International Journal of Clinical Anesthesia and Research https://www.anesthesiaresjournal.com/feed Introduction Anesthesia is considered as freedom from pain. It is a medical treatment that prevents patients from feeling pain during surgery. Several researches in anesthesia have made possible countless procedures that improve human health, longevity and quality of life. With time and gained knowledge this term has become a sub discipline of medical science. International Journal of Clinical Anesthesia and Research publishes diverse range of manuscripts in the proliferating arears of research in anesthesia. International Journal of Clinical Anesthesia and Research provides a unique dais for the authors, scientists and researchers to publish their articles focusing various aspects related to the application of anesthesia protocol in consideration with patient’s age and his/her exact disease condition. Reasons for Publishing Since its birth in 1845, anesthesia is a relatively young science. In several countries, anesthesia has markedly progressed during the course of the last few decades. Over the last few decades, there have been significant improvements in drugs, equipment and techniques related to anesthesia. However, the major challenge in anesthesiology has come from improvement in patient safety. Moreover, ethical; practical; and relational challenges have also changed the consent of anesthesiologists’ views of current and future patients, their practices as well as their profession. International Journal of Clinical Anesthesia and Research takes this initiative to publish manuscripts focusing researches on how a person's genetic makeup influences the way he or she responds to anesthetics which can assist the doctors to further adapt anesthesia to individual patients. Brief Communication Minimising Carbon Footprint in Anaesthesia Practice Nisha Gandhi and Abinav Sarvesh SPS* 2024-10-19 12:21:30 Carbon footprint refers to the total amount of greenhouse gas emitted in the atmosphere by an individual or by an organization causing global warming. There are various causes of greenhouse gas emissions and anaesthetic gases are one amongst them. Greenhouse gases warm the earth by absorbing infrared energy and slowing the rate at which the energy escapes into space. Each greenhouse gas has two important properties. One is the amount of infrared energy that a gas can absorb and the other is the lifetime of that gas in the atmosphere. Anaesthesia as a speciality contributes to carbon footprinting in three ways: direct emission, energy use, and operating room wastes and supplies. Direct emission of Waste Anaesthetic Gases (WAG) from anaesthesia workstations can either be scavenged and thrown out into the environment causing a green greenhouse gas effect or can pollute the operating room due to poor scavenging. Various techniques such as reducing direct emissions, energy use optimisation, and waste management have been tried in minimising carbon footprint in anaesthesia practice but providing safety to the patient is considered of utmost importance. https://www.anesthesiaresjournal.com/articles/ijcar-aid1025.pdf Case Study An Instance of Green-tinted Urine Related to the use of Propofol Bindhya Maharjan*, Jeevan Singh, Shibesh Chandra Mishra, Saubhagya Neupane 2024-08-20 12:52:22 Urine typically has an amber-yellow color due to the amorphous pigment urochrome, a distinct scent, and an average pH of 6.0, which is somewhat acidic. Green urine can result from drug intake, dyes, infections, adverse drug reactions, and other causes. Less than 1% of propofol users experience green urine, a rare and benign side effect. The green tint in urine is caused by the phenolic metabolites of propofol. In this case, a 33-year-old man diagnosed with organophosphorus poisoning and aspiration pneumonia had been given a modest dose of propofol sedation for six hours and began to exhibit green urine. After five hours of halting the propofol infusion, the urine returned to its usual color. Healthcare practitioners should be aware of this unusual but safe side effect of propofol. https://www.anesthesiaresjournal.com/articles/ijcar-aid1024.pdf Mini Review Deciphering the Rosetta Stone - Trans-Mitral Doppler Patterns for a Simplified Study of Left Ventricular Systolic Dysfunction George Thomas* 2023-08-30 17:04:46 There is a renewed interest in heart failure treatments. With this, there is an increasing interest in heart failure with preserved ejection fraction. Trans-mitral Doppler is commonly used in the assessment of ‘diastolic’ function. It is fashionable to discuss diastolic dysfunction and diastology with the result that the more important systolic dysfunction has become passé. The current literature equates trans-mitral Doppler patterns to diastolic function when actually it is more relevant in systolic dysfunction. This article is an attempt to correct this flawed perception of trans-mitral Doppler. https://www.anesthesiaresjournal.com/articles/ijcar-aid1023.pdf Case Report Anesthesia mumps: a case report Maher Al-Hajjaj,Anfal Salim,Mahmoud Mohammad,Maab Mohamed,Ahmad Tawosh,Ababca Fatima Zohra 2023-02-10 14:56:39 A 25 years old pregnant woman had a painful labor in her 38th week of pregnancy. Because of a previous delivery by a cesarean section, she underwent a second cesarean section. Her past medical and family history was unimportant. We performed the surgery under spinal anesthesia. The surgery was uneventful and the baby was in a good health. After 9 hours of surgery, she complained of painless swelling in the parotid glands. Physical examination and laboratories were normal. We started rehydration with normal saline and one dose of hydrocortisone (100 mg IV route). Close monitoring showed no problems in swallowing or any purulent discharge. Two days later, we had a complete resolution of the swelling. We discharged the woman with her child with no complaints. Our case is one of the rare cases of anesthesia mumps after spinal anesthesia. Physicians should be careful in considering such rare cases. Early diagnosis and management is the key. https://www.anesthesiaresjournal.com/articles/ijcar-aid1022.pdf Mini Review Anesthesia for epilepsy surgery Alexandre Pacchioni,João Kazuo Yano,João A Assirati 2023-01-16 10:04:44 Anesthesia for neurosurgery, “neuro-anesthesia”, involves techniques, drugs, monitoring and objectives as diverse as the area of surgical activity is vast (surgery for vascular alterations, tumors, craniostenosis, spine, epilepsy, etc.). https://www.anesthesiaresjournal.com/articles/ijcar-aid1021.pdf Observational Study To evaluate the stress response to tracheal intubation by macintosh laryngoscope and intubating laryngeal mask airway Somika Agarwal,Sapna Bansal 2022-12-19 11:37:47 Aim: To evaluate the hemodynamic changes and side effects during endotracheal intubation with Macintosh laryngoscope and intubating laryngeal mask airway.Materials and methods: A prospective, simple randomized, comparative study on 100 patients 18 years - 60 years of age, divided into two groups: Group A comprising intubation with Macintosh laryngoscope and Group B intubation through ILMA.Results: Total intubation time (in seconds) of group A was 24.38 + 3.26 seconds and of the group, B was 42.94 + 1.24 seconds. At 2,4 and 6, a higher rise in mean heart rate was noted in group A (p < 0.05). At 2,4,6 and 8 minutes difference in mean SBP and mean DBP of the two groups was statistically significant with a p - value of < 0.05 with a significant increase of mean SBP and mean DBP in patients of group A. The difference for all complications was not significant between the two groups.Conclusion: Intubation via intubating laryngeal mask airway can be done as an alternative to direct laryngoscopy using a Macintosh blade as intubation via intubating laryngeal mask airway has shown to have lesser hemodynamic changes. https://www.anesthesiaresjournal.com/articles/ijcar-aid1020.pdf Case Report A case report of hepatic actinomycosis: A rare form of presentation Nieto Piñar Yasmina,Hernández González Verónica Lisseth,Borges SA Marcio 2022-09-20 11:33:16 Hepatic Actinomycosis (HA) is a very rare abdominal actinomycosis that can be confused with hepatic involvement due to a tumor. Liver involvement can occur from an abdominal focus or by blood dissemination from another focus. This disease is much more common in men between 50 - 70 years and in a situation of immunosuppression. Symptoms are nonspecific and diagnosis includes histopathology, cultures, and imaging test. Treatment includes prolonged antibiotic therapy with antibiotics such as penicillin and drainage of abscesses.We present a case of a 54-year-old man patient with a record of three years of chronic pancreatitis of probably alcoholic origin, who developed hepatic actinomycosis, requiring drainage of liver abscesses and directed antibiotic treatment. https://www.anesthesiaresjournal.com/articles/ijcar-aid1019.pdf Case Report A witnessed intra-operative blood transfusion-related air embolism under epidural anaesthesia for vesicovaginal fistula repair Gyadale AN,Adeyanju BT,Ayegbusi EO,Adeyiolu AT,Olabode AA,Suberu SO,Olajide MA 2022-06-21 14:04:57 The transfusion is a normal life-saving procedure conducted commonly by the nurses at the prescription of the attending physician or the emergency physicians. It is generally a safe procedure if guidelines for processing and administering are carefully followed. Blood transfusion is an independent risk factor for morbidity and mortality and major complications arising from transfusion are generally rare. We present a case of a mild case of iatrogenic air embolism exacerbated by pressure infusion for a patient who had undergone an exploratory laparotomy for an iatrogenic fistula repair under epidural anesthesia. https://www.anesthesiaresjournal.com/articles/ijcar-aid1018.pdf Case Report Nasopalatin duct cysts: Report of ten cases and review of literature Melike Baygin,Melek Koltuk,Banu Gurkan Koseoglu 2020-11-10 00:00:00 Nasopalatine duct cyst is the most common non-odontogenic cyst. It develops in the midline of the anterior maxilla. It is usually asymptomatic and sometimes it can be overlooked or misdiagnosed. We present 10 patients who applied to Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery. https://www.anesthesiaresjournal.com/articles/ijcar-aid1016.pdf Research Article A comparison of complications associated with nutrition between the patients receiving enteral or parenteral in the intensive care unit Ahmet Eroglu,Seyhan Sumeyra Asci,Ahmet Eroglu 2020-09-29 00:00:00 The aim of this study was to investigate and compare the complications including infection and mortality associated with enteral and parenteral nutrition on patients in the ICU of a university hospital. In this study, a total of 100 patients who were under follow-up in the ICU for two years were examined. In our study, demographic characteristics, the reason for admission, comorbidity, initial ICU laboratory values, morbidity and mortality during the follow-up period of the patients who only received enteral nutrition (EN) or parenteral nutrition (PN) were evaluated, and the results between two were compared as well as evaluating the complications within the groups. The comparison of the reason for admission between the EN and PN groups showed that surgical reasons were significantly higher in the PN group. Nosocomial infections, the presence of infection and the development of sepsis were significantly higher in the EN group. The 28-day mortality rate was higher in the PN group compared to the EN group. The length of stay in the ICU and on mechanical ventilation was longer in the EN group. There was no significant difference in the 28-day mortality, readmission to the ICU and repeated endotracheal intubation between the two groups. Because there is no statistical difference between EN and PN groups in point of infection and mortality, we conclude that the length of stay in the ICU and reason for admission play a more crucial role in the development of infection and on mortality rather than enteral or parenteral nutrition route. https://www.anesthesiaresjournal.com/articles/ijcar-aid1015.pdf Research Article The choice of optimal modern muscle relaxants (rocuronium bromide, atracurium besilate and cisatracurius besilate) in one-day surgery in children Nasibova EM 2020-06-15 00:00:00 The choice of the optimal muscle relaxant in one-day surgery in children with “small” surgical interventions remains relevant to this day. In modern pediatric surgery, the requirements for the quality of muscle relaxation are highest. However, along with the effectiveness of the drug, its duration and controllability of the action, as well as the safety of use, are important [1-7]. The aim of the study: To determine the pharmacoeconomic rationale for the rational use of muscle relaxants, depending on the duration of operations in one-day surgery in children. Material and research methods: The study was conducted in surgical clinics of the Azerbaijan Medical University. The study included 156 children who were operated on routinely from 0 to 16 years old (risk of anesthesia I-II ASA), who used combined endotracheal anesthesia during surgery. Based on the requirements of the GCP international program (Good Clinical Practice), the inclusion of children in the study was carried out only after the written consent of the parents. The studied patients were divided into 3 groups depending on the muscle relaxant used: IA (n = 52) - rocuronium bromide (esmeron), IB (n = 52) - atracurium besilate (tracrium), IC (n = 52) - cisatracurius besilate (nimbex). Depending on the type of general anesthesia, these groups were also divided into 2 subgroups: anesthesia based on isoflurane + fentanyl ″ + iso ″ and anesthesia based on sevoflurane + fentanyl ″ + sev ″. The main groups were also divided into 2 age subgroups: children under 2 years of age – IA1, IB1, IC1 and children from 2 to 16 years old – IA2, IB2, IC2. https://www.anesthesiaresjournal.com/articles/ijcar-aid1014.pdf Case Report Anaesthetic management of an elderly patient with ischaemic heart disease and previous MI undergoing elective inguinal hernia repair: Case report Khaleel Ahmad Najar(Senior Resident),Anka Amin(Assistant Professor),Mohammad Ommid(Associate Professor) 2020-05-25 00:00:00 Ischemic heart disease may occur in isolation, or in combination with the pathological process of vascular ageing, arteriosclerosis. These two conditions have differing impacts on the haemodynamic changes in response to anaesthesia and surgery. Hypertension is not a feature of ischemic heart disease, and vice versa, but where the two conditions co-exist, hypertension aggravates and accelerates the pathological processes of ischemic heart disease. Patients older than 40 yrs. presenting for anaesthesia and surgery must therefore be considered at risk of any combination of these three conditions. Anaesthetic techniques must also be chosen to minimize haemodynamic changes which in the normal healthy patient cause no serious morbidity, but which, in the patient with ischemic heart disease, can lead to serious morbidity or death. Here we report a 70 years old (BMI of 23.3) elderly, hypertensive Male patient with ischemic heart disease with previous MI (EF of 40% - 5%) undergoing elective Inguinal hernia repair. We Opted Spinal anesthesia over General anaesthesia as it should be an asset in cardiac patients undergoing non-cardiac lower abdominal surgeries to reduce preload and after load, stress response, coagulation responses, improves coronary perfusion, provides better postoperative analgesia, reduces incidence of perioperative MI, maintains myocardial oxygen supply demand ratio and avoids harmful effects of GA such as hypotention due to intravenous induction drugs, tachycardia and hypertension due to pressor response during direct laryngoscopy and tracheal intubation. https://www.anesthesiaresjournal.com/articles/ijcar-aid1013.pdf Research Article Blockade of the distal sciatic nerve with the patient in the supine position using a newly developed position aid with integrated ultrasound probe holder Michael Schütz,Jens Magunia,Hans-Bernd Hopf 2019-07-09 00:00:00 Background: We have developed a femoral supporting pad with an integrated ultrasound probe holder and examined its practical usability on patients with lower limb surgery. Objectives: To evaluate the function of this novel femoral supporting pad with respect to its practicability during the performance of a distal sciatic nerve blockade, the time needed to perform this blockade including the catheter insertion and the quality of postoperative analgesia within the first 24 hours. Methods: 50 patients which had been scheduled for elective lower leg, ankle or foot surgery had received a continuous blockade of the distal sciatic nerve. Sciatic nerve blockade was performed sonographically controlled with the patients in supine position by using our novel femoral supporting pad with an integrated ultrasound probe holder. Primary endpoint: duration of the intervention. Secondary endpoints: pain intensity (visual analogue scale VAS 0-10) at the first postoperative day; cumulative opioid (piritramide) requirement during their stay on the post Anaesthesia care unit (PACU) with vs. without distal sciatic nerve blockade. Results: 49/50 patients received a distal sciatic catheter, which had been sonographically placed within a mean time (mean ± sd) of 11:30 ± 3:13 minutes. VAS at the first postoperative day was (mean ± sd) 1 ± 2 at rest and 2 ± 2 as maximum. The piritramide requirement during PACU stay (mean ± sd) was 11 ± 8 mg without vs. 3 ± 6 mg with distal sciatic nerve blockade (p< 0.05). Conclusion: Continuous distal sciatic nerve blockade using a novel femoral supporting pad with an integrated ultrasound probe holder was feasible in 49 of 50 patients within 11 minutes and 30 seconds. https://www.anesthesiaresjournal.com/articles/ijcar-aid1012.pdf Case Report Benzine as fire source in operation room Domingos Dias Cicarelli,Fernando Chuluck Silva,Carolina Martins Ricardo,Ana Carolina Makinoo Antunes,Murilo Alexandre Carmona,Maria José Carvalho Carmona 2019-07-04 00:00:00 Provide a safety anesthesia to patient is only possible with the knowledge of material surrounding the operation room. Benzine is highly flammable substance and can produce several injures without the necessary care. This case describes a small fire caused by the presence of benzine in the surgical field concomitant with the use of electrocautery, which caused slight burns to the patient, but which could have been catastrophic, and proposes the use of protocols to prevent such accidents. https://www.anesthesiaresjournal.com/articles/ijcar-aid1011.pdf Research Article Knowledge, attitudes and skills of doctors, nurses and emergency medical technicians in pre-hospital care and emergency medicine who accompany patients in ambulances which arrive at the National Hospital of Sri Lanka Chrishantha Abeysena,Gangadevi Nandasena 2018-12-19 00:00:00 Objective: To assess the knowledge, attitudes, and skills in pre-hospital care and emergency medicine of doctors, nurses and Emergency Medical Technicians (EMT), who accompanied emergency patients in ambulances? Methods: A descriptive cross-sectional study was conducted among the doctors, nurses, and EMT who accompanied emergency patients in ambulances to the National Hospital. All ambulances arriving from August to October 2008 (n=409) were screened. A self-administered questionnaire with 30 items was used to assess knowledge, attitudes, and skills. The knowledge was categorized into three levels, EMT-basic level, EMT-intermediate level, and EMT-paramedic level and the scores were converted into the percentages. Results: The overall knowledge score on basic, intermediate and paramedic level were 57.5%, 42.9%, and 33.9% respectively. The knowledge on airway management (84.3%), bleeding control (82.9%), patient transport (71%) and first aids (61%) at the EMT-basic level were higher, however oxygen administration (37.1%) and basic life support (38.6%), spinal immobilization (45.7%), traction splinting (47%) and triage (48.6%) were lower. For the EMT-intermediate level, knowledge on endotracheal intubation (41.4%) and initial cardiac drug therapy (44.3%) were low. For the EMT-paramedic level, the knowledge on the advanced respiratory support (53%), ECG interpretation (37%), pharmacology (13%) and paediatric life support (20%) were lower. Most staff showed positive attitudes towards the need of basic knowledge in pre-hospital care (97.1%, n=34), need for proper training (97.1%, n=34) and cost for pre-hospital care (77.1%, n=27), while they showed relatively negative attitudes towards the outcome of pre-hospital care (74.3%, n=26). For the required skills for advanced life support, most of the staff showed skills in IV cannulation (71.4%, n=25) and IV drug administration (71.4%, n=25) however less skills were shown cricothyroidotomy (22.9%, n=8), pleural drainage (25.7%, n=9) and laryngoscopy and intubation (31.4%, n=11). Conclusion: The knowledge at the EMT-basic level was average and intermediate and paramedic levels were lower than average. The attitudes were generally positive. However they lacked some specific skills. https://www.anesthesiaresjournal.com/articles/ijcar-aid1010.pdf Research Article Some aspects of quality of ambulance care and completeness of information in the transfer forms of emergency patients who arrived in ambulances at the National Hospital of Sri Lanka Chrishantha Abeysena,Gangadevi Nandasena 2018-11-20 00:00:00 Objective: To describe some aspects of the quality of ambulance care and completeness of information in the transfer forms of emergency patients who arrived in ambulances to the National Hospital of Sri Lanka (NHSL). Methods:This was a descriptive study. All ambulances arrived at the NHSL during the study period with an emergency patient were selected (n=409) and from those 250 transfer forms, which could be traced were taken. An interviewer-administered questionnaire was used for ambulance staff. A Checklist, which has been derived from the standard patent chart, was used to determine the availability of information on transfer forms. Results: Of the 409 ambulances, the patient was accompanied by a doctor in 4% (n=16), a nurse in 4% (n=15) and Emergency Medical Technicians (EMTs) in 1% (n= 4), and there were 675 miner employees and 409 drivers. Twenty six percent (n= 4) of doctors, 12.5% (n= 2) of nurses, 100% (n=4) of EMTs, 56.9% (n=189) of drivers and 24.3% (n=164) of minor employees had received training in emergency medicine/pre-hospital care. The time interval between receipt of the message and loading the patient to the ambulance was >15 minutes on 19% (n= 75) of the occasions and from the latter time to commencement of the journey was >15 minutes on 7% (n=27) of the occasions. The call number of sending facility 0.4% (n=1) and sending time 33.2% (n=83) were poorly documented. The past surgical histories 20.8% (n=52), chronic diseases 48% (n=120), psychological problems 13.2% (n=33) and allergies 9.2% (n=23) were poorly documented. Details of physical examination findings except cardio-vascular system were not documented in >50% of transfer forms. Medications had been documented fairly (>60%) in most of the transfer forms and however, the procedures (IV fluids, ECG) were poorly documented (<30%). Conclusion: The completeness of information in the transfer form was not up to standards. This emphasizes for need of well-structured standard transfer form in the country. https://www.anesthesiaresjournal.com/articles/ijcar-aid1009.pdf Research Article Effects of intraoperative epidural anesthesia during hepatectomy on intraoperative and post-operative patient outcomes Christopher Mallard,Brad Withers,Brooke Bauer,Paul A Sloan,Sean Dineen,Annette Rebel 2018-11-13 00:00:00 Objective: The objective of this study was to evaluate the effects of intraoperative epidural anesthesia combined with balanced general anesthesia on intraoperative hemodynamics and fluid requirement, and on postoperative patient outcome. Design: The study design was a retrospective data analysis of patients undergoing open hepatectomy at a single tertiary care center from May, 2013 to June, 2016. Patients undergoing hepatectomies were separated into two groups: patients not receiving epidural local anesthetic intraoperatively (either no epidural or epidural catheter not used intraoperatively) were designated the control group and patients receiving epidural local anesthetic intraoperatively (bolus and/or continuously). Patients were excluded if they underwent laparoscopic or non-elective procedures. Results: 103 patients were included in the data analysis: Control n=14, Epidural = 89 patients. There were no major differences in demographics between groups. Epidural patients did not have higher requirements in intraoperative intravenous fluid administration, blood loss, or vasopressor use compared to control patients. Patients who received epidurals required less intravenous opioids with better post-operative pain scores initially and also on post-operative day 2. There were no differences in length of time to ambulation, or post-operative acute kidney injury amongst groups. Conclusions: This study shows that patients undergoing hepatectomies using combined epidural and general anesthesia: 1) have no increased requirement for intraoperative crystalloid, colloid, or blood component therapy, 2) require lower total intravenous opioid dose, and 3) subjectively report better pain control. Therefore, intraoperative epidural anesthesia combined with general anesthesia may be advantageous for ERAS protocol based oncological procedures. https://www.anesthesiaresjournal.com/articles/ijcar-aid1008.pdf Research Article Assessing the Neurocognitive function effects of ketamine in Cardiac Surgical patients Demet Dogan Erol 2018-10-23 00:00:00 Background: Despite remarkable progress in surgical, cardiopulmonary bypass (CPB) and anesthetic tecniques, neurocognitive damage still remains an important cause of postoperative morbidity in cardiac surgery. The aetiology of neurocognitive damage is likely to be multifocal; including macro and microemboli, cerebral hypoperfusion, inflammation and nonpulsatile flow. N-methyl-D-asparticAcid (NMDA) receptors play an important role during neurocognitive damage. Ketamine is a non-competitive antagonist to the phencyclidine site of NMDA receptor for glutamate and directly suppresses proinflammatory cytokine production. The aim of the present study was to evaluate whether ketamine has neuroprotective effects during open-heart surgery through the use of neurocognitive tests. Methods: We considered all patients aged between 58-76 years who were referred to a single cardiothoracic surgical team for elective, primary coronary revascularization. Patients were excluded from the study for the following reasons: a history of neurological, psychiatric, gastrointestinal, hepatic, renal, hematologic and clotting systems disorder and repeat procedures. Undergoing CPB were randomized 2 groups: Group1 (ketamine)(n=25) or Group2 (propofol)(n= Patients 25) In the propofol group, anesthesia was induced with 3mg/kg propofol, 1µg/kg remifentanyl, 0.1mg/kg vecuronium. Remifentanyl 0.5-1μg/kg/min was infused intravenously throughout the whole procedure. In the ketamine group, anesthesia was induced with 1-2mg/kg propofol, 1-2mg ketamin, 0.1mg/kg vecuronium. Ketamin 1mg/kg/hour was infused intravenously. Pressors, inotropic agents and antiarrhythmics were used as needed. The Mini-Mental State Examination(MMSE) was administered the day before surgery and three days later. The change in scores for MMSE was calculated for each patient and all the group. The results were compared statistically with paired simple t-test. Results: The mean age, CBP duration, lowest temperature was not statistically significant (Table1). Peroperative and postoperative blood pressures and pulse rates showed differences between groups. There were no preoperative differences between the groups on any of the mean MMSE score (Table2). The ECG monitoring revealed that most patients remained in sinus rhythm, with no difference between groups. Conclusions: We could not demonstrate that intraoperatively administered ketamine resulted in greater neuroprotective effects compared with propofol. Ketamine in combination with propofol during cardiac surgery is associated with a stable hemodynamic profile. Propofol may reduce the delivery of microemboli to the cerebral circulation by decreasing the cerebral blood flow. Propofol has a direct neuroprotective effect in vitro, although Roach et al. could not demonstrate a protective effect of propofol during open-heart surgery. Propofol enhances the antiinflammatory response to surgery by several mechanisms. This might have masked a neuroprotective effect of ketamine because propofol was administered in both groups in our study. https://www.anesthesiaresjournal.com/articles/ijcar-aid1007.pdf Research Article The incidence of hemodynamic and respiratory adverse events in morbidly obese presenting for Bariatric surgery Tomi Myrberg,Veronica Atterhem,Magnus Hultin 2018-07-25 00:00:00 Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of significant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery. Design: Retrospective, observational study. Setting: A 250-bed county hospital in northern Sweden. Subjects: 219 morbidly obese patients (body mass index > 35 kg/m2) who underwent bariatric surgery between 2003 and 2008. Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia. Results: The incidence of confirmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age (p < 0.001) but not with body mass index (BMI). 3.7% (n = 8/219) of cases were marked as difficult intubations. A transient period of hypoxemia was observed in 6.8% (n = 15/219) and was more common with increasing BMI (p = 0.005). Fourteen different drug combinations were used in the study population. Of those administered an induction anesthetic drug, 72.6% (n = 159/193) were given an overdose when calculated by lean body weight, but this did not correlate significantly to SAP falls (p = 0.468). Conclusion: The incidence of a significant blood pressure fall upon induction of anesthesia was common. The incidence of airway and ventilation problems were low. Overdosing of anesthetics and excessive variation in applied anesthesia methods were found. https://www.anesthesiaresjournal.com/articles/ijcar-aid1006.pdf Research Article The impact of two different doses of Dexmedetomidine to Local Anesthetic Mixture on the quality of single injection Peribulbar Block in Vitreoretinal operations Nagat S EL-Shmaa,Ramadan Salama,Mohamed El-Kashlan 2018-01-30 00:00:00 Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations Design: A prospective, double-blinded and randomized study. Setting: carried out in operating room of our university hospital. Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017. Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 µgdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 µg dexmedetomidine Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction. Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I. Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction. https://www.anesthesiaresjournal.com/articles/ijcar-aid1005.pdf Research Article Quantification of the pressures generated during insertion of an epidural needle in labouring women of varying body mass indices Wee MYK,Isaacs RA,Vaughan N,Dubey VN,Parker B 2017-12-01 00:00:00 Objective: The primary aim of this study was to measure pressure generated on a Tuohy needle during the epidural procedure in labouring women of varying body mass indices (BMI) with a view of utilising the data for the future development of a high fidelity epidural simulator. High-fidelity epidural simulators have a role in improving training and safety but current simulators lack a realistic experience and can be improved. Methods: This study was approved by the National Research Ethics Service Committee South Central, Portsmouth (REC reference 11/SC/0196). After informed consent epidural needle insertion pressure was measured using a Portex 16-gauge Tuohy needle, loss-of-resistance syringe, a three-way tap, pressure transducer and a custom-designed wireless transmitter. This was performed in four groups of labouring women, stratified according to BMI kg/m2: 18-24.9; 25-34.9; 35-44.9 and >=45. One-way ANOVA was used to compare difference in needle insertion pressure between the BMI groups. A paired t-test was performed between BMI group 18-24.9 and the three other BMI groups. Ultrasound images of the lumbar spine were undertaken prior to the epidural procedure and lumbar magnetic resonance imaging (MRI) was performed within 72h post-delivery. These images will be used in the development of a high fidelity epidural simulator. Results: The mean epidural needle insertion pressure of labouring women with BMI 18-24.9 was 461mmHg; BMI 25-34.9 was 430mmHg; BMI 35-44.9 was 415mmHg and BMI >=45 was 376mmHg, (p=0.52). Conclusion: Although statistically insignificant, the study did show a decreasing trend of epidural insertion pressure with increasing body mass indices. https://www.anesthesiaresjournal.com/articles/ijcar-aid1004.pdf Case Report Evolution of anaesthesia in transapical aortic valve implantation Running head: Anaesthesia and transcatheter valve Marzia Cottini, Lappa A,Donfrancesco S,Francesco Musumeci 2017-09-20 00:00:00 The Transcatheter Aortic Valve Implantation (TAVI) had emerged more and more in the last twenty years. According to the scientific literature, this is an approved, suitable and alternative therapeutic choice to conventional surgery for aortic valve disease in high risk patients. The most of patients are octogenarians or nonagenarians, with multiple comorbidities (neurological,vascular,oncologic, haematological, etc). The evolution of TAVI techniques and its devices have improved the quality of results and reduced the peri- and post-procedural complications. Cardiac anaesthesia and analgesia in TAVI patients is very important and fundamental to a quickly and complete clinical restoring after the procedure. An optimal balance of drugs and peri-procedural management could reduce the neurological events (such as delirium), the days of hospitalization and the admission of intensive care unit. According to our experience in transapical approach, the low dose of propofol and desflurane allowed to optimal cardiac anaesthesia and rapid mechanical ventilation weaning in complex patient undergone to transcatheter valve implantation with transapical approach. Moreover, our protocol reduced considerably the incidence of perioperative delirium. https://www.anesthesiaresjournal.com/articles/ijcar-aid1003.pdf Research Article Endovascular treatment of complex cerebral arterial saccular aneurysms with different methods of coiling: 14 years of experience review Dmytro V Scheglov,Stanislav V Konotopchik,Maryna Y Mamonova,Oleg E Sviridyuk 2017-06-21 00:00:00 The Objective: to improve the treatment results for patients with cerebral arterial saccular aneurysms by optimizing of differentiated approach to the using of endovascular assisting occlusion techniques. Materials and Methods: The work is based on the comprehensive survey and treatment of 1345 patients with cerebral saccular arterial aneurysms (AA), who were treated at the SO “Scientific-Practical Center of endovascular neuroradiology of NAMS of Ukraine” from 2002 to 2016. 214 cases were selected for further clinical-instrumental dynamic observation in follow-up period. All patients were operated by endovascular approach in “before hemorrhage” period, in acute or “cold” period of the disease on for symptomatic or asymptomatic intracranial saccular AA in both vascular pools with balloon-remodeling or stent-assisting techniques using with the coiling or just detachable coils (DC) using-mono-coils occlusion technique. Depending on the initial endovascular occlusion method, the patients were divided into three groups for observation: I group (mono-coils occlusion)-82 (38.3%) patients, II group (balloon-remodeling technique using)-68 (31.8%) patients, group III (stent-assisting technique occlusion)-64 (29.9%) patients. The life quality and the level of social adaptation were evaluated before hospital discharge and at the follow-up control examinations by Glasgow Outcome Scale (GOS) and by the modified Rankine scale (mRS). AA radicalism occlusion was assessed by Modified Raymond-Roy Scale (MRRS) (Mascitelli JR, et al., 2015). AA occlusion I and II by MRRS was considered as “Effective”. Results: 9 criteria of cerebral saccular AA complexity inherent in endovascular surgery have been developed based on the technical and surgical features of endovascular methods of the cerebral AA occlusion and X-ray-anatomical characteristics of aneurysms, which complicated the “effective” reconstructive occlusion of AA cavity. The evaluation of the AA complexity criteria prognostic significance to achieve the “effective” primary occlusion, shown different results in different groups: high prognostic significance of 4 criteria was shown in group I, of 2 criteria - in group III, and no any criteria significance in group II. There was no statistically significant difference between groups in the primary AA occlusion efficacy and initial good results by GOS and mRS. It was proved that endovascular occlusion of complex cerebral AA with the assisting methods using has high efficiency in all periods of the disease, unlike the method of mono-coils occlusion, which is most effective in acute and “cold” periods. There was no statistically significant difference between the number of intraoperative, postoperative and non-surgical complications (p>0.05). It was found that all methods of complex AA endovascular occlusion can effectively prevent the disease recurrence despite the differences between them in the stability of the AA cavity occlusion. Conclusions: Consideration of developed AA complexity criteria during endovascular surgery planning allows to choose the most optimal and safe individual method of primary or phased AA occlusion and helps to reduce the frequency of AA recanalization in follow-up period. The choice of the complex AA occlusion method doesn’t effect on result of primary treatment, the number of intraoperative complications and the quality of primary occlusion. However, an analysis of the long-term treatment results indicates that the assisting techniques have proven advantages according to the occlusion stability. https://www.anesthesiaresjournal.com/articles/ijcar-aid1002.pdf Case Report Submitral Ventricular Pseudoaneurysm: Unusual and Late Complication of Cardiac Surgery Marzia Cottini,Amedeo Pergolini,Giordano Zampi,Vitaliano Buffa,Paolo Giuseppe Pino,Federico Ranocchi,Riccardo Gherli,De Marco Marina,Carlo Contento,Myriam Lo Presti,Francesco Musumeci 2017-01-21 00:00:00 Despite the background of advances in cardiac surgery procedures for higher risk population, the postoperative complication has already been a challenge for cardiac surgeon and Heart-Team. Future perspectives to exceed this challenge could be periodically patient’s follow up and advance diagnostic workup. We describe the diagnosis of a large sub mitral left Ventricle Pseudoaneurysm that was identified in a 59-year-old woman 17 years after she underwent aortic and mitral valve replacement for rheumatic valvular disease https://www.anesthesiaresjournal.com/articles/ijcar-aid1001.pdf
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<title>International Journal of Clinical Anesthesia and Research</title>
<link>https://www.anesthesiaresjournal.com/feed</link>
<description>Introduction Anesthesia is considered as freedom from pain. It is a medical treatment that prevents patients from feeling pain during surgery. Several researches in anesthesia have made possible countless procedures that improve human health, longevity and quality of life. With time and gained knowledge this term has become a sub discipline of medical science. International Journal of Clinical Anesthesia and Research publishes diverse range of manuscripts in the proliferating arears of research in anesthesia. International Journal of Clinical Anesthesia and Research provides a unique dais for the authors, scientists and researchers to publish their articles focusing various aspects related to the application of anesthesia protocol in consideration with patient&rsquo;s age and his/her exact disease condition. Reasons for Publishing Since its birth in 1845, anesthesia is a relatively young science. In several countries, anesthesia has markedly progressed during the course of the last few decades. Over the last few decades, there have been significant improvements in drugs, equipment and techniques related to anesthesia. However, the major challenge in anesthesiology has come from improvement in patient safety. Moreover, ethical; practical; and relational challenges have also changed the consent of anesthesiologists&rsquo; views of current and future patients, their practices as well as their profession. International Journal of Clinical Anesthesia and Research takes this initiative to publish manuscripts focusing researches on how a person's genetic makeup influences the way he or she responds to anesthetics which can assist the doctors to further adapt anesthesia to individual patients.</description>
<item>
<type>Brief Communication</type>
<title>Minimising Carbon Footprint in Anaesthesia Practice</title>
<author>Nisha Gandhi and Abinav Sarvesh SPS*</author>
<pubDate>2024-10-19 12:21:30</pubDate>
<description>Carbon footprint refers to the total amount of greenhouse gas emitted in the atmosphere by an individual or by an organization causing global warming. There are various causes of greenhouse gas emissions and anaesthetic gases are one amongst them. Greenhouse gases warm the earth by absorbing infrared energy and slowing the rate at which the energy escapes into space. Each greenhouse gas has two important properties. One is the amount of infrared energy that a gas can absorb and the other is the lifetime of that gas in the atmosphere. Anaesthesia as a speciality contributes to carbon footprinting in three ways: direct emission, energy use, and operating room wastes and supplies. Direct emission of Waste Anaesthetic Gases (WAG) from anaesthesia workstations can either be scavenged and thrown out into the environment causing a green greenhouse gas effect or can pollute the operating room due to poor scavenging. Various techniques such as reducing direct emissions, energy use optimisation, and waste management have been tried in minimising carbon footprint in anaesthesia practice but providing safety to the patient is considered of utmost importance.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1025.pdf</link>
</item>
<item>
<type>Case Study</type>
<title>An Instance of Green-tinted Urine Related to the use of Propofol</title>
<author>Bindhya Maharjan*, Jeevan Singh, Shibesh Chandra Mishra, Saubhagya Neupane</author>
<pubDate>2024-08-20 12:52:22</pubDate>
<description>Urine typically has an amber-yellow color due to the amorphous pigment urochrome, a distinct scent, and an average pH of 6.0, which is somewhat acidic. Green urine can result from drug intake, dyes, infections, adverse drug reactions, and other causes. Less than 1% of propofol users experience green urine, a rare and benign side effect. The green tint in urine is caused by the phenolic metabolites of propofol. In this case, a 33-year-old man diagnosed with organophosphorus poisoning and aspiration pneumonia had been given a modest dose of propofol sedation for six hours and began to exhibit green urine. After five hours of halting the propofol infusion, the urine returned to its usual color. Healthcare practitioners should be aware of this unusual but safe side effect of propofol.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1024.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Deciphering the Rosetta Stone - Trans-Mitral Doppler Patterns for a Simplified Study of Left Ventricular Systolic Dysfunction</title>
<author>George Thomas*</author>
<pubDate>2023-08-30 17:04:46</pubDate>
<description>There is a renewed interest in heart failure treatments. With this, there is an increasing interest in heart failure with preserved ejection fraction. Trans-mitral Doppler is commonly used in the assessment of &lsquo;diastolic&rsquo; function. It is fashionable to discuss diastolic dysfunction and diastology with the result that the more important systolic dysfunction has become pass&eacute;. The current literature equates trans-mitral Doppler patterns to diastolic function when actually it is more relevant in systolic dysfunction. This article is an attempt to correct this flawed perception of trans-mitral Doppler.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1023.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Anesthesia mumps: a case report</title>
<author>Maher Al-Hajjaj,Anfal Salim,Mahmoud Mohammad,Maab Mohamed,Ahmad Tawosh,Ababca Fatima Zohra</author>
<pubDate>2023-02-10 14:56:39</pubDate>
<description>A 25 years old pregnant woman had a painful labor in her 38th week of pregnancy. Because of a previous delivery by a cesarean section, she underwent a second cesarean section. Her past medical and family history was unimportant. We performed the surgery under spinal anesthesia. The surgery was uneventful and the baby was in a good health. After 9 hours of surgery, she complained of painless swelling in the parotid glands. Physical examination and laboratories were normal. We started rehydration with normal saline and one dose of hydrocortisone&nbsp;(100 mg IV route). Close monitoring showed no problems in swallowing or any purulent discharge. Two days later, we had a complete resolution of the swelling. We discharged the woman with her child with no complaints. Our case is one of the rare cases of anesthesia mumps after spinal anesthesia. Physicians should be careful in considering such rare cases. Early diagnosis and management is the key.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1022.pdf</link>
</item>
<item>
<type>Mini Review</type>
<title>Anesthesia for epilepsy surgery</title>
<author>Alexandre Pacchioni,João Kazuo Yano,João A Assirati</author>
<pubDate>2023-01-16 10:04:44</pubDate>
<description>Anesthesia for neurosurgery, &ldquo;neuro-anesthesia&rdquo;, involves techniques, drugs, monitoring and objectives as diverse as the area of surgical activity is vast (surgery for vascular alterations, tumors, craniostenosis, spine, epilepsy, etc.).</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1021.pdf</link>
</item>
<item>
<type>Observational Study</type>
<title>To evaluate the stress response to tracheal intubation by macintosh laryngoscope and intubating laryngeal mask airway</title>
<author>Somika Agarwal,Sapna Bansal</author>
<pubDate>2022-12-19 11:37:47</pubDate>
<description>Aim: To evaluate the hemodynamic changes and side effects during endotracheal intubation with Macintosh laryngoscope and intubating laryngeal mask airway.Materials and methods: A prospective, simple randomized, comparative study on 100 patients 18 years - 60 years of age, divided into two groups: Group A comprising intubation with Macintosh laryngoscope and Group B intubation through ILMA.Results: Total intubation time (in seconds) of group A was 24.38 + 3.26 seconds and of the group, B was 42.94 + 1.24 seconds. At 2,4 and 6, a higher rise in mean heart rate was noted in group A (p &lt; 0.05). At 2,4,6 and 8 minutes difference in mean SBP and mean DBP of the two groups was statistically significant with a p - value of &lt; 0.05 with a significant increase of mean SBP and mean DBP in patients of group A. The difference for all complications was not significant between the two groups.Conclusion: Intubation via intubating laryngeal mask airway can be done as an alternative to direct laryngoscopy using a Macintosh blade as intubation via intubating laryngeal mask airway has shown to have lesser hemodynamic changes.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1020.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>A case report of hepatic actinomycosis: A rare form of presentation</title>
<author>Nieto Piñar Yasmina,Hernández González Verónica Lisseth,Borges SA Marcio</author>
<pubDate>2022-09-20 11:33:16</pubDate>
<description>Hepatic Actinomycosis (HA) is a very rare abdominal actinomycosis that can be confused with hepatic involvement due to a tumor. Liver involvement can occur from an abdominal focus or by blood dissemination from another focus. This disease is much more common in men between 50 - 70 years and in a situation of immunosuppression.&nbsp;Symptoms are nonspecific and diagnosis includes histopathology, cultures, and imaging test. Treatment includes prolonged antibiotic therapy with antibiotics such as penicillin and drainage of abscesses.We present a case of a 54-year-old man patient with a record of three years of chronic pancreatitis of probably alcoholic origin, who developed hepatic actinomycosis, requiring drainage of liver abscesses and directed antibiotic treatment.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1019.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>A witnessed intra-operative blood transfusion-related air embolism under epidural anaesthesia for vesicovaginal fistula repair</title>
<author>Gyadale AN,Adeyanju BT,Ayegbusi EO,Adeyiolu AT,Olabode AA,Suberu SO,Olajide MA</author>
<pubDate>2022-06-21 14:04:57</pubDate>
<description>The transfusion is a normal life-saving procedure conducted commonly by the nurses at the prescription of the attending physician or the emergency physicians. It is generally a safe procedure if guidelines for processing and administering are carefully followed. Blood transfusion is an independent risk factor for morbidity and mortality and major complications arising from transfusion are generally rare.&nbsp;We present a case of a mild case of iatrogenic air embolism exacerbated by pressure infusion for a patient who had undergone an exploratory laparotomy for an iatrogenic fistula repair under epidural anesthesia.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1018.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Nasopalatin duct cysts: Report of ten cases and review of literature</title>
<author>Melike Baygin,Melek Koltuk,Banu Gurkan Koseoglu</author>
<pubDate>2020-11-10 00:00:00</pubDate>
<description>Nasopalatine duct cyst is the most common non-odontogenic cyst. It develops in the midline of the anterior maxilla. It is usually asymptomatic and sometimes it can be overlooked or misdiagnosed. We present 10 patients who applied to Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1016.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>A comparison of complications associated with nutrition between the patients receiving enteral or parenteral in the intensive care unit</title>
<author>Ahmet Eroglu,Seyhan Sumeyra Asci,Ahmet Eroglu</author>
<pubDate>2020-09-29 00:00:00</pubDate>
<description>The aim of this study was to investigate and compare the complications including infection and mortality associated with enteral and parenteral nutrition on patients in the ICU of a university hospital. In this study, a total of 100 patients who were under follow-up in the ICU for two years were examined. In our study, demographic characteristics, the reason for admission, comorbidity, initial ICU laboratory values, morbidity and mortality during the follow-up period of the patients who only received enteral nutrition (EN) or parenteral nutrition (PN) were evaluated, and the results between two were compared as well as evaluating the complications within the groups. The comparison of the reason for admission between the EN and PN groups showed that surgical reasons were significantly higher in the PN group. Nosocomial infections, the presence of infection and the development of sepsis were significantly higher in the EN group. The 28-day mortality rate was higher in the PN group compared to the EN group. The length of stay in the ICU and on mechanical ventilation was longer in the EN group. There was no significant difference in the 28-day mortality, readmission to the ICU and repeated endotracheal intubation between the two groups. Because there is no statistical difference between EN and PN groups in point of infection and mortality, we conclude that the length of stay in the ICU and reason for admission play a more crucial role in the development of infection and on mortality rather than enteral or parenteral nutrition route.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1015.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The choice of optimal modern muscle relaxants (rocuronium bromide, atracurium besilate and cisatracurius besilate) in one-day surgery in children</title>
<author>Nasibova EM</author>
<pubDate>2020-06-15 00:00:00</pubDate>
<description>The choice of the optimal muscle relaxant in one-day surgery in children with &ldquo;small&rdquo; surgical interventions remains relevant to this day. In modern pediatric surgery, the requirements for the quality of muscle relaxation are highest. However, along with the effectiveness of the drug, its duration and controllability of the action, as well as the safety of use, are important [1-7]. The aim of the study: To determine the pharmacoeconomic rationale for the rational use of muscle relaxants, depending on the duration of operations in one-day surgery in children. Material and research methods: The study was conducted in surgical clinics of the Azerbaijan Medical University. The study included 156 children who were operated on routinely from 0 to 16 years old (risk of anesthesia I-II ASA), who used combined endotracheal anesthesia during surgery. Based on the requirements of the GCP international program (Good Clinical Practice), the inclusion of children in the study was carried out only after the written consent of the parents. The studied patients were divided into 3 groups depending on the muscle relaxant used: IA (n = 52) - rocuronium bromide (esmeron), IB (n = 52) - atracurium besilate (tracrium), IC (n = 52) - cisatracurius besilate (nimbex). Depending on the type of general anesthesia, these groups were also divided into 2 subgroups: anesthesia based on isoflurane + fentanyl &Prime; + iso &Prime; and anesthesia based on sevoflurane + fentanyl &Prime; + sev &Prime;. The main groups were also divided into 2 age subgroups: children under 2 years of age &ndash; IA1, IB1, IC1 and children from 2 to 16 years old &ndash; IA2, IB2, IC2.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1014.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Anaesthetic management of an elderly patient with ischaemic heart disease and previous MI undergoing elective inguinal hernia repair: Case report</title>
<author>Khaleel Ahmad Najar(Senior Resident),Anka Amin(Assistant Professor),Mohammad Ommid(Associate Professor)</author>
<pubDate>2020-05-25 00:00:00</pubDate>
<description>Ischemic heart disease may occur in isolation, or in combination with the pathological process of vascular ageing, arteriosclerosis. These two conditions have differing impacts on the haemodynamic changes in response to anaesthesia and surgery. Hypertension is not a feature of ischemic heart disease, and vice versa, but where the two conditions co-exist, hypertension aggravates and accelerates the pathological processes of ischemic heart disease. Patients older than 40 yrs. presenting for anaesthesia and surgery must therefore be considered at risk of any combination of these three conditions. Anaesthetic techniques must also be chosen to minimize haemodynamic changes which in the normal healthy patient cause no serious morbidity, but which, in the patient with ischemic heart disease, can lead to serious morbidity or death. Here we report a 70 years old (BMI of 23.3) elderly, hypertensive Male patient with ischemic heart disease with previous MI (EF of 40% - 5%) undergoing elective Inguinal hernia repair. We Opted Spinal anesthesia over General anaesthesia as it should be an asset in cardiac patients undergoing non-cardiac lower abdominal surgeries to reduce preload and after load, stress response, coagulation responses, improves coronary perfusion, provides better postoperative analgesia, reduces incidence of perioperative MI, maintains myocardial oxygen supply demand ratio and avoids harmful effects of GA such as hypotention due to intravenous induction drugs, tachycardia and hypertension due to pressor response during direct laryngoscopy and tracheal intubation.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1013.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Blockade of the distal sciatic nerve with the patient in the supine position using a newly developed position aid with integrated ultrasound probe holder</title>
<author>Michael Schütz,Jens Magunia,Hans-Bernd Hopf</author>
<pubDate>2019-07-09 00:00:00</pubDate>
<description>Background: We have developed a femoral supporting pad with an integrated ultrasound probe holder and examined its practical usability on patients with lower limb surgery. Objectives: To evaluate the function of this novel femoral supporting pad with respect to its practicability during the performance of a distal sciatic nerve blockade, the time needed to perform this blockade including the catheter insertion and the quality of postoperative analgesia within the first 24 hours. Methods: 50 patients which had been scheduled for elective lower leg, ankle or foot surgery had received a continuous blockade of the distal sciatic nerve. Sciatic nerve blockade was performed sonographically controlled with the patients in supine position by using our novel femoral supporting pad with an integrated ultrasound probe holder. Primary endpoint: duration of the intervention. Secondary endpoints: pain intensity (visual analogue scale VAS 0-10) at the first postoperative day; cumulative opioid (piritramide) requirement during their stay on the post Anaesthesia care unit (PACU) with vs. without distal sciatic nerve blockade. Results: 49/50 patients received a distal sciatic catheter, which had been sonographically placed within a mean time (mean &plusmn; sd) of 11:30 &plusmn; 3:13 minutes. VAS at the first postoperative day was (mean &plusmn; sd) 1 &plusmn; 2 at rest and 2 &plusmn; 2 as maximum. The piritramide requirement during PACU stay (mean &plusmn; sd) was 11 &plusmn; 8 mg without vs. 3 &plusmn; 6 mg with distal sciatic nerve blockade (p&lt; 0.05). Conclusion: Continuous distal sciatic nerve blockade using a novel femoral supporting pad with an integrated ultrasound probe holder was feasible in 49 of 50 patients within 11 minutes and 30 seconds.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1012.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Benzine as fire source in operation room</title>
<author>Domingos Dias Cicarelli,Fernando Chuluck Silva,Carolina Martins Ricardo,Ana Carolina Makinoo Antunes,Murilo Alexandre Carmona,Maria José Carvalho Carmona</author>
<pubDate>2019-07-04 00:00:00</pubDate>
<description>Provide a safety anesthesia to patient is only possible with the knowledge of material surrounding the operation room. Benzine is highly flammable substance and can produce several injures without the necessary care. This case describes a small fire caused by the presence of benzine in the surgical field concomitant with the use of electrocautery, which caused slight burns to the patient, but which could have been catastrophic, and proposes the use of protocols to prevent such accidents.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1011.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Knowledge, attitudes and skills of doctors, nurses and emergency medical technicians in pre-hospital care and emergency medicine who accompany patients in ambulances which arrive at the National Hospital of Sri Lanka</title>
<author>Chrishantha Abeysena,Gangadevi Nandasena</author>
<pubDate>2018-12-19 00:00:00</pubDate>
<description>Objective: To assess the knowledge, attitudes, and skills in pre-hospital care and emergency medicine of doctors, nurses and Emergency Medical Technicians (EMT), who accompanied emergency patients in ambulances? Methods: A descriptive cross-sectional study was conducted among the doctors, nurses, and EMT who accompanied emergency patients in ambulances to the National Hospital. All ambulances arriving from August to October 2008 (n=409) were screened. A self-administered questionnaire with 30 items was used to assess knowledge, attitudes, and skills. The knowledge was categorized into three levels, EMT-basic level, EMT-intermediate level, and EMT-paramedic level and the scores were converted into the percentages. Results: The overall knowledge score on basic, intermediate and paramedic level were 57.5%, 42.9%, and 33.9% respectively. The knowledge on airway management (84.3%), bleeding control (82.9%), patient transport (71%) and first aids (61%) at the EMT-basic level were higher, however oxygen administration (37.1%) and basic life support (38.6%), spinal immobilization (45.7%), traction splinting (47%) and triage (48.6%) were lower. For the EMT-intermediate level, knowledge on endotracheal intubation (41.4%) and initial cardiac drug therapy (44.3%) were low. For the EMT-paramedic level, the knowledge on the advanced respiratory support (53%), ECG interpretation (37%), pharmacology (13%) and paediatric life support (20%) were lower. Most staff showed positive attitudes towards the need of basic knowledge in pre-hospital care (97.1%, n=34), need for proper training (97.1%, n=34) and cost for pre-hospital care (77.1%, n=27), while they showed relatively negative attitudes towards the outcome of pre-hospital care (74.3%, n=26). For the required skills for advanced life support, most of the staff showed skills in IV cannulation (71.4%, n=25) and IV drug administration (71.4%, n=25) however less skills were shown cricothyroidotomy (22.9%, n=8), pleural drainage (25.7%, n=9) and laryngoscopy and intubation (31.4%, n=11). Conclusion: The knowledge at the EMT-basic level was average and intermediate and paramedic levels were lower than average. The attitudes were generally positive. However they lacked some specific skills.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1010.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Some aspects of quality of ambulance care and completeness of information in the transfer forms of emergency patients who arrived in ambulances at the National Hospital of Sri Lanka </title>
<author>Chrishantha Abeysena,Gangadevi Nandasena</author>
<pubDate>2018-11-20 00:00:00</pubDate>
<description>Objective: To describe some aspects of the quality of ambulance care and completeness of information in the transfer forms of emergency patients who arrived in ambulances to the National Hospital of Sri Lanka (NHSL). Methods:This was a descriptive study. All ambulances arrived at the NHSL during the study period with an emergency patient were selected (n=409) and from those 250 transfer forms, which could be traced were taken. An interviewer-administered questionnaire was used for ambulance staff. A Checklist, which has been derived from the standard patent chart, was used to determine the availability of information on transfer forms. Results: Of the 409 ambulances, the patient was accompanied by a doctor in 4% (n=16), a nurse in 4% (n=15) and Emergency Medical Technicians (EMTs) in 1% (n= 4), and there were 675 miner employees and 409 drivers. Twenty six percent (n= 4) of doctors, 12.5% (n= 2) of nurses, 100% (n=4) of EMTs, 56.9% (n=189) of drivers and 24.3% (n=164) of minor employees had received training in emergency medicine/pre-hospital care. The time interval between receipt of the message and loading the patient to the ambulance was &gt;15 minutes on 19% (n= 75) of the occasions and from the latter time to commencement of the journey was &gt;15 minutes on 7% (n=27) of the occasions. The call number of sending facility 0.4% (n=1) and sending time 33.2% (n=83) were poorly documented. The past surgical histories 20.8% (n=52), chronic diseases 48% (n=120), psychological problems 13.2% (n=33) and allergies 9.2% (n=23) were poorly documented. Details of physical examination findings except cardio-vascular system were not documented in &gt;50% of transfer forms. Medications had been documented fairly (&gt;60%) in most of the transfer forms and however, the procedures (IV fluids, ECG) were poorly documented (&lt;30%). Conclusion: The completeness of information in the transfer form was not up to standards. This emphasizes for need of well-structured standard transfer form in the country.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1009.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Effects of intraoperative epidural anesthesia during hepatectomy on intraoperative and post-operative patient outcomes</title>
<author>Christopher Mallard,Brad Withers,Brooke Bauer,Paul A Sloan,Sean Dineen,Annette Rebel</author>
<pubDate>2018-11-13 00:00:00</pubDate>
<description>Objective: The objective of this study was to evaluate the effects of intraoperative epidural anesthesia combined with balanced general anesthesia on intraoperative hemodynamics and fluid requirement, and on postoperative patient outcome. Design: The study design was a retrospective data analysis of patients undergoing open hepatectomy at a single tertiary care center from May, 2013 to June, 2016. Patients undergoing hepatectomies were separated into two groups: patients not receiving epidural local anesthetic intraoperatively (either no epidural or epidural catheter not used intraoperatively) were designated the control group and patients receiving epidural local anesthetic intraoperatively (bolus and/or continuously). Patients were excluded if they underwent laparoscopic or non-elective procedures. Results: 103 patients were included in the data analysis: Control n=14, Epidural = 89 patients. There were no major differences in demographics between groups. Epidural patients did not have higher requirements in intraoperative intravenous fluid administration, blood loss, or vasopressor use compared to control patients. Patients who received epidurals required less intravenous opioids with better post-operative pain scores initially and also on post-operative day 2. There were no differences in length of time to ambulation, or post-operative acute kidney injury amongst groups. Conclusions: This study shows that patients undergoing hepatectomies using combined epidural and general anesthesia: 1) have no increased requirement for intraoperative crystalloid, colloid, or blood component therapy, 2) require lower total intravenous opioid dose, and 3) subjectively report better pain control. Therefore, intraoperative epidural anesthesia combined with general anesthesia may be advantageous for ERAS protocol based oncological procedures.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1008.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Assessing the Neurocognitive function effects of ketamine in Cardiac Surgical patients </title>
<author>Demet Dogan Erol</author>
<pubDate>2018-10-23 00:00:00</pubDate>
<description>Background: Despite remarkable progress in surgical, cardiopulmonary bypass (CPB) and anesthetic tecniques, neurocognitive damage still remains an important cause of postoperative morbidity in cardiac surgery. The aetiology of neurocognitive damage is likely to be multifocal; including macro and microemboli, cerebral hypoperfusion, inflammation and nonpulsatile flow. N-methyl-D-asparticAcid (NMDA) receptors play an important role during neurocognitive damage. Ketamine is a non-competitive antagonist to the phencyclidine site of NMDA receptor for glutamate and directly suppresses proinflammatory cytokine production. The aim of the present study was to evaluate whether ketamine has neuroprotective effects during open-heart surgery through the use of neurocognitive tests. Methods: We considered all patients aged between 58-76 years who were referred to a single cardiothoracic surgical team for elective, primary coronary revascularization. Patients were excluded from the study for the following reasons: a history of neurological, psychiatric, gastrointestinal, hepatic, renal, hematologic and clotting systems disorder and repeat procedures. Undergoing CPB were randomized 2 groups: Group1 (ketamine)(n=25) or Group2 (propofol)(n= Patients 25) In the propofol group, anesthesia was induced with 3mg/kg propofol, 1&micro;g/kg remifentanyl, 0.1mg/kg vecuronium. Remifentanyl 0.5-1&mu;g/kg/min was infused intravenously throughout the whole procedure. In the ketamine group, anesthesia was induced with 1-2mg/kg propofol, 1-2mg ketamin, 0.1mg/kg vecuronium. Ketamin 1mg/kg/hour was infused intravenously. Pressors, inotropic agents and antiarrhythmics were used as needed. The Mini-Mental State Examination(MMSE) was administered the day before surgery and three days later. The change in scores for MMSE was calculated for each patient and all the group. The results were compared statistically with paired simple t-test. Results: The mean age, CBP duration, lowest temperature was not statistically significant (Table1). Peroperative and postoperative blood pressures and pulse rates showed differences between groups. There were no preoperative differences between the groups on any of the mean MMSE score (Table2). The ECG monitoring revealed that most patients remained in sinus rhythm, with no difference between groups. Conclusions: We could not demonstrate that intraoperatively administered ketamine resulted in greater neuroprotective effects compared with propofol. Ketamine in combination with propofol during cardiac surgery is associated with a stable hemodynamic profile. Propofol may reduce the delivery of microemboli to the cerebral circulation by decreasing the cerebral blood flow. Propofol has a direct neuroprotective effect in vitro, although Roach et al. could not demonstrate a protective effect of propofol during open-heart surgery. Propofol enhances the antiinflammatory response to surgery by several mechanisms. This might have masked a neuroprotective effect of ketamine because propofol was administered in both groups in our study.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1007.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The incidence of hemodynamic and respiratory adverse events in morbidly obese presenting for Bariatric surgery</title>
<author>Tomi Myrberg,Veronica Atterhem,Magnus Hultin </author>
<pubDate>2018-07-25 00:00:00</pubDate>
<description>Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of significant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery. Design: Retrospective, observational study. Setting: A 250-bed county hospital in northern Sweden. Subjects: 219 morbidly obese patients (body mass index &gt; 35 kg/m2) who underwent bariatric surgery between 2003 and 2008. Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia. Results: The incidence of confirmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age (p &lt; 0.001) but not with body mass index (BMI). 3.7% (n = 8/219) of cases were marked as difficult intubations. A transient period of hypoxemia was observed in 6.8% (n = 15/219) and was more common with increasing BMI (p = 0.005). Fourteen different drug combinations were used in the study population. Of those administered an induction anesthetic drug, 72.6% (n = 159/193) were given an overdose when calculated by lean body weight, but this did not correlate significantly to SAP falls (p = 0.468). Conclusion: The incidence of a significant blood pressure fall upon induction of anesthesia was common. The incidence of airway and ventilation problems were low. Overdosing of anesthetics and excessive variation in applied anesthesia methods were found.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1006.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>The impact of two different doses of Dexmedetomidine to Local Anesthetic Mixture on the quality of single injection Peribulbar Block in Vitreoretinal operations </title>
<author>Nagat S EL-Shmaa,Ramadan Salama,Mohamed El-Kashlan</author>
<pubDate>2018-01-30 00:00:00</pubDate>
<description>Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations Design: A prospective, double-blinded and randomized study. Setting: carried out in operating room of our university hospital. Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017. Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 &micro;gdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 &micro;g dexmedetomidine Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction. Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I. Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1005.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Quantification of the pressures generated during insertion of an epidural needle in labouring women of varying body mass indices </title>
<author>Wee MYK,Isaacs RA,Vaughan N,Dubey VN,Parker B</author>
<pubDate>2017-12-01 00:00:00</pubDate>
<description>Objective: The primary aim of this study was to measure pressure generated on a Tuohy needle during the epidural procedure in labouring women of varying body mass indices (BMI) with a view of utilising the data for the future development of a high fidelity epidural simulator. High-fidelity epidural simulators have a role in improving training and safety but current simulators lack a realistic experience and can be improved. Methods: This study was approved by the National Research Ethics Service Committee South Central, Portsmouth (REC reference 11/SC/0196). After informed consent epidural needle insertion pressure was measured using a Portex 16-gauge Tuohy needle, loss-of-resistance syringe, a three-way tap, pressure transducer and a custom-designed wireless transmitter. This was performed in four groups of labouring women, stratified according to BMI kg/m2: 18-24.9; 25-34.9; 35-44.9 and &gt;=45. One-way ANOVA was used to compare difference in needle insertion pressure between the BMI groups. A paired t-test was performed between BMI group 18-24.9 and the three other BMI groups. Ultrasound images of the lumbar spine were undertaken prior to the epidural procedure and lumbar magnetic resonance imaging (MRI) was performed within 72h post-delivery. These images will be used in the development of a high fidelity epidural simulator. Results: The mean epidural needle insertion pressure of labouring women with BMI 18-24.9 was 461mmHg; BMI 25-34.9 was 430mmHg; BMI 35-44.9 was 415mmHg and BMI &gt;=45 was 376mmHg, (p=0.52). Conclusion: Although statistically insignificant, the study did show a decreasing trend of epidural insertion pressure with increasing body mass indices.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1004.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Evolution of anaesthesia in transapical aortic valve implantation Running head: Anaesthesia and transcatheter valve </title>
<author>Marzia Cottini, Lappa A,Donfrancesco S,Francesco Musumeci</author>
<pubDate>2017-09-20 00:00:00</pubDate>
<description>The Transcatheter Aortic Valve Implantation (TAVI) had emerged more and more in the last twenty years. According to the scientific literature, this is an approved, suitable and alternative therapeutic choice to conventional surgery for aortic valve disease in high risk patients. The most of patients are octogenarians or nonagenarians, with multiple comorbidities (neurological,vascular,oncologic, haematological, etc). The evolution of TAVI techniques and its devices have improved the quality of results and reduced the peri- and post-procedural complications. Cardiac anaesthesia and analgesia in TAVI patients is very important and fundamental to a quickly and complete clinical restoring after the procedure. An optimal balance of drugs and peri-procedural management could reduce the neurological events (such as delirium), the days of hospitalization and the admission of intensive care unit. According to our experience in transapical approach, the low dose of propofol and desflurane allowed to optimal cardiac anaesthesia and rapid mechanical ventilation weaning in complex patient undergone to transcatheter valve implantation with transapical approach. Moreover, our protocol reduced considerably the incidence of perioperative delirium.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1003.pdf</link>
</item>
<item>
<type>Research Article</type>
<title>Endovascular treatment of complex cerebral arterial saccular aneurysms with different methods of coiling: 14 years of experience review</title>
<author>Dmytro V Scheglov,Stanislav V Konotopchik,Maryna Y Mamonova,Oleg E Sviridyuk</author>
<pubDate>2017-06-21 00:00:00</pubDate>
<description>The Objective: to improve the treatment results for patients with cerebral arterial saccular aneurysms by optimizing of differentiated approach to the using of endovascular assisting occlusion techniques. Materials and Methods: The work is based on the comprehensive survey and treatment of 1345 patients with cerebral saccular arterial aneurysms (AA), who were treated at the SO &ldquo;Scientific-Practical Center of endovascular neuroradiology of NAMS of Ukraine&rdquo; from 2002 to 2016. 214 cases were selected for further clinical-instrumental dynamic observation in follow-up period. All patients were operated by endovascular approach in &ldquo;before hemorrhage&rdquo; period, in acute or &ldquo;cold&rdquo; period of the disease on for symptomatic or asymptomatic intracranial saccular AA in both vascular pools with balloon-remodeling or stent-assisting techniques using with the coiling or just detachable coils (DC) using-mono-coils occlusion technique. Depending on the initial endovascular occlusion method, the patients were divided into three groups for observation: I group (mono-coils occlusion)-82 (38.3%) patients, II group (balloon-remodeling technique using)-68 (31.8%) patients, group III (stent-assisting technique occlusion)-64 (29.9%) patients. The life quality and the level of social adaptation were evaluated before hospital discharge and at the follow-up control examinations by Glasgow Outcome Scale (GOS) and by the modified Rankine scale (mRS). AA radicalism occlusion was assessed by Modified Raymond-Roy Scale (MRRS) (Mascitelli JR, et al., 2015). AA occlusion I and II by MRRS was considered as &ldquo;Effective&rdquo;. Results: 9 criteria of cerebral saccular AA complexity inherent in endovascular surgery have been developed based on the technical and surgical features of endovascular methods of the cerebral AA occlusion and X-ray-anatomical characteristics of aneurysms, which complicated the &ldquo;effective&rdquo; reconstructive occlusion of AA cavity. The evaluation of the AA complexity criteria prognostic significance to achieve the &ldquo;effective&rdquo; primary occlusion, shown different results in different groups: high prognostic significance of 4 criteria was shown in group I, of 2 criteria - in group III, and no any criteria significance in group II. There was no statistically significant difference between groups in the primary AA occlusion efficacy and initial good results by GOS and mRS. It was proved that endovascular occlusion of complex cerebral AA with the assisting methods using has high efficiency in all periods of the disease, unlike the method of mono-coils occlusion, which is most effective in acute and &ldquo;cold&rdquo; periods. There was no statistically significant difference between the number of intraoperative, postoperative and non-surgical complications (p&gt;0.05). It was found that all methods of complex AA endovascular occlusion can effectively prevent the disease recurrence despite the differences between them in the stability of the AA cavity occlusion. Conclusions: Consideration of developed AA complexity criteria during endovascular surgery planning allows to choose the most optimal and safe individual method of primary or phased AA occlusion and helps to reduce the frequency of AA recanalization in follow-up period. The choice of the complex AA occlusion method doesn&rsquo;t effect on result of primary treatment, the number of intraoperative complications and the quality of primary occlusion. However, an analysis of the long-term treatment results indicates that the assisting techniques have proven advantages according to the occlusion stability.</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1002.pdf</link>
</item>
<item>
<type>Case Report</type>
<title>Submitral Ventricular Pseudoaneurysm: Unusual and Late Complication of Cardiac Surgery </title>
<author>Marzia Cottini,Amedeo Pergolini,Giordano Zampi,Vitaliano Buffa,Paolo Giuseppe Pino,Federico Ranocchi,Riccardo Gherli,De Marco Marina,Carlo Contento,Myriam Lo Presti,Francesco Musumeci</author>
<pubDate>2017-01-21 00:00:00</pubDate>
<description>Despite the background of advances in cardiac surgery procedures for higher risk population, the postoperative complication has already been a challenge for cardiac surgeon and Heart-Team. Future perspectives to exceed this challenge could be periodically patient&rsquo;s follow up and advance diagnostic workup. We describe the diagnosis of a large sub mitral left Ventricle Pseudoaneurysm that was identified in a 59-year-old woman 17 years after she underwent aortic and mitral valve replacement for rheumatic valvular disease</description>
<link>https://www.anesthesiaresjournal.com/articles/ijcar-aid1001.pdf</link>
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