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

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.