Webinar on Anesthesia and Surgery September 27-27, 2021 London, UK

Biography:

Abstract:

Difficult airway remains the greatest challenge faced during administration of anaesthesia on a day to day basis. Maintaining a patent airway is essential for adequate oxygenation and ventilation and failure to do so can be life threatening. We, as anaesthesiologists, are sometimes caught in a dilemma of choice of anaesthesia in diificult airway patients and feel comfortable by giving regional anaesthesia.

 We report a case of 65 year old male, who had develpoed PTRA 18 years back posted for SSG. Pre-anaesthetic examination showed no history of neck and back stiffness, backache., but on examination patient had MPT Grade-3,restricted neck extension, fluorosis of oral cavity and narrow IVS. Spinal anaesthesia in L3-L4 IVS using 23G spinal needle in sitting position, median approach was attempted multiple times, LP was attempted in other lumbar IVS using median approach which was unsuccessful. Paramedian approach was attempted in lumbar IVS multiple times, but could finally get in L3-L4 IVS. Inj. Bupivacaine Heavy 2.5%CC given. Patient was put in supine position and level of block assessed.

Though the plan of anaesthesia was regional technique. Difficult intubation cart, fibre-optic technique for difficult intubation was arranged priorly in case of failure of regional anaesthesia/local anaesthetic toxicity/high or total spinal anaesthesia.

 

Biography:

 

Vakhtang Shoshiashvili is specialized in Anesthesiology and has a quite a few experience of regional anesthesia and pain management. He also contributed in treatment of cancer pain conditions. Since, 2013 he is an expert in anesthesia and intensive care at TSMU and Ministry of Health Care and Social Affairs Republic of Georgia. Currently, he is also an Associate Professor at European University and since 2016 is working as an Anesthesiologist at Research Institute of Clinical Medicine Tbilisi, Georgia.

 

 

Abstract:

Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design and the technique used also affect the risk. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing and improves with lying down. Conservative therapies such as bed rest, hydration and caffeine are commonly used as prophylaxis and treatment for this condition. We are presenting a case report of PDPH after pilonidal cystectomy. The patient was a 23 years old male, non-smoker has spinal puncture with B. Braun Spinocan 25 G Quincke type needle on the L3-4 level. Five minutes later after injecting of 3.5 ml Marcaine (“Astra Zeneca”) there was an acceptable depth of spinal anesthesia where surgery and anesthesia was done without complication. On second day patient was ambulated at home, no headaches. On third day after surgery patient felt severe postural headache. Hydration and caffeine was not helpful. We decided to relieve this pain condition by the sphenopalatine ganglion block with 2% lidocaine application through the transnasal cotton ended catheter. Pain was relieved immediately. Duration of the application was five minutes. Procedure was repeated for 1 h with interval of three times. PDPH was relieved completely. We are concluding that sphenopalatine ganglion block with transnasal 2% lidocaine application is a simple, effective and safe tool for PDPH treatment which is usable for ambulated patients.

 

Biography:

Dr. Dessain is currently working at Southmead Hospital as Clinical Research Fellow. She completed her core anesthetic training and this project in London prior to starting her current post in Bristol. 

 

Abstract:

Background

Single dose of intravenous dexamethasone has been shown to improve postoperative analgesia in obstetric patients [1, 2]  Our aim was to establish if a single dose of dexamethasone would improve pain scores and reduce opioid consumption as part of multimodal analgesic regime.

Methods 

Over a 6 month period data was collected for 34 patients undergoing elective C-section. A control group received standardised CSE and intraoperative analgesics The intervention group received an additional single dose of intravenous 6.6mg dexamethasone (n=20). Postoperatively patients received standardised analgesia and were reviewed the following day.  Primary outcomes were postoperative opioid consumption and subjective pain score using VAS.

Results

Patients receiving dexamethasone showed significantly lower pain scores on the first postoperative day ((median (IQR) − 2.5 (1 - 4)) compared to the control group (median (IQR) - 6 (5 - 7)), p=0.001 with no side-effects. There was no benefit of dexamethasone on the average hourly opioid consumption ((median (IQR) − 1.125mg/hr (0 - 1.8mg/hr)) compared to the control group ((median (IQR) - 0.65mg/hr (0 - 1.25mg/hr)), p=0.516.

Conclusions

IV Dexamethasone is a safe non-opiate adjunct which reduced postoperative pain scores and should considered  during C-sections.

 

Biography:

Abstract:

Introduction: Neurofibromatosis (NF1) is a autosomal dominant disease and can involve numerous organs and organ-systems of our body. Neurofibromas (cutaneous)are the characteristic lesion of NF1 and  spinal neurofibromas are also commonly seen in patients with NF1. Frequency of  spinal neurofibroma is thoracic, followed by cervical, lumbar and rarely sacral region. Of these spinal neurofibromas, majority are intra-dural extra-medullary, and few are intra-meduallary(1%) in location.

The intra-oral manifestation of disease can give rise to airway obstruction, ventilation and positional problems for securing airway with Direct layrngoscopy. The common cardiac manifestation is hypertension in young patient and may be associated with other neoplasms as such pheochromocytoma, carcinoid tumor, GIST. Abnormalities of interest for anaesthetist are short stature, bony abnormalities(scoliosis, kyphosis), cognition disorders, attention and hyper activity disorder. The anaesthetic management of these patients requires assessment of all possible abnormalities and associated disturbances to prevent any peri-operative complication. we report the anaesthetic management of a 35 years female patient with neurofibromatosis type1, scheduled for resection of a tumor (intra-dural extra-medullary neurofibroma ) located in spine, a prominent  neurofibroma  at lumbar (L5- S1)..

 

 

  Case report: A 35years-old female, weighing 48 kgs, a known case of Neurofibromatosis type-1. She presented with lower back ache and pain in both lower limbs with radiation of pain more on right side than left. She also complained of difficulty in walking and numbness in lower limbs. These symptoms were progressively increasing. She did not have any surgery in the past. On examination, she was poorly built with multiple, cutaneous nodular neurofibromas present all over her body since childhood. On Systemic examination no abnormality was revealed. She was diagnosed as a case of intra-dural extra-medullary neurofibroma at lumbar region (L5- S1 ) and posted for excision in prone position.

Detailed anaesthetic management will be discussed later.