International Conference on Anesthesia and Intensive Care Treatment September 12-13, 2016 San Antonio, USA

Biography:

Dr Sudha P is an Associate Professor in Anaesthesiology at Regional Cancer Centre, Trivandrum, Kerala, India

She has Post graduate Degree (M.D) and Diploma in Anaesthesiology (DA),Post Graduate diploma in Health and Hospital Administration (PGDHHA) and degree of Master of Hospital Administration(MHA),  from the University of Kerala, India

Her Areas of professional Interest are Pain management, Regional Anaesthesia, Nerve Blocks, and Hospital Management. She was awarded UICC: ICRETT fellowship thrice for doing projects in MD Anderson Cancer Centre, Houston, Texas, Memorial Sloan Kettering Cancer Centre, Newyork and TJ Samson Community Hospital, Glasgow, Kentucky.

She  has publications in reputed Indian and International journals

Abstract:

Background: Numerous factors affect the risk of recurrence and metastasis after cancer surgery. Studies have observed that anaesthetic techniques have effects on tumour recurrence. 
Methods: Medical records of newly diagnosed ovarian serous adenocarcinoma patients who underwent radical hysterectomy with bilateral salpingoopherectomy from 1995-2008 were analysed for the effect of anaesthetic techniques and drugs on tumour recurrence & metastasis free survival rate and mortality rate. Univariate association between overall survival and anaesthesia technique was assessed using Kaplan-Meier survival estimates and Cox regression. Multivariate association was tested after adjusting potential confounding factors.
Results: The overall survival rate (RR at 95% CI=3.16(1.79-5.60) was significantly better in patients who received regional anaesthesia for surgery than those who had general anaesthesia. Other factors significantly associated with overall survival rate in univariable analysis were,perioperative blood transfusion,preoperative Ca 125 level, FIGO stage, tumour size and lymphatic metastasis.Kaplan Meier survival curve showed that regional anesthesia group had higher overall survival rate.Recurrence rate did not show significant difference in univariable(Odds 95% CI 1.42 P = 0.273)and multivariable(Odds 95% CI = 0 P = 0.846) analysis.Al1the 18 patients who had metastasis underwent surgery under GA.
Conclusions: This study showed marked increase in overall survival rate in patients who underwent surgery under regional anaesthesia when compared to those who had surgery under general anaesthesia. Prospective randomized control trials are needed for better evaluation.

Biography:

Dr. Parul Maheshwari is currently working as an Assistant Professor in the Department of Anesthesiology, University of Oklahoma Health Sciences Center, USA, a multispecialty, tertiary care hospital and is the only Level 1 trauma center in the state of Oklahoma. Dr. Maheshwari completed her Anesthesiology residency and Cardiothoracic and Vascular Anesthesiology fellowship at University of Texas Health Science Center, Houston. She is a Diplomate of American Board of Anesthesiology and National Board of Echocardiography. She has been extensively involved with teaching and mentorship of students, residents, and fellows. She has been a member of departmental and hospital committees. She is an editorial board member for Journal of International Archives of Clinical Anesthesia Research and has numerous peer reviewed publications.

Abstract:

Pain is one of the main predictable postoperative adverse outcome and is reason for distress in patients. Adequate pain control is important for perioperative period. Any single analgesic may not be capable of providing best pain control with minimum or no side effect. Multimodal analgesia is combining different entities to decrease pain as well as the side effects of medications and improve patient satisfaction. Combination of drugs allow modulation of pain at various points in the neurochemical pathway, resulting in synergistic and/or additive analgesia which is corner stone of multimodal analgesia. Multimodal analgesia not only decreases pain and discomfort, but also decreases over all cost by decreasing length of stay.

My talk will focus on concepts of multimodal analgesia, its advantages, different modalities used and its impact on patient care.

Biography:

Elizabeth McIntyre completed her MD at the University of Toledo in 2013.  She is currently in anesthesia residency at Beaumont Health System in Royal Oak, MI.  After residency, she will attend critical care fellowship at Northwestern University in Chicago, IL.

Abstract:

Critical aortic stenosis (AS) is a rare and life­threatening complication in pregnancy. Tachycardia in pregnancy increases cardiac output while decreasing ventricular filling time, which is deleterious in AS. Physicians often recommend termination of pregnancy for the sake of maternal health. In this case, critical AS diagnosed at 17 weeks gestational age (GA) was treated with emergent replacement of the aortic valve at 21 weeks GA with survival of mother and fetus.

A 35 year old multiparous female at 17 weeks GA with past medical history of gestational hypertension and hyperlipidemia presented emergently with dyspnea on exertion and newly diagnosed left bundle branch block. The patient was found to have critical AS and moderate aortic regurgitation by transthoracic echo. She was admitted to the cardiac intensive care unit for medical management until the fetus reached viability. At 21 weeks GA, the patient acutely decompensated, experiencing a 4 minute asystolic episode and receiving cardiopulmonary resuscitation. Multidisciplinary discussions led by the intensivist resulted in emergent coronary artery bypass grafting as well as an aortic valve replacement and aortic root endarterectomy with survival of mother and fetus.  

Multidisciplinary discussions organized and executed by the critical care intensivist are imperative for appropriate and timely treatment of AS in the parturient patient. In mild AS, parturients may betreated with medical therapy and expectant management until delivery, after which the valve can be surgically repaired. In more severe cases, symptomatic AS in pregnancy may be treated with balloon valvuloplasty. In this case, conservative management was first attempted. The parturient also did not qualify for balloon valvuloplasty or TAVR due to concurrent moderate to severe  AR.  However, acute decompensation in the patient’s cardiac status required emergent surgical intervention at 21 weeks GA. Intensivists managing parturients with severe symptomatic AS should consider surgical replacement and initiate multidisciplinary coordination between obstetricians and cardiothoracic surgeons.

Biography:

Ochukpue Ceejay he works in the  department of Anaesthesiology, in University of Benin Teaching Hospital, Benin City, Nigeria 

Abstract:

Background/Purpose: The need for ventilatory support is one of the commonest indications for admission into the intensive care unit (ICU). Despite the usefulness of mechanical ventilation, its damaging effect on the lungs has also been widely recognized in the literature.

Methods: The study was a prospective, case-control survey of all mechanically ventilated patients admitted in our ICU from November 2013 to April 2014. For every ventilated patient, a non-ventilated similar patient served as a control.

Results: A total of 128 patients were admitted into the ICU over the six month period and 44 patients constituting 34.4% were mechanically ventilated. The average duration of mechanical ventilation was 12.30±10.10 days. Duration of mechanical ventilation, use arterial of arterial blood gas measurement and ionotropic support had significant effect on weaning from ventilation with p values of 0.005, 0.05 and <0.001 respectively. Mechanically ventilated patients had >4 times chance of death than non-ventilated patients.

Conclusions: Mechanical ventilation, though, a useful therapeutic intervention in the ICU is associated with increased mortality. Duration of ventilation, use of arterial blood gas (ABG) and need for ionotropic support influenced successful weaning off ventilator. It may be expedient therefore to weigh risk: benefit assessment of mechanical ventilation before commencement in the ICU.  

Biography:

Dr. Praveen Maheshwari is currently working as an Assistant Professor in the Department of Anesthesiology, University of Oklahoma Health Sciences Center, USA, a multispecialty, tertiary care hospital and is the only Level 1 trauma center in the state of Oklahoma. Dr. Maheshwari completed his Anesthesiology residency and Cardiothoracic and Vascular Anesthesiology fellowship at the University of Texas Health Science Center, Houston. He is a Diplomate of American Board of Anesthesiology and National Board of Echocardiography. He has been actively involved with teaching and mentorship of students, residents, and fellows. He has been a member of numerous departmental and hospital committees. He is a question writer for American Society of Anesthesiology and a junior editor for American Board of Anesthesiology. He has been invited to present lectures at regional meetings and have done presentations at national and international meetings. He has numerous peer reviewed publications. He is an editorial board member and is a peer reviewer for several Anesthesiology journals.

Abstract:

Prevalence of obesity is increasing all over the world. Obese patients are not just large but they also have multiple physiological and anatomical changes associated with obesity. These patients have multiple co morbidities associated with obesity which are independent predictors of poor outcome in the perioperative period. Obesity has its effect on bolus dosing and infusions of medications. Obesity makes these patients at higher risk for anesthesia. So it is very important for anesthesiologists to know about all these changes and how to manage these patient safely and efficiently in the perioperative period.

The aim of my talk is to understand the magnitude of the problem, anatomical and physiological changes of obesity, comorbidities associated with obesity, their effect on anesthesia and their management in the perioperative period.

Biography:

Ochukpue Ceejay he works in the  department of Anaesthesiology, in University of Benin Teaching Hospital, Benin City, Nigeria 

Abstract:

BACKGROUND/OBJECTIVES:

Age itself is not a disease process but may be associated with age related diseases. However, with increasing age, the incidence and mortality is higher.¹

MATERIALS AND METHODS: Data was collected over a 13-year period (1997 -2010) for patients aged 60 years and above, undergoing both elective and emergency cases after approval from the Institution’s Ethics Committee. The study determined the patient’s demographics and characteristics, indication for surgery, grade of anaesthesia provider and analysed data using SPSS version 20.

RESULTS: There was a total of 1530 elderly patients within the 13-year study period. The mean age was 69.7 ± 7. 7 years with a modal age of 60 years. 64.9% of the study population were males.  Most of the surgical cases were for cataract excision (28.3%) and malignancies (13.6%) under local anaesthesia (49.6%) and general anaesthesia (38.9%) respectively. Regional anaesthetic techniques were more commonly employed than general anaesthesia (p = 0.037, RR = 3.1, 95% CI 1.2 – 8). Consultant anaesthetists (15.8%), senior registrars (74.7%) and registrars (9.5%) provided anaesthesia for the geriatric population. Adverse outcomes recorded were hypotension (4.1%), haemmorhage (2.2%) and cardiac arrest (0.3%).

CONCLUSION: A high proportion of the anaesthetic care is for the elderly. There was a three-fold chance of regional anaesthesia than general anaesthesia for surgical procedures in the elderly. Although regional anaesthesia accounts for a high proportion of anaesthetic options, consultant anaesthetists should be more involved in the care of the elderly.

Biography:

Kishor Khanal he works for department of anesthesiology  in Tribhuwan University Teaching Hospital Kathmandu, India Nepal.

Abstract:

•      A 51 year old male from Western Nepal presented to Bharatpur College of Medical sciences with headache, vomiting and abnormal behavior in the form of irrelevant talking for 3 days. There were no episodes of seizures.  CSF examination showed total cell count of 800 with 58% eosinophils,sugar of 20.5 gm/dl and protein of 171 mg/dl. Investigations done for dengue,leptospirosis and malaria were all negative and CT scan was normal. A provisional diagnosis of  Tubercular meningitis was made and anti-tubercular therapy was started empirically. As the patient failed to improve,he was referred to Tribhuwan University Teaching Hospital. After 2 days he was intubated and shifted to ICU for sudden fall in GCS (E1M1V1). His cranial nerves were intact and the meningeal signs were absent. CSF routine examination revealed a cell count of 280 with 10% Eosinophils and no red cells. The  opening pressure was 12 cm of water. CSF wet mount preparation revealed trophozoites of Naegleria fowleri and CSF culture grew Naegleria fowleri.The CT scan findings were normal. The patient’s GCS still failed to improve and tracheostomy was done after 14 days of intubation. The wet mount preparation of CSF examined after the completion of intrathecal Amphotericin still showed motile trophozoites of Naegleria. Gradually his pupils became sluggishly reactive and ultimately pupillary reflexes along with other brainstem reflexes were absent on 19^th day of admission to ICU. One day later he went into asystole and CPR was done but he could not be revived. He was then decleared dead on 20th day of admission to ICU. 

•      Naegleria fowleri PAM is both a diagnostic and therapeutic challenge in ICU. It presents in a manner very similar to acute bacterial meningitis but, because it is much less common than pyogenic meningitis, the diagnosis may be missed initially. In the index case we presented,we diagnosed the case with the microscopy of wet mount preparation and confirmed with culture on nutrient agar.The limitation of our diagnosis was that molecular diagnostic tests could not be performed due to unavailability. We administered a combination of drugs used during the successful treatment of few survived cases at doses mentioned in the case reports. The result of our case management is different than other studies in that the duration of survival of the patient was longer than that  mentioned in most case reports with  mortality.

Biography:

Benzy V.K Worked as Lecturer in MES College of Engineering in Department of Applied electronics and Instrumentation from 01/01/04 to 31/8/2006. She Worked as an Assistant Professor at Prime College of Engineering, Palakkad Department of Electronics and Communication from 24/06/2011 to 17/10/2012.

She has done PhD in Engineering from Govt. Engineering College, at Calicut University during 2012-2015. She completed her M. Tech in Technology Management in at University of Kerala during 2002-2004 and B. Tech in Applied Electronics and Instrumentation Engineering at M.E.S College of Engineering, Kerala during 1996 – 2000

Abstract:

Modern depth of anaesthesia monitors use frontal EEG signal to derive DoA measures. The anesthetic drugs acts mainly on the Central Nervous System (CNS) hence, EEG signal processing during anesthesia is useful to monitor the patient’s depth of anesthesia. This study aims to measure Depth of Anesthesia (DoA) using approximate entropy of EEG signals and classify them according to the DoA . Approximate Entropy of the EEG signal is extracted as a measure of DoA from the EEG signals collected during the four phases of general anesthesia called awake, induction, maintenance and recovery. Approximate entropy is a time domain algorithm that measures the regularity and randomness of the EEG signals during different phases of anesthesia, where EEG signal is considered as a time series data. A low value of approximate entropy indicates anesthetized state where as high value indicates that the patient is awake. Approximate Entropy values is high in awake because of the increased randomness in the EEG signal. EEG shows regularity when depth of anesthesia increases. Induction phase EEG signals are more regular compared to all other EEG signals. Therefore the approximate entropy in the Induction phase shows low values. Finally these approximate entropy features are compared with with commercially available BIS and got 81 percent correlation.

Artificial neural network (ANN) is used in this study to classify EEG signal according to different anaesthetic stages. A feed forward back propagation ANN is used to implement the classification. The activation function employed for all the neuron units in the network is tansig. Approximate Entropy extracted during the four phases are applied as input to the artificial neural network. The whole data set is divided in to two groups training data set and testing data set. Training data sets trains the network where as the testing data set would check the effectiveness of the classifier. In this study, there were four output classes: awake state, light anaesthesia state , moderate anaesthesia state and deep anaesthesia state. The classification accuracy is 91.6 percent. Present study helps to assist Anaesthesiologist in anaesthesia   decision making and management.

Biography:

Benzy V.K Worked as Lecturer in MES College of Engineering in Department of Applied electronics and Instrumentation from 01/01/04 to 31/8/2006. She Worked as an Assistant Professor at Prime College of Engineering, Palakkad Department of Electronics and Communication from 24/06/2011 to 17/10/2012.

She has done PhD in Engineering from Govt. Engineering College, at Calicut University during 2012-2015. She completed her M. Tech in Technology Management in at University of Kerala during 2002-2004 and B. Tech in Applied Electronics and Instrumentation Engineering at M.E.S College of Engineering, Kerala during 1996 – 2000

Abstract:

Modern depth of anaesthesia monitors use frontal EEG signal to derive DoA measures. The anesthetic drugs acts mainly on the Central Nervous System (CNS) hence, EEG signal processing during anesthesia is useful to monitor the patient’s depth of anesthesia. This study aims to measure Depth of Anesthesia (DoA) using approximate entropy of EEG signals and classify them according to the DoA . Approximate Entropy of the EEG signal is extracted as a measure of DoA from the EEG signals collected during the four phases of general anesthesia called awake, induction, maintenance and recovery. Approximate entropy is a time domain algorithm that measures the regularity and randomness of the EEG signals during different phases of anesthesia, where EEG signal is considered as a time series data. A low value of approximate entropy indicates anesthetized state where as high value indicates that the patient is awake. Approximate Entropy values is high in awake because of the increased randomness in the EEG signal. EEG shows regularity when depth of anesthesia increases. Induction phase EEG signals are more regular compared to all other EEG signals. Therefore the approximate entropy in the Induction phase shows low values. Finally these approximate entropy features are compared with with commercially available BIS and got 81 percent correlation.

Artificial neural network (ANN) is used in this study to classify EEG signal according to different anaesthetic stages. A feed forward back propagation ANN is used to implement the classification. The activation function employed for all the neuron units in the network is tansig. Approximate Entropy extracted during the four phases are applied as input to the artificial neural network. The whole data set is divided in to two groups training data set and testing data set. Training data sets trains the network where as the testing data set would check the effectiveness of the classifier. In this study, there were four output classes: awake state, light anaesthesia state , moderate anaesthesia state and deep anaesthesia state. The classification accuracy is 91.6 percent. Present study helps to assist Anaesthesiologist in anaesthesia   decision making and management.

Biography:

Mohammad reza hashempour has completed his Doctorate at the age of 25 years from Army  University of medical sciences and postdoctoral studies in Surgery from Golestan University School of Medicine. He has published papers in reputed journals.    
 

Abstract:

Tracheal laceration occurs rarely and if it doesn’t diagnose early,it's life-threatening and can result in mortality.It has different risk factors and identifying these risk factors and proper managing the airway can reduce this tribble event.Different studies declare different aspects of tracheal laceration treatment,but standard treatment is surgical repair.Here,we are going to introduce a case of tracheal rupture with several risk factors that managed successfully with surgical treatment.

Biography:

Elizabeth McIntyre completed her MD at the University of Toledo in 2013.  She is currently in anesthesia residency at Beaumont Health System in Royal Oak, MI.  After residency, she will attend critical care fellowship at Northwestern University in Chicago, IL.

Abstract:

Recurrent laryngeal nerve (RLN) paralysis is an uncommon complication of regional blockade of the brachial plexus at the level of the interscalenes. Ipsilateral placement of a peripheral nerve catheter (PNC) in patients with a history of unilateral vocal cord (VC) paralysis is not contraindicated, however, contralateral placement of PNC should be avoided as bilateral VC paralysis may occur. Postoperative management of a patient with bilateral VC paralysis includes multidisciplinary monitoring of the airway and removal of the PNC. A 79 year old female with a past medical history of hypothyroidism and arthritis presented to the surgical intensive care unit (SICU) with respiratory distress, stridor, and impending respiratory failure requiring reintubation after receiving a right interscalene PNC for shoulder arthroplasty. While in the SICU, a previously unknown history of left VC paralysis after total thyroidectomy was elicited from the patient’s family (this was previously treated with cord medialization). The PNC was removed, and patient remained intubated until effects of long acting local anesthetic were diminished.  Patient was taken to the operating room for direct laryngoscopy and found to have unilateral chronic left VC paralysis with resolution of temporary right VC paralysis, presumably from interscalene PNC. In patients with a known history of unilateral VC paralysis, regional blockade to the contralateral interscalene is contraindicated. While rare, RLN paralysis as a sequelae of an interscalene PNC can cause temporary or permanent ipsilateral VC paralysis. Healthcare providers caring for patients with bilateral VC paralysis should consider historical injuries as well as regional techniques that may have contributed to the acute condition.  In this case, temporary RLN paralysis was alleviated with removal of the interscalene PNC and supportive care was provided until ENT was able to directly visualize an improvement in vocal cord motion and extubation was tolerated. 

Biography:

Ochukpue Ceejay he works in the  department of Anaesthesiology, in University of Benin Teaching Hospital, Benin City, Nigeria

Abstract:

Introduction

A reduction in anaesthesia related complications has been observed following the introduction of regional techniques. The use of subarachnoid block has become an established and reliable method of providing anaesthesia for lower abdominal, obstetric and lower limb surgeries due to its ease of performance, rapid onset of action and cost effectiveness.

Objectives

This study aimed to determine the intraoperative complications associated with subarachnoid block, its management and outcome in parturients undergoing caesarean section.

Methods

125 consecutive parturients scheduled for caesarean section under spinal anaesthesia were recruited. Approval was obtained from the Institution's Ethics Committee. History, demographic characteristics, indications for caesarean section and intraoperative events were documented. Data was analysed using SPSS version 20.

Results

The commonest complication observed was hypotension with an incidence of 36.3%. Severe hypotension was managed with ephedrine and rapid fluid boluses. Other complications were shivering, tachycardia, bradycardia, nausea and vomiting.

Conclusion

Subarachnoid block is safe for caesarean section if the anaesthetist is aware of the complications associated with its use. Early recognition and prompt management of complications by the anaesthetist is paramount. Precautions to prevent complications where possible, by carefully monitoring of the patient and management of the complications appropriately and as soon as possible will ensure good outcome.

Biography:

Ochukpue Ceejay he works in the  department of Anaesthesiology, in University of Benin Teaching Hospital, Benin City, Nigeria

Abstract:

INTRODUCTION: Pulmonary oedema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli.

CASE DESCRIPTION: R.O, a 27 year- old para 2⁺⁰ who was referred to the University of Benin Teaching Hospital, Benin City, Nigeria from a peripheral centre at 35⁺³ weeks gestation with a history of sudden onset of difficulty in breathing and non-productive cough of one hour duration.

She was diagnosed hypertensive at 20 weeks gestation and placed on tabs methydopa 250mg 8hourly. There was a history of pregnancy induced hypertension during the first confinement in 2005.

On examination, she was in respiratory distress (RR-40cpm) with bilateral pitting pedal oedema. She was also tachycardic (125bpm, regular and good volume) and had a blood pressure of 180/80mmHg. There was good air entry with bilateral basal crepitation on auscultation of the chest. First and second heart sounds were heard and there were no murmurs. Abdominal examination revealed a uterine size of 34weeks with a cephalic presenting singleton foetus and a foetal heart rate of 165bpm (regular).

A diagnosis of pulmonary oedema secondary to severe preeclampsia was made. She was counseled for emergency caesarean section. Optimisation was commenced with intravenous labetalol 25mg stat, intravenous magnesium sulphate 4g and 1g/hr subsequently. Intravenous frusemide 100mg stat was also given.

The investigations revealed a haemoglobin level of 11.8gdl, white blood cell count of 19,000cells/mm³ platelet count of 176,000cells/mm³, urea 24mg/dL, creatinine 0.6mg/dL and proteinuria of 2++. She was reviewed by the duty anaesthesiologists, gave consent for general anaesthesia and was transferred to the labour ward theatre. Oropharyngeal structures were in keeping with Mallampati II and she was classified ASA IVE.

 In the theatre, the anaesthetic machine and ancillary equipment with resuscitation drugs were prepared. She had acid prophylaxis (intravenous ranitidine 50mg, 10mg metoclopramide). A multi-parameter monitor was attached and baseline vital signs showed a pulse rate of 96bpm, blood pressure of 114/76mmHg and oxygen saturation (Sp0₂) of 84% on 100% oxygen. The electrocardiogram was normal.

Rapid sequence induction of anaesthesia with Sellick’s manoeuver was the technique of choice. She was preoxygenated with 100% oxygen. Induction of anaesthesia was with 300mg of sodium thiopentone, endotracheal intubation was facilitated with 100mg of suxamethonium using a size 7.5mm ID cuffed portex endotracheal tube and 500mls of frothy sputum was suctioned from it. Anaesthesia was maintained with 0.8% isoflurane in 100% oxygen and neuromuscular blockade was achieved using 30mg atracurium.