Revista de Anestesiologia Clínica: Acesso Aberto

Covid has led to innovations and strategies, primarily to manage patients with hypoxia and respiratory failure. Although devastating, the pandemic brought the best out of the medical fraternity in terms of patient care and research. Undoubtedly, invasive ventilation is the last resort in patients with progressive dyspnea not manageable with non-invasive methods; still, non-invasive ventilation methods are becoming popular and have proven their worth. CPAP and Bipap played a vital role during the first and second pandemic waves, with HFNC gradually becoming popular with the intensivists and ICU physicians because of its unique advantages(1).

Background: As the number of total joint arthroplasty (TJA) cases continues to grow operating room (OR) suites can evaluate parallel processing strategies to reduce the length of time the patient is in the OR as a mechanism to increase throughput of cases. The goals of this study were to 1) assess the safety and success rate of performing spinal anesthesia in the hospital preoperative area and 2) measure the OR times for patients after the first case of the day undergoing total hip (THA) or knee arthroplasty (TKA) in an inpatient setting.

Methods: A retrospective review of electronic medical records (EMR) was performed on all patients after the first case of the day who underwent unilateral THA or TKA via spinal anesthesia by three orthopedic surgeons between January 2017 and December 2018. Spinal anesthesia was performed based on anesthesiologist preference either in the OR or in the preoperative holding area. Measured OR times included time from patient entry into the OR to: incision, surgery closure end, OR exit, and discharge from the Post Anesthesia Care Unit (PACU). Spinal anesthesia failure (inability to perform surgery without conversion to general anesthesia), high spinals requiring airway management, hypotension or bradycardia needing treatment in the holding area, and cardiac arrest were the primary clinical adverse events abstracted from the EMR.

Results: Twenty-five % (n=398) of a total of 1594 TJAs (720 THAs and 874 TKAs, 924 females and 572 males) received spinal anesthesia by 8 anesthesiologists in the preoperative holding area, with the remaining 1,196 patients receiving the spinal anesthetic in the OR. These 398 TJA patients had a mean and standard deviation (SD) of 70.7 (10.3) years of age, body mass index of 30.4 (6.7), American Society of Anesthesiologists (ASA) Physical Status of 2.3 (0.5) with 269 ASA 2 patients and 129 ASA 3 patients, with 36% males, and 42% undergoing THA. 100% of patients successfully had the spinal anesthetic with isobaric bupivacaine 0.5% (no additives) placed in the preoperative area, with no high spinals, and the time in minutes from entering the OR to: incision equaled mean (SD) of 42 (16), to surgery closure end 140 (21), OR exit 155 (20), and PACU discharge 297 (90). Complications included emesis (n=2), and persistent hypotension (n=4).

Conclusions: All 398 TJA patients had a spinal anesthetic successfully placed in the preoperative area with a minimal number of complications which provides evidence that anesthesiologists can choose patients in which spinal anesthesia is feasible and can be performed safely in the preoperative holding area. 

Traumatic brain injury is a major public health concern not only in our country but everywhere else. It is an emerging research priority which needs to be extensively studied keeping in mind its huge burden on public health. But in our country there is lack of scientific research and education in field of trauma. It affects a large proportion of individual. Road traffic accidents contributes to the major burden of Traumatic brain injury. The definition of TBI is an‘alteration in brain function, or other evidence of brain pathology, caused by an external force’. However, this unitary epidemiological definition encompasses a complex disease process with diverse injury subtypes that may overlap. There is an increasing drive to differentiate these subtypes to allow precision-medicine approaches to management

Purpose: The aim of the study is to evaluate the effectiveness of lavender aromatherapy on patients undergoing outpatient surgery to reduce anxiety scores, improve patient’s vital signs, and reduce the use of anti-anxiety medications.

Methods: Vital signs and anxiety scores were documented before and after 30 minutes of lavender aromatherapy in perioperative area. Patients’ interest in anti-anxiety medication before surgery, and patient experience with the aromatherapy was also assessed.

Findings: 75% of patients reported a decrease in their anxiety score number and 57% reported a decrease in anxiety range 30 minutes after the start of aromatherapy. 39% of patients saw a reduction in the Mean Arterial Pressure (MAP) by 10 units or more and 31% saw a reduction in heart rate by 10 units or more after aromatherapy use (p values<<0.05). 22% of patients did not require an anxiolytic medication prior to entering the OR (Operating Room). 55% of patients returned surveys back with mainly positive feedback about the project.

Conclusions: Lavender aromatherapy proves to be an effective method in reducing anxiety scores, improving patient’s vital signs, and reducing use of anti-anxiety medications among patients undergoing outpatient surgery.

Background: Mechanical ventilating was an essential life supporting method for crucially ill cases. The weaning outcomes influences the morbidities and mortalities of cases when their main disorder advances.

Aim and objectives: To evaluate the predictive value of heart, lung and diaphragmatic US in the process of weaning in mechanically ventilated patients over 48 hours.

Methods: This is a prospective observational single group research which was performed at Menoufia University hospitals between (May 2019 and May 2020).  The study included 62 mechanically ventilated patients over 48 hours fulfilling weaning criteria underwent one Hour Spontaneous Breathing Trail (SBT). Before extubating, data collection comprised US evaluation of LVEF, LVDF was assessed using Left Atrial Area (LAA), early diastolic transmitral flowing velocity wave (E), late diastolic transmitral flow velocity wave (A), early diastolic mitral annulus velocity E′ (average septal and lateral E′), E/A, E de-acceleration time, E/E′, lungs losing of ventilation scoring and diaphragmatic movements./

Results: A high significant relation was found among weaning and LVEF, E’, E/E’ and LAA (p< 0.001) and statistically significant relation between weaning and E/A.Using aeration score it was shown that above 15.5, it can predict failure of weaning with Area Under Curve (AUC) of 0.781. Using diaphragmatic dysfunction, it was shown that if there were full diaphragmatic dysfunction, it can predict failure of weaning with AUC of 0.639.

Conclusion: The US characteristics of heart, lung, and diaphragm providing serious information around cardio-pulmonary and diaphragmatic job throughout SBT. Unsuccessful weaning was more predominant if markers of left ventricular diastolic dysfunctions, increased Lung aeration score and diaphragmatic dysfunction were present.