Juniper Publishers Journal of Anesthesia and Intensive Care Medicine

Juniper Publishers - Journal of Anesthesia Introduction Coagulopathy is a common finding in patients with sepsis and is considered to be a risk factor for mortality [ 1 ]. Mechanisms like imbalance between coagulation and fibrinolysis have been attributed to coagulopathy in sepsis. The spectrum of coagulopathy can range from a hypercoagulable state to a hypocoagulable state [ 2 ]. Conventional coagulation assays (CCAs) like prothrombin time (PT) and activated partial thromboplastin time (aPTT) are routinely done to assess coagulation status in patients with sepsis. However, these coagulation tests have certain inherent limitations associated with them [ 3 ]. These limitations include their inability to detect hypercoagulable state and also cannot assess the fibrinolytic system. Rotational thromboelastography (TEG) and thromboelastometry (ROTEM) evaluate whole clot formation and can be useful point-of-care tests [ 3 ]. There is ongoing research to establish the effi...

Juniper Publishers - Journal of Anesthesia Introduction Mechanical ventilation (MV) is a widely used resource within intensive care units (ICUs) for the maintenance of the lives of critically ill patients. However, its prolongation is associated with several complications, such as pneumonia, hemodynamic disorders, lung injury and diaphragmatic dysfunction; the latter defined as the set of structural and functional alterations produced by the inactivity of the diaphragm muscle during MV [ 1 , 2 ]. Several investigations developed since the 1990s on the impact of MV have been able to show changes in the diaphragm as a consequence of the prolonged use of positive pressure in the airway [ 2 - 5 ]. These changes reduce and modify the correct diaphragmatic functioning, making the weaning process more complicated and delayed due to the difficulty for the patient to spontaneously assume ventilatory work [ 2 , 3 ]. This translates into an increase in the number of hospital ...

Juniper Publishers - Journal of Anesthesia Background There is high incidence of perioperative complications in hip surgeries after femoral neck fractures in older age group. Objective In this review, we try to detect the safest anesthetic technique for those patients. Introduction Hip fracture is a worldwide problem affecting 1.6million and will affect 2.6 annually by 2025 [ 1 ].Hip fractures are associated with high risk of morbidity and mortality, approximately 1-6% of patients will die during their hospital stay [ 2 - 4 ], 4-10% will die with in 30 days of their admission [ 5 ], and 18%- 28% of the patients die with in one year of their fractures [ 6 ] this is mainly due to pulmonary and cardiovascular complications [ 7 ]. Postoperative delirium is a frequent complication in elderly patients with hip fractures and the incidence is varying between 16% and 62% [ 8 ]. Patients ...

Juniper Publishers - Journal of Anesthesia Introduction There are three main goals of clinical airway management-appropriate oxygenation, appropriate ventilation, and protection of the airway from injury. Let's briefly look at each of these goals. Oxygenation Oxygenation is controlled via the concentration of oxygen (fraction of inspired oxygen - Fi0 2 ) delivered to the patient, although "PEEP" adjustment can be equally important to improve oxygenation in ventilated patients with acute lung injury (PEEP or positive end expiratory pressure, is the minimum lung distending pressure over expiration during positive pressure ventilation; it is usually set between 2 and 5 cm H 2 O in patients with normal lungs). The minimum oxygen concentration used during general anesthesia is usually 0.3 (30%) and can be increased to 1.0 (100%) by decreasing the concentration air administered (or of nitrous oxide (N 2 O) in patients where this is used during general an...

Juniper Publishers - Journal of Anesthesia Abstract The dynamic parameters, stroke volume variation (SVV) and pulse pressure variation (PPV), are used to guide fluid resuscitation in ventilated patients. We investigated whether SVV, PPV and pleth variability index (PVI), an automatic measurement of the plethysmographic waveform amplitude changes, can be used to predict fluid responsiveness in ventilated patients with severe sepsis or septic shock. We measured cardiac index, (CI, transpulmonary thermodilution PiCCO2) SVV, PPV, global end-diastolic index (GEDI), central venous (CVP), arterial blood pressure and PVI (Masimo Radical 7) before and after infusion of 500ml Gelofusine® over 30min in 31 deeply sedated ventilated patients (tidal volume 8ml/kg) with severe sepsis and septic shock. We obtained one full set of measurements in 30 patients. 10 patients increased CI by at least 15% ("responders”), 20 patients were "non-responders”. Baseline haemodynamic ...

Juniper Publishers - Journal of Anesthesia Introduction Hair restoration is one of the commonest cosmetic surgery procedure in men [ 1 ]. The procedure is performed under local anaesthesia. Many of the patients are anxious about the degree of pain to be expected during and after the surgery. The pain of the local anaesthetic agent is dependent on various factors like needle gauge, composition, temperature, pH, speed of injection, anatomical structure/area etc. Various maneuvers are used to decrease the pain during the administration of local anaesthesia like vibration anaesthesia Cryotherapy etc [ 2 - 4 ]. With the introduction of newer drugs for local anaesthesia, the safety is increased. Peripheral nerve blocks constitute a major tool in the armamentarium in the office-based cosmetic surgery procedures. Supraorbital (SO) and supratrochlear (ST) nerve are the terminal branches of the frontal nerve [ 5 ]. These nerves supply mainly the skin of the forehead. These n...