Anesthesia 1 Anesthesia
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Hemodynamically Unstable/ Shocked Patient in OR. Challenge For
Journal of Anesthesia & Critical Care: Open Access Opinion Open Access Hemodynamically unstable/ shocked patient in OR challenge for teamwork efficacy when time is critical Volume 7 Issue 4 - 2017 Dimosthenis Petsas,1 Yasir Othman AT,1 Marton Hannus,1 Eljona Cumashi2 Opinion 1Anaesthetics Department, HMG Hospital, UAE 2OB/GYNAE Department, HMG Hospital, UAE In the present article we present a case report with comments/ suggestions about team dynamics. The emergency case report is only Correspondence: Dimosthenis Petsas, Anaesthetics used to highlight the importance of teamwork dynamics and many Department, HMG Hospital Dubai, Dubai Healthcare City, Building 57, UAE, PO BOX 505005, Tel 00306972008383, clinical details are not mentioned. Treating a hemodynamically Email unstable/shocked patient can be a challenging procedure and requires perfect teamwork to have the best possible outcome. Reviewing Received: March 10, 2017 | Published: March 15, 2017 the present case report we should always keep in mind that the organization is a private hospital with all the differences in resources compared to a large public hospital. A 33-year old female patient presented to ER department with signs of circulatory shock (low blood pressure, tachycardia, drowsiness and clumsy sweaty skin). Her vital signs were BP=75/35 mmHg, HR ranging from 120-135 bpm, temperature was 35.9 Celsius, pale skin and drowsiness. Initial resuscitation in ER included administration of Table 2 Intraoperative hemoglobin and coagulation 2 liters IV ringers lactate and oxygen through face mask at 5-6 lt/ min. There was temporary improvement of vital signs. Bloods were sent Investigation Value for complete blood count, coagulation, biochemistry. -
Defeating Surgical Anguish: a Worldwide Tale of Creativity
Journal of Anesthesia and Patient Care Volume 3 | Issue 1 ISSN: 2456-5490 Research Article Open Access Defeating Surgical Anguish: A Worldwide Tale of Creativity, Hostility, and Discovery Iqbal Akhtar Khan*1 and Charles J Winters2 1Independent Scholar, Lahore, Pakistan 2Neurosurgeon, Washington County, 17-Western Maryland Parkway, Suit #100, Hagerstown, MD21740, United States *Corresponding author: Iqbal Akhtar Khan, MBBS, DTM, FACTM, PhD, Independent Scholar, Lahore, Pakistan, E-mail: [email protected] Citation: Iqbal Akhtar Khan, Charles J Winters (2018) Defeating Surgical Anguish: A Worldwide Tale of Creativity, Hostility, and Discovery. J Anesth Pati Care 3(1): 101 Received Date: March 01, 2018 Accepted Date: December 11, 2018 Published Date: December 13, 2018 In Memoria There are countless persons who have suffered through the ages around the world but not mentioned in any text or inscription. The following examples are sad but true tales of the journey through experimentation and torture. Ms. Eufame MacAlyane of Castle Hill Edinburg who, in 1591, was burned alive by order of the ruler of Scotland, King James I, who was an early opponent of “pain free labor”. Her “unforgivable offense” was to seek pain relief during labor [1]. Mrs. Kae Seishu volunteered as the brave first human subject to test “Tsusensan”, an oral anesthetic mixture formulated by her husband Dr. Seishu Hanaoka. The product met great success but she became permanently blind, presumably from repeated experimentation [2]. Their husbands’ agony and anguish is unimaginable! As such, it was a personalized, immeasurable, and unsharable experience. Apropos is a quote from an Urdu poet! Unknown remained their beloveds’ graves, Their nameless, traceless sanctuary. -
Annual Medical Student Abstract Journal
Medicine of the Highest Order 2015 Annual Medical Student Abstract Journal Sponsored by: Center for Advocacy, Community Health, Education and Diversity Offices for Medical Education Medical Student Research Faculty Advisory Committee Community Outreach Faculty Advisory Committee International Medicine Faculty Advisory Committee Medical Humanities Faculty Advisory Committee Basic Science, Clinical & Translational Research Aaserude, Eric & Hong, Steven Preceptor: Beau Abar, Ph.D. University of Rochester School of Medicine and Dentistry Department of Emergency Medicine Access to care and depression among emergency department patients Introduction: Major depressive disorder is a serious, common public health concern that is characterized by a series of symptoms including depressed mood and diminished interest or pleasure in most activities of the day (DSM-V). The prevalence of depression during a lifetime is 16.2% and the 12-month prevalence is 6.6%. 1 In particular, several studies have shown that among patients in the Emergency Department (ED), the prevalence of depression is even higher than in the general population.2-3 One study showed that the prevalence of a positive depression screen is approximately 33%, and using a 33% positive predictive value, an estimated 10.5% would met the diagnostic criteria for major depressive disorder.2 Because of the high concentration of patients with depression, the ED may serve as an important forum for the identification of depression and the intervention in the disease process.4 Concomitant to identification of potential concerns regarding depression is the issue of patient access to appropriate care. Many patients lack the ability to affordably receive efficacious treatment due to insurance-related barriers.5 Furthermore, other individuals may be unaware of their level of access for primary and behavioral health services, and this lack of awareness will lead to patients in need not receiving the care appropriate to their concerns. -
Dr John Collins Warren, 17 October 1846 1844
"Gentlemen, this is no humbug" Dr John Collins Warren, 17 October 1846 1844: Horace Wells 1846: William T. Morton Characteristic differences between anesthesia and sleep Anesthesia Sleep Drug-induced Endogenously generated No homeostatic control Homeostatic and circadian regulation Failure to initiate is non-existent Failure to initiate is a recognized pathology Onset Not altered by environmental factors Significantly modulated by environmental factors Duration function of homeostatic and Duration dependent on dose circadian factors Depth at a given anesthetic dose is Depth fluctuates rhythmically and constant spontaneously Failure to maintain is non-existent Failure to maintain is a recognized Altered minimally by environmental pathology Maintenance factors Significantly altered by environmental factors Return to normal wakefulness within Returns to normal wakefulness in hours minutes to days Timing of wakefulness governed by Duration of anesthesia and elimination of environment, sleep duration, and circadian Offset agent governs timing of wakefulness rhythm Goals of general anesthesia Amnesia partial or complete loss of memory Sedation decreased level of arousal Hypnosis impairment of neural functions that are required to respond to verbal commands different anatomical targets anatomical different Immobility different mechanisms / of actions different lack of movements in response to noxious stimuli myorelaxation, analgesia, anxiolysis Can one drug apply for all these features? Do all general anesthetics can induce these features? Anesthesia -
A Comparison Between the I-Gel® and Air-Q® Supraglottic Airway Devices
Hindawi BioMed Research International Volume 2018, Article ID 5202957, 7 pages https://doi.org/10.1155/2018/5202957 Research Article A Comparison between the i-gelD and air-QD Supraglottic Airway Devices Used for the Patients Undergoing General Anesthesia with Muscle Relaxation Nilofar Massoudi ,1 Mohammad Fathi,1 Navid Nooraei ,2 and Alireza Salehi1 Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Anesthesiology Research Center, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence should be addressed to Navid Nooraei; [email protected] Received 14 February 2018; Revised 30 April 2018; Accepted 17 May 2018; Published 18 November 2018 Academic Editor: Yukio Hayashi Copyright © 2018 Nilofar Massoudi et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Te aim of the present study was to compare two supraglottic airway (SGA) devices (i.e., the i-gel5 ©IntersurgicalLtd and air-Q5 (Reusable) Cookgas company) in terms of the insertion time, amount of leak during ventilation with maximum positive pressure, and postoperative complications in patients referring to Modarres Hospital in Tehran. Method. Te present double-blind clinical trial was performed on 60 patients undergoing elective surgeries that required general anesthesia with muscle relaxation. Patients were randomly assigned to either i-gel5 (n =30)orAir-Q5 (n =30)groups.Results. Te mean age, body mass index, duration of surgery, duration of anesthesia, and gender ratio were not signifcantly diferent between the two groups. -
Health Hazard Evaluation Report 77-85-445
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE CENTER FOR DISEASE CONTROL NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH CINCINNATI, OHIO 45226 HEALTH HAZARD EVALUATION DETERMINATION REPORT NO. 77-85-445 MESA VETERINARY HOSPITAL GOLDEN, COLORADO NOVEMBER 1977 I. TOXICITY DETERMINATI ON A Health Hazard Evaluation was conducted by the National Institute for Occupational Safety and Health (NIOSH) in the Mesa Veterinary Hospital, Golden, Colorado. On August 22 &24, 1977, environmental samples were col lected to determine concentrations of waste anesthetic gases. Findings on the days of this evaluation indicate that the mean 8-hou r time weighted average exposure to nitrous oxide was 34 ppm for the veterinarian and 45 ppm for the anesthesia technicians. Average exposure to halogenated anesthetic was 0.8 and 2.2 ppm for the same two groups. These concentrations were slightly above the NIOSH Recommended Limit of 25 ppm nitrous oxide and 0.5 ppm ha logenated anesthetic. Since information on adverse health effects due to exposure to waste anesthetic gases is not completely definitive and many unknown factors still exist, recommended permissible levels of exposure are not defined as safe levels but rather as levels which are attainable with current technology. These levels should prevent the effects caused by acute exposure and significantly reduce the risk associated with long term, low level exposure . Recommendations to further reduce concentrations are included in this report. II. DISTRIBUTION AND AVAILABILI TY OF DETERMINATION REPORT Copies of this Determination Report are currently available upon request from NIOSH, Division of Technical Services, Information and Dissemination Section, 4676 Columbia Parkway, Cincinnati, Ohio 45226. -
ETHER in VOGUE: Nathan Cooley Keep and William Morton by Walter C
M ASSACHUSETTS GENERAL HOSPITAL BICENTENNIAL 1811-2011 “KEEP-ing” ETHER in VOGUE: Nathan Cooley Keep and William Morton By Walter C. Guralnick, DMD, and Leonard B. Kaban, DMD, MD This paper was presented originally at the 150th celebration of the first demonstration of ether anesthesia, Massachusetts General Hospital . For anyone connected with dentistry, celebrating the demonstration in 1846 by Boston dentist William Morton, is a memorable event. It is especially meaningful for those of us gathered here this evening in the historical Ether Dome. Particularly interesting in the Ether story is the role of Nathan Cooley Keep, an anesthesiologist and the first Dean of the Harvard Dental School. Furthermore, it will be enlightening to trace the estimable record of dentists and oral and maxillofacial surgeons in the administration of ambulatory anesthesia, a continuum of Morton’s watershed demonstration. Nathan Cooley Keep, who received an M.D. degree from the Harvard Medical School in 1827, was the leading dental practitioner of his era in Boston. He was born in Longmeadow, Massachusetts, a suburb of Springfield, in 1800. As a child, he was noted to have extraordinary mechanical skill. This ability was explained by The Historical and Genealogical Register (April 1878), in its memorial minute upon Dr. Keep’s death, as being inherited from his father who had “great ingenuity and mechanical skill.” Keep’s admirable humane qualities and his biological curiosity were also noted and ascribed to his mother, in the same document which stated: “… his own knowledge of disease; his fertility in suggesting relief in the sick room and his willingness and ability to lend personal help in relieving suffering in all forms, were a kind of natural inheritance from his mother.” Because of his skill with tools, young Keep was apprenticed at the age of 15 to a New Jersey jeweler. -
Susan Burns, BS, RVT, VTS (Anesthesia)
Susan Burns, BS, RVT, VTS (Anesthesia) Graduated from University of California at Davis in 1984 with a Bachelor of Science in Wildlife Biology. Received Registered Veterinary Technician License in 1991. Consultant for Pfizer Animal Health (Zoetis) November 2005 to present. Applied for AVTA acceptance in 2009 and passed examination in October 2009. Currently she is chairman of the AVTA exam committee. Susan has spoken locally, statewide and nationally in the US on various anesthetic topics. She has her own anesthetic consulting business and has been employed at East Bay Veterinary Specialist in Walnut Creek, California for the last 25 years. Susan L. Burns BS, RVT, VTS (Anesthesia) 9925 San Luis Ave. San Ramon, CA. 94583 (925)413-6289 [email protected] EDUCATION Veterinary Technician Specialty – Anesthesia 2009 California Registered Veterinary Technician 1991 BS in Wildlife Biology, University of California Davis 1984 Professional Experience Speaking Engagements 2007-present VCA-San Francisco Veterinary Specialists San Francisco, California, “Patient Monitoring with Multi Parameter Monitors Oct/Nov. 2013 San Francisco SPCA San Francisco, California, “Ventilation & ETCO2” March 2013 Central Veterinary Conference Kansas City, Kansas, “Geriatric Anesthesia: Welcome to Senior Living”, “Pediatric Anesthesia: What You Didn’t Learn in Kindergarten” & “Ventilation vs. ETCO2” August 2011 San Francisco SPCA San Francisco, California, “Anesthetic SOS” July 2011 San Francisco SPCA San Francisco, California, “Successful Everyday Anesthesia” -
Postoperative Sore Throat: More Answers Than Questions
EDITORIAL Postoperative Sore Throat: More Answers Than Questions Phillip E. Scuderi, MD ostoperative sore throat (POST) is a common adverse oral airway). The site or sites of mucosal injury would event after general anesthesia. Typically, the incidence obviously vary depending on the airway device. For in- Pof POST is highest in patients who are tracheally stance, endotracheal intubation can result in injury to any intubated; however, POST also occurs when a laryngeal mask portion of the pharynx as well as injury to the larynx and airway (LMA) is used.1 Even patients who are managed with trachea. Placement of an LMA can reasonably be expected a facemask are not immune.1 Most of the measures that have to cause injury to pharyngeal mucosa in the supraglottic been recommended for reducing this complication have been regions only, whereas the use of a facemask with an oral directed at limiting the physical trauma that might result from airway should result in injury to only the oropharynx, airway instrumentation and manipulation. Surprisingly few assuming that no other injuries occurred because of suc- investigations have evaluated pharmacologic interventions tioning or other airway maneuvers. It is therefore some- as a means of reducing POST. Furthermore, no single drug what surprising to note that the reported incidence of POST has achieved widespread acceptance in the clinical commu- after LMA insertion is, at least in some studies, remarkably nity. In this issue of Anesthesia & Analgesia, 4 articles similar to that seen with endotracheal intubation.6,7 Al- describe simple prophylactic measures that seem to signifi- though this might lead one to infer that the mechanism and 2–5 cantly reduce the incidence of POST. -
A Consideration of the Introduction. of Surgical Anaiesthesia This Accession Is Part of the RARE BOOK COLLECTION' of the WOOD LIBRARY-MUSEUM of ANESTHESIOLOGY, Inc
4AJ Aed i A Consideration of the Introduction. of Surgical Anaiesthesia This Accession is part of the RARE BOOK COLLECTION' of The WOOD LIBRARY-MUSEUM OF ANESTHESIOLOGY, Inc. Olt, 19 13 1 93~n 195 Accession No./1 Acknowledgment is made to don nor Accession No.___L~f A Consideration of the Introduction of Surgical Anaesthesia BY WILLIAM H. WELCH, M.D., LL.D. Professor of Pathology Johns Hopkins University Baltimore, Maryland II I I , JIL I The Barta Press, Boston A CONSIDERATION OF THE INTRODUC- TION OF SURGICAL ANIESTHESIA. * BY WILLIAM H. WELCH, M.D. , LL.D. Professorof Pahology,Johns Hopkins University, Baltimore, Md. IT is a happy conception of the trustees and staff of the Massachusetts General Hospital to set apart the sixteenth of October as "Ether Day," and to provide for the annual public celebration, in this historic place, of the anniversary of that most beneficent gift of medicine to mankind, - the introduction of surgical anaesthesia. I esteem it a high honor to be invited to deliver the annual address in commemoration of the great event which took place within these walls sixty- two years ago to-day. Of the significance of this event there can be no question, whatever controversy there may be concerning the exact share of all who participated in the discovery of surgical anaesthesia. The attendant circumstances were such as to make the operation performed on Oct. 16, 1846, in the surgical amphitheater of this hospital, by John Collins Warren, upon the patient, Gilbert Abbott, placed in the sleep of ether anaesthesia by William Morton, the decisive event from which date the first convincing, public demonstration of surgical anaesthesia, the con- tinuous, orderly, historical development of the subject, and the promulgation to the world of the glad tidings of this conquest of pain. -
Oral Magnesium Lozenge Reduces Postoperative Sore Throat a Randomized, Prospective, Placebo-Controlled Study
Oral Magnesium Lozenge Reduces Postoperative Sore Throat A Randomized, Prospective, Placebo-controlled Study Hale Borazan, M.D.,* Ahmet Kececioglu, M.D.,† Selmin Okesli, M.D.,‡ Seref Otelcioglu, M.D.‡ ABSTRACT Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/117/3/512/257313/0000542-201209000-00019.pdf by guest on 30 September 2021 What We Already Know about This Topic • Sore throat is a prevalent adverse outcome from endotracheal Background: Postoperative sore throat (POST) is an unde- intubation sirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The pres- What This Article Tells Us That Is New ent study aimed to investigate the effect of preoperative ad- ministration of oral magnesium lozenge on POST. • Compared with placebo, the administration of magnesium lozenge 30 min preoperatively is effective to reduce both inci- Methods: Seventy patients undergoing orthopedic surgery dence and severity of postoperative sore throat were randomly allocated into two groups, to either receive placebo (control) or magnesium lozenges (magnesium) to be dissolved by sucking 30 min preoperatively. Patients were OSTOPERATIVE sore throat (POST) is a common assessed for incidence and severity (four-point scale, 0–3) of P complaint in patients receiving general anesthesia fol- POST at 0, 2, 4, and 24 h postoperatively. The primary lowing orotracheal intubation, with reported incidences of 21–65%.1,2 Irritation and inflammation of the airway were outcome was sore throat at 4 h after surgery. The secondary 3 outcome was the severity of POST at four evaluation time- considered the causes of POST. -
Journal of the SURGICAL HUMANITIES
Journal of the SURGICAL HUMANITIES DEPARTMENT OF SURGERY | UNIVERSITY OF SASKATCHEWAN Spring 2014 Journal of the SURGICAL HUMANITIES CONTENTS EDITOR-IN-CHIEF Francis Christian EDITORAL BOARD Francis Christian Ivar Mendez Taras Mycyk Justine Pearl Marlessa Wesolowski David Swann GRAPHIC DESIGN, COMMUNICATIONS AND MARKETING Department of Surgery University of Saskatchewan COVER PAGE Primal (96” x 60” - acrylic on canvas) Marlessa Wesolowski CONTACT US Journal of the Surgical Humanities c/o Surgical Humanities Program Department of Surgery University of Saskatchewan Health Sciences Building 107 Wiggins Road, 4th floor, Suite B419 Saskatoon SK S7N 5E5 TEL: 306.966-7323 [email protected] http://goo.gl/zdhXgN 2 | JOURNAL OF THE SURGICAL HUMANITIES 04 MESSAGE FROM THE CHAIR CONTENTS Ivar Mendez 05 EDITORIAL Francis Christian 06 ETHER DAY Murray Dease 16 MY CONVERSATION Marlessa Wesolowski 20 OLGA THE GOLDEN OWL Thompson Bird 22 FAMILY MEETING Justine Pearl 24 OSLERIUM Introduction by Francis Christian 26 A WAY OF LIFE (PART 1) Sir William Osler 28 POETRY CORNER FEATURING... Erick McNair 30 ZHIVAGO: DOCTOR IN LITERATURE Francis Christian 32 HOW TO BE A DOCTOR Stephen Butler Leacock 33 SUBMISSION GUIDELINES JOURNAL OF THE SURGICAL HUMANITIES | 3 he Surgical Humanities Program was conceived as a platform to sustain and encourage our Tfaculty, residents and students to intergrate the humanities to their daily surgical practice. We firmly believe that the humanities as expressed by activities MESSAGE such as the visual arts, music, literature, poetry and philosophy are not only complimentary to surgery but have a synergistic effect in enhancing our clinical work encouraging creativity and innovation and from the promoting education.