A Safe Subarachnoid Block in Idiopathic Thrombocytopenic Purpura with Severe Thrombocytopenia

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) still presents particular challenges for anesthetists, especially when the patient needs surgery. Preparing a patient with ITP in elective surgery is an advantage for anesthetists since it gives us time to prepare the patient properly. CASE REPORT: We present a case of a 36-year-old woman scheduled for an elective laparotomy due to an ovarian cyst. She had been diagnosed with ITP in 2015 and was admitted to the intensive care unit (ICU) for post-operative bleeding. CONCLUSION: Individual experience in elective surgery should lead anesthetists to a better judgment in emergency cases with ITP

Intraoperative monitoring of the central and peripheral nervous systems:a narrative review

The central and peripheral nervous systems are the primary target organs during anaesthesia. At the time of the inception of the British Journal of Anaesthesia, monitoring of the central nervous system comprised clinical observation, which provided only limited information. During the 100 yr since then, and particularly in the past few decades, significant progress has been made, providing anaesthetists with tools to obtain real-time assessments of cerebral neurophysiology during surgical procedures. In this narrative review article, we discuss the rationale and uses of electroencephalography, evoked potentials, near-infrared spectroscopy, and transcranial Doppler ultrasonography for intraoperative monitoring of the central and peripheral nervous systems.</p

LOW-FLOW ANESTHESIA TECHNIQUE REDUCES EMERGENCE AGITATION IN PEDIATRIC PATIENTS UNDERWENT GENERAL ANESTHESIA

Objectives: This study was designed to see the risk factors that contribute to emergence agitation (EA) and also to know the effectiveness of low-flow (LF) anesthesia technique in EA in pediatric patients. Methods: A total of 200 pediatric patients aged 6 months–6 years underwent surgery with general anesthesia were divided into two groups. The high-flow (HF) group was maintained with 5 l fresh gas flow (FGF), and the LF group was maintained with 500 ml FGF. The outcome was measured after the surgery was completed on Face, Legs, Activity, Cry, and Consolability and pediatric anesthesia emergence delirium (PAED) scores. Agitation defined in PAED score ≥10, and no agitation defined in PAED score &lt;10. Results: EA incidence in the HF group was higher compared to the LF group (59.5 vs. 4.7%, p&lt;0.001). HF anesthesia technique was a single risk factor for agitation event, whereas LF anesthesia may prevent EA incidence until up to 92.7%. Conclusion: LF anesthesia reduced agitation incidences. The effectiveness of LF was 92.7% in reducing the incidence of agitation. HF anesthesia was the main risk factor for agitation incidences

Pre-operative Neutrophil-to-Lymphocyte Ratio is Associated with Post-operative Opioid Requirements and Length of Stay after Thoracotomy

BACKGROUND: Surgical pain and prolonged hospital length of stay (LOS) affect a large proportion of patients after thoracotomy. Inflammation plays a crucial role in the mechanism and progression of pain and the outcomes. AIM: The objective of this study was to investigate the association between the pre-operative neutrophil-to-lymphocyte ratio (NLR) and post-operative pain and LOS in patients undergoing thoracotomy. METHODS: This was a retrospective, observational study on 157 patients who underwent thoracotomy under general anesthesia. We classified the subjects into two study groups: Group with for patients with NLR &lt;2 and Group 2 for NLR ≥2. We measured the post-operative pain by gathering the data of post-operative opioid needs. We used Pearson’s and Spearman’s correlation tests to assess the association of the parameters. RESULTS: The mean of total oral morphine equivalent in the first 48 h following thoracotomy in Group 1 was 140.8 ± 60.4 mg compared to Group 2’s 109.7 ± 55.8 (p &lt; 0.05). The median hospital’s LOS was longer in Group 2 compared to Group 1 (7 vs. 10, p &lt; 0.001). We found a weak positive correlation between pre-operative NLR (R = 0.267, p = 0.002) and post-operative opioid requirements, and a weak positive correlation between pre-operative NLR and the hospital’s LOS (R = 0.345, p &lt; 0.001). CONCLUSION: Pre-operative NLR correlates with post-operative opioid requirements and the time hospital’s LOS in patients who underwent elective thoracotomy

The ultrasonic cardiac output monitor (USCOM) as a tool in evaluating fluid responsiveness in pediatric patients underwent emergency surgery

ABSTRACTBackground: Assessment fluid adequacy in pediatric patients underwent surgery is a challenge for anesthesiologists. Hemodynamic parameters used as fluid monitoring sometimes don’t accurately provide valid information. Ultrasonic Cardiac Output Monitor (USCOM) is one of the non-invasive methods that are easy to operate and may provide various hemodynamic parameters monitoring information.Objective: Analyze the effectiveness of Stroke Volume Variation (SVV) and Stroke Volume Index (SVI) by using USCOM in assessing fluid responsiveness in preoperative pediatric patients who underwent emergency surgeries.        Method: This study was conducted on 16 pediatric patients underwent emergency surgeries. Before general anesthesia is given, blood pressure, mean arterial pressure, heart rate, cardiac index, SVV, SVI were recorded before and after administration of 10 mL/kg of fluid given within 20 minutes.Results: 10 subjects responded with SVV and SVI changes of more than 10% compared to 6 non-responders. SVV changes between responders and non-responders were 31.5±1.58 and 7.5±1.04, respectively. SVV percentage changes between responders and non-responders were 38.04±0.47 and 5.24±4.89, respectively.Conclusion: SVV and SVI recorded by USCOM showed significant fluid responsiveness changes in pediatric patients underwent emergency surgeries in 62.5% of the subjects

DEXMEDETOMIDINE PROVIDES BETTER HEMODYNAMIC STABILITY COMPARED TO CLONIDINE IN SPINE SURGERY

Introduction: Spine surgery presents a number of challenges to the anesthesiologist. The α2 adrenergic agonist drugs are commonly used in such cases to provide hemodynamic and sympathoadrenal stability. Dexmedetomidine (DEX) is one of the most potent and highly selective α2-adrenergic receptor agonists. Another α2 adrenergic agonist drug that is used widely is clonidine. The study aims to compare both drugs in terms of hemodynamic stability in spine surgeries.Patients and Methods: 30 patients underwent spinal surgery were classified into one of the following group: DEX group (received DEX 1 mcg/kg in 10 minutes followed by 0.5 mcg/kg/hour during the course of the surgery) or CLO group (received clonidine 1 mcg/kg in 10 minutes followed by 1 mcg/kg/hour during surgery), by consecutive sampling. All other treatments and medications were similar in both groups. The systolic and diastolic blood pressure, mean arterial pressure, and heart rate were recorded every 5 minutes. Data was then analyzed by SPSS.Result: The patients in the DEX group had a better mean arterial pressure (p=0.002) and heart rate (p=0.018) stability compared to those in the CLO group.Conclusion: The administration of dexmedetomidine provides a better hemodynamic stability compared to clonidine in patients underwent spinal surgery

Steroid Induced Cataract in Langerhans Cell Histiocytosis Patient

BACKGROUND: Cataract is an opacification of the lens. Pediatric cataracts can be congenital or acquired. Acquired cataract including the one caused by corticosteroid used. It occurred as bilateral posterior subcapsular cataracts and tended to be progressive. Treatment of choice is lens extraction with or without intraocular lens (IOL). CASE PRESENTATION: We present a case of posterior subcapsular cataract that occurs in a patient with Langerhans cell histiocytosis that was using corticosteroid therapy. CONCLUSION: The routine ophthalmologic examination should be performed in children who received treatment with corticosteroids in the long term so that with early detection it can be given early treatment

Comparison of Clinical Outcome between Craniectomy and Craniotomy as Surgical Management of Traumatic Acute Subdural Hematoma: A Systematic Review and Meta-analysis

BACKGROUND: Acute subdural hematoma (ASDH) is a major problem in traumatic brain injury. Surgical techniques for treating ASDH are varied, including cranioplastic craniotomy and large decompressive craniectomy. The superiority of craniectomy and craniotomy for treating ASDH is still controversial. AIM: The aim of this study was to compare the clinical outcome between craniectomy and craniotomy for treating traumatic ASDH through systematic review and meta-analysis. METHODS: This study used electronic articles published in PubMed, EBSCO, Google Scholar, and Directory of Open Access Journal. Articles included were full-text observational studies in Indonesian or English. Clinical outcome using the Glasgow Outcome Scale was compared between craniectomy and craniotomy. Statistical analysis was done using Review Manager 5.3. RESULTS: Six articles met our inclusion and exclusion criteria. We performed random effect model analysis because of high heterogeneity between studies (I2 = 77%; X2 = 21.98). The pooled risk ratio between craniectomy and craniotomy on poor outcomes was 1.41 (p = 0.02; 95% CI: 1.06–1.88). CONCLUSION: Craniectomy increases the risk of poor clinical outcomes in treating a traumatic ASDH