supraclavicular Brachial plexus block also described as the “spinal of arm”, provides a rapid onset, complete, predictable, and dense anesthesia for the mid humerus, forearm and hand surgery. Brachial plexus block also causes sympathetic block with resultant improvement in blood flow, reduction in vasospasm, and edema which is more favorable for an acute hand injury and reconstructive plastic surgery. In the present study, we compared the anesthetic quality with the addition of either clonidine, fentanyl, or dexmedetomidine to 0.5â„… ropivacaine for supraclavicular brachial plexus block in regard to the onset and duration of sensory/motor block and duration of analgesia at a tertiary hospital. Material and Methods: Present study was the prospective, interventional and comparative study carried out in the department of anaesthesiology, in patients 18-60 years, ASA grade1/2, Mallampati grades 1 and 2, posted for elective upper limb surgeries. 60 patients were randomly divided into three groups, each group includes 20 patients, (Group D- Dexmedetomidine, C- Clonidine, F- Fentanyl). Results: 60 patients scheduled to undergo elective upper limb surgeries were randomly divided into three groups (Group D, C, F), each group includes 20 patients. Age, gender, ASA status, weight, height and mean duration of surgery were comparable in three groups and the difference was statistically insignificant. The difference between the onset of sensory blockade, mean time of onset of complete sensory blockade, duration of complete sensory blockade was found to be statistically significant. Intergroup analysis in groups D, C and F for the onset of sensory blockade, onset of complete sensory blockade and duration of complete sensory blockade in three different groups noted a statistically significant difference. The difference for the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade was found to be statistically significant as (p<0.05), there is a difference noted between Group D, C, and F. Intergroup statistical analysis of the onset of motor blockade, the onset of complete motor blockade and duration of motor blockade between group D vs C and group D vs F were statistically significant, whereas between group C vs F it was insignificant. The duration of analgesia was prolonged in Group D, C, F and was found to be statistically significant. Intergroup analysis of duration of analgesia between three different groups. The difference between group D vs C, between group D vs F, and between-group C vs F was statistically significant. The time of 1st rescue analgesia was prolonged in Group D, C, F and was statistically significant (p<0.05). Intergroup analysis of the time of 1st rescue analgesia between three different groups. The difference between group D vs C, between group D vs F, and between group C vs F were statistically significant. Conclusion: Dexmedetomidine, clonidine added to ropivacaine shortens the onset of sensory and motor blockade, prolongs the duration of the sensory blockade as compared to fentanyl. Dexmedetomidine shortens the onset of sensory and motor blockade much more than clonidine.
8 Elagolix Sodium: Novel GnRH Antagonist for the Treatment of Endometriosis , Joyson Paul, Rohit Bhatia*
Endometriosis is a category of lesions and fibroids which occur in the innermost lining of the uterus that is the endometrial layer and spreads to the other parts of the neighboring tissues. It is characterized by inflammation, pelvic pain, menstrual bleeding, and Dysmenorrhea. Endometriosis exists in 3 forms based on its spreadability. i.) superficial peritoneal lesions ii.) deep infiltrating lesion and iii.) cyst. Traditional treatments involve are NSAIDS, Oral contraceptives, Aromatase inhibitors, and GnRH agonists. Elagolix emerges out to be the latest potent drug that acts by inhibiting the GnRH receptor. Unlike other allopathy medicine, it is not an asymptomatic pain reliever but acts on the root cause of the disease. FDA has approved it for specific treatment of endometriosis in July 2018. It is believed that endometriosis occurs by an increase in the production of estrogen. Elagolix competitively binds to the GnRH receptors and prevents the binding of the Gonadotropin hormone flowing through blood capillaries from the Hypothalamus to the pituitary gland and thereby stops the formation of Oestrogen in the reproductive system which ultimately ceases in the proliferation of endometrial layers and tissue spread. In estrogen biosynthesis, the aromatase P450 enzyme plays a vital role. Elagolix belongs to BCS class III and available in the oral dosage form of 150, 200mg. It is rapidly absorbed and Cmax reaches within 1hour. The plasma protein binding is 80%. In this review, various aspects related to Elagolix sodium have been summarised, which include pathophysiology, Mode of Action, Structure-activity relationship, Pharmacokinetics, pharmacodynamics, and clinical studies with minimal side effects.